brain

Could Non-Invasive Brain Procedure Help Solve Chronic Pain?

/ Thomas Cohn, MD

ultrasound brainResearchers out of Virginia Tech are exploring the possibility of using targeted soundwaves to put an end to chronic pain sensations.

According to the research published in the journal PAIN on Feb. 5, researchers believe that low-intensity soundwaves aimed at a place deep in the brain called the insula could positively impact the perception of pain as well as some of the bodily effects of chronic pain, like heart rate variability.

““This is a proof-of-principle study,” said study lead author Wynn Legon, an assistant professor at the Fralin Biolmedical Research Institute at Virginia Tech. “Can we get the focused ultrasound energy to that part of the brain and does it do anything? Does it change the body’s reaction to a painful stimulus to reduce your perception of pain?”

Harnessing Ultrasound Technology

Ultrasound technology is commonly associated with the ability to view a baby inside a mother’s womb, but it has plenty of other helpful medical uses. High intensity ultrasound can ablate tissues, while low intensity soundwaves can alter electrical activity within a nerve. The latter was the idea behind Legon’s latest study.

For the study involving 23 patients, researchers applied heat to the back of their hands to induce discomfort. At the same time, a wearable headpiece delivered focused ultrasound waves to a specific spot in their brain that was guided by magnetic resonance imaging. Participants were asked to rate their pain perception during each application from zero to nine. At the same time, researchers monitored a person’s heart and heart rate variability, which can help to interpret the body’s reaction to painful stimulus.

When the soundwaves were administered, participants reported an average reduction in pain of three-fourths of a point.

“That might seem like a small amount, but once you get to a full point, it verges on being clinically meaningful,” said Legon. “It could make a significant difference in quality of life, or being able to manage chronic pain with over-the-counter medicines instead of prescription opioids.”

The study also found that the ultrasound application reduced the measured physical responses to the stress of pain – heart rate and heart rate variability.

“Your heart is not a metronome. The time between your heart beats is irregular, and that’s a good thing,” Legon said. “Increasing the body’s ability to deal with and respond to pain may be an important means of reducing disease burden.”

Although the research is in its infancy, it presents a new angle for tackling the issue of chronic pain. Hopefully future studies will find similar results, as a non-invasive and non-addictive treatment is the ideal answer to the problem of chronic pain.

For now, if you’re looking for a more traditional way to overcome your chronic pain condition, sync up with Dr. Cohn and his team. For more information, or for help with a specific chronic pain issue, reach out to Dr. Cohn’s office today at (952) 738-4580.

Effective Chronic Pain Treatment Starts With The Brain

/ Thomas Cohn, MD

brain painA new study published in JAMA Network Open suggests that targeting the brain and a person’s attitudes toward pain may be an effective method for treating chronic pain conditions.

More specifically, the study sought to influence a person’s pain attributions – which are their beliefs about the underlying causes of pain – to help reduce pain severity. For the study, a group of individuals with chronic pain underwent pain reprocessing therapy (PRT), which is a form of treatment that teaches people to perceive pain signals sent to the brain as less threatening. Researchers found that two thirds of people treated with PRT reported being pain-free or nearly pain-free after treatment. Only 20 percent of people in the placebo group said the same.

“Our study shows that discussing pain attributions with patients and helping them understand that pain is often ‘in the brain’ can help reduce it,”said the study’s first author Yoni Ashar, Ph.D., assistant professor of internal medicine at the University of Colorado Anschutz Medical Campus. “This study is critically important because patients’ pain attributions are often inaccurate. We found that very few people believed their brains had anything to do with their pain. This can be unhelpful and hurtful when it comes to planning for recovery since pain attributions guide major treatment decisions, such as whether to get surgery or psychological treatment.”

Pain And The Brain

Researchers concluded by saying that it is important for chronic pain patients to really try to better understand their pain and how their brain is processing pain signals. Prior to PRT treatment, only 10 percent of participants viewed their chronic pain issue as something that was due to a mind or brain process. After PRT therapy, that number increased to 51 percent. The study found that the more participants shifted to viewing their pain as due to mind or brain processes, the greater the reduction in reported chronic back pain intensity.

“These results show that shifting perspectives about the brain’s role in chronic pain can allow patients to experience better results and outcomes,” Ashar said.

This study touches on something we oftentimes convey with our patients, which is that pain isn’t just a physical issue. The brain-pain connection is real, and we oftentimes need to take a step back and reframe how we think about our pain condition in order to give ourselves the best chance to overcome it. It’s easier said than done, but it can be done.

If you want to learn more about your pain condition and the power of reframing how you think about pain, reach out to Dr. Cohn and his team today at (952) 738-4580.

Can You Fool Your Brain Into Chronic Pain Relief?

/ Thomas Cohn, MD

brain pain foolHappy April Fool’s Day! We thought we’d try to keep on topic by talking about how you can “fool” your brain into helping you overcome your chronic pain condition. So even though we’re sharing this on a day reserved for tricks and pranks, know that this is actually a real idea with real science behind it!

Your brain helps dictate how pain is perceived in your body, but it also performs countless other tasks, so if we can take its attention off our pain, we may be able to help drown out some of those pain signals that are causing discomfort. That’s why we always preach on this blog that chronic pain is both a physical and mental task. Your brain needs to heal and help fuel recovery just like the area of your body that’s causing pain. And you can help do that by distracting it.

Now, that’s not to say that every time a flare up develops that you should just go for a run or work on a crossword puzzle to help distract your brain, but engaging your brain has been scientifically proven to help reduce pain sensations. Find outlets that really engage your mind, and odds are you may notice that you’re not noticing your pain as much. Bonus points if it’s an active activity, because exercise and movement can also help drive home physical recovery.

Setting Expectations

Your brain is also in control of setting expectations for things, including pain. If a nurse says a shot is going to hurt, all of a sudden your brain starts to anticipate this pain and it could actually lead to you being more perceptive to pain, which isn’t a good thing. Conversely, it’s why it may take a second longer to realize you’re in pain if you accidentally have the sink running too hot when you go to wash your hands. It’s still going to be painful, but the expectation wasn’t there, and that plays an interesting role in how you perceive pain.

Expectation setting is very important in how you manage your chronic pain condition. It’s why we always preach that you work towards a good head space and focus on the positives instead of the negatives. If you wake up every day expecting chronic pain to dictate your life, you may actually be more perceptive to this pain. It can be a self-defeating cycle, but if you’re aware of how your expectations affect your perception of pain, you can fool your brain into making chronic pain less of a problem.

This is easier said than done, and oftentimes it’s easier to do with a pain management specialist by your side. We can talk over your concerns, your goals and the biggest challenges chronic pain is causing in your life. Then, we’ll work on how to focus on the positives and your goals instead of the negatives and your shortcomings. This individualized assessment can help you get to a great mindset to tackle any challenges your chronic pain condition throws your way.

So if you are dealing with a chronic pain condition and you want help tackling either the mental or physical side of the problem, reach out to Dr. Cohn’s office to see what we can do for you.

Burning the Brain to Eliminate Pain

/ Thomas Cohn, MD

ultrasound brainYears ago as an engineer, I learned about using ultrasound to evaluate structures in the body. Ultrasound uses tuned sound waves and their reflections from structures to study a variety of things. In the body, one can look at various soft tissues from the heart, to the unborn infant, to nerves, muscles and a variety of tissues using ultrasound technology. In physical therapy, ultrasound can be used to provide deep tissue heating. Outside of the body, it is used in non-invasive testing of many materials including airplanes, looking for stress fractures and locations of potential failure. The overall unique feature is that sound waves are being used safely, without radiation to look at the body.

Going on to the next level of thinking, sound waves are interesting since they act like any other wave. That means waves that are exact opposites of each other can cancel each other out when they meet; this process is used in noise cancelling headphones. Combining waves from several sources can also enlarge sound waves. Sophisticated computer techniques then can focus a number of beams in one point and at this location all the energy could cause the area to heat up. For years I thought about the potential of being able to focus ultrasound beams. Now with some very sophisticated equipment, this is finally beginning to be tried on an experimental basis.

Concentrated Ultrasound and Pain

A medical trial has begun at the University of Maryland to focus beams of ultrasound to a small area in the brain in order to treat certain conditions, including neuropathic pain. Other conditions being treated are movement disorders like the tremors caused by Parkinson’s Disease. The specific pains being treated are suppose to be caused by central damage to the nervous system and must include problems in the central processing of sensory signals in the brain. The pain must be from documented damage to nerves, the spinal cord, or into the neurons in the brain. Furthermore, all people in the study currently must have failed conventional techniques, it will be given only to five patients, and they must have had phantom limb pain from an amputation, a spinal cord injury or pain that does not respond to neurosurgery.

For now, the patients are placed in a special apparatus within an MRI scanner, and over 1,000 elements focus ultrasound beams to a discreet 5-6 millimeter area of brain that is then burned and destroyed. This treatment of pain is pretty unique. At this time we have not clearly identified a region in the brain that is definitely responsible for ongoing difficulties with chronic neuropathic pain. In the past, physicians have tried to cut out various areas in the brain and even place electrodes in the brain to pace out possibly abnormal signals causing pain. Surgeons have cut nerves in all kinds of places to prevent people from having painful sensations and have even cut off body parts in attempt to solve pain problems.

However all these solutions have found very limited use and usually failed over time to be successful. The main reason is pain is a extremely complex event far beyond just electrical signals from a damaged location in the body. Pain is a perceptual event involving an emotional response to some sort of signal that can be very diffuse in the body. Destroying a part of the brain is not a reversible event especially since we have no definite way to determine if a specific location in the brain just controls all the pain signals.  

The concept of focusing an ultrasound beam to one place in the brain to stop chronic neuropathic pain is intriguing. Pausing for a second and realizing that the process destroys a segment of brain makes one review our history of other tissue destroying attempts to cure pain. Chronic pain is extremely complex. Pain physicians know from experience that there is rarely a simple solution for most patients. We have a long history of failed destructive techniques to treat pain. No matter how intriguing this may sound, until we can absolutely determine that there is an definitive correlation to pain and a specific area in the brain and that this area is causing the pain, destroying parts of the brain appears to be ill-advised. Often the less we do as physicians, the better off it is for the patient. Or as part of the Hippocratic Oath says, “do no harm.”

The Benefits Of Brain Exercise

/ Thomas Cohn, MD

brain exerciseA new study reported from the University of California – Irvine in the Proceedings of the National Academy of Sciences revealed that even a brief amount of exercise improves the brain. It is well known that prolonged exercise has benefits from the heart to the brain. Exercise improves circulation and helps to reduce the effects of aging. Animal studies have shown that exercise increases the formation of new cells in the hippocampal region of the brain. This region is essential for memory creation and storage. Unfortunately, what works in animals is not necessarily true in humans.

Your Brain on Exercise

The twist in this study was whether a memory type of activity could be improved by participating in a low grade exercise. The subjects chosen were the usual paid college student (eager victims with minimal chance of other medical issues), and they were first asked to perform a computerized memory test. They were then sat on an exercise bike for ten minutes and either asked to do nothing (the control group) or slowly pedal in order to increase the heart rate by 30% for ten minutes.

After either the rest or exercise, the memory test was repeated. Interestingly, the light exercise group showed a clear improvement in memory tasks. The reason for the immediate boost in memory ability is not clear. The main theory is that the light exercise improved blood flow to the brain and hormone levels may have been involved.

The main message is that light exercise is beneficial to the brain and memory. Light exercise can be walking or many other types of activities. The exercise does not need to be intense, and it does not need to be prolonged. Daily exercise for ten minutes at a time appears to be beneficial to the brain. As we get older, we need to keep the brain healthy. It is important to exercise and even the simple things from walking to things like yoga or tai chi move the body and improve the brain.

Son if you find yourself with 10-15 minutes of free time throughout the day, try to do something active and stimulate your brain!