Functional MRIs: Making Pain Visible

Patient Expert

Have you ever felt that your doctor underestimated your pain? Have you ever felt that others didn't believe you have pain? Have you ever wished you could prove that you're in pain? An exciting new development has wide-ranging implications for the assessment and treatment of pain.

Studies of Pain Using fMRI

Researchers are using functional magnetic resonance imaging (fMRI) to study what happens in the brain when people experience pain. Functional MRIs provide a sort of 3-D movie of the brain as it response to pain.

Recent studies scanned study participants under number of different conditions. First, participants had thermal stimuli (heat) applied to their arm. One study tested whether there was a difference of physical pain and emotional pain (such as the pain of a relationship ending), one scanned the response to opioid painkillers and another study scanned the response to different levels of heat. The studies showing that a fMRI could detect pain with 90-100 percent accuracy. They further revealed that a number of regions of the brain were involved in the perception of pain, including "the thalamus, the posterior and anterior insulae, the secondary somatosensory cortex, the anterior cingulate cortex, the periaqueductal gray matter, and other regions."

The results showed that physical and emotional pain is expressed in different ways in the brain. As well, the study of response to opioid painkillers demonstrated that importance of belief in treatment. Participants were hooked up to an IV, some told that they were getting in opioid pain killer, others not. Those who believed they were receiving a painkiller reported less pain than their brain indicated.

Application and Limitations

These tests are not intended to be a sort of lie detector to prove or disprove that people are in pain. Primarily, the application of such studies lie in beginning to create an objective measurement of pain, especially in people who are non-verbal or unconscious in order to provide better pain management.

Researchers emphasized that these studies do have certain limitations. They cautioned against generalizing these results, as study participants were healthy volunteers, rather than people living with chronic pain. Tor Dessart Wager, the leader of these studies, pointed out that pain from different sources, such as illnesses or wounds, may show differently in scans. As well, other types of pain, such as the pain of fibromyalgia, may show up in different areas of the brain.

What This Means for You

At this time, research using fMRIs to study response to pain primarily studies pain and pain management and has no clinical application. That is, you should not ask your doctor for a fMRI to prove your pain. At this time, there isn't enough of a knowledge base for the results to be meaningful and no medical professionals trained in interpreting such scans.

However, those of us who live with chronic pain can still gain from these studies in two ways. First, the studies prove that it is possible to objectively measure pain, which will have far-reaching ramifications for the field of pain management. In the future, it may be possible to use brain scans to assess the effectiveness of different kinds of pain medication. Secondly, pay attention to the study that showed participants reported less pain than their brains showed when they believed they were getting an opioid pain reliever. In other words, your beliefs and mental state can have a significant impact on your experience of pain. This does not mean that you shouldn't get the pain medication you need, but it is a tantalizing suggestion of the powers of the mind in coping with pain. Exploring non-medication techniques such as meditation, mindfulness and visualization in addition to medication may be important factors in finding better quality of life.

Lene is the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain.