Picturing Your Brain: What the Latest in Neuroimaging Tells Us About Chronic Pain

What does our brain really tell us about chronic pain and how can we use that information to combat pain more effectively than traditional treatments?


As many pain sufferers know, pain is not only physiological but also psychological. Symptoms overlap. The same symptoms can even have different causes. This all makes pain difficult to study, diagnose, and treat. 

In recent years, however, there have been significant innovations in brain imaging, known as neuroimaging.

What can all these pictures of the brain really tell us?

These technological advances offer promising insights into how to treat pain. They also mean we know more about pain progression and diagnosis. Better neuroimaging techniques will hopefully lead to a more personalized medicine and increased knowledge about the mind-body connection in managing pain.

Neuroimaging

Not too long ago, the only way to see what was going on inside the brain was to open up the skull. That was until non-invasive brain imaging technologies came along in the mid-20th century, and improvements have continued since.

These different technologies allow medical professionals to “see” the brain, taking measures of blood flow and other activity. This “picture” of the brain is high resolution — there is a high degree of accuracy about where exactly this activity occurs.

Though there are many different types of neuroimaging, most of what we will be talking about here is an fMRI, which is short for a functional magnetic resonance imaging.

Pain Progression, Treatment, & Diagnosis

New neuroimaging studies mean we know more than ever about pain progression, treatment, and diagnosis. This is exciting news for anyone suffering from chronic pain! 

One way that neuroimaging does this is through locating biomarkers. These are useful in a few key ways for chronic pain sufferers:

  1. Prognosis: How will the pain progress?
  2. Prediction: How will the patient respond to different treatment options?
  3. Diagnosis: What is the precise pain disorder?

Before going further, let’s define what a biomarker is. According to the National Institute of Health, a biomarker is “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.” (Biomarkers are not what an individual actually feels, that’s important but different, and is referred to as a clinical endpoint). 

Biomarkers are pretty great, because they can tell us a lot about pain. Let’s take a closer look.

Diagnostic Biomarkers

The presence of diagnostic biomarkers determines whether or not an fMRI can detect pain. Sometimes these biomarkers can allow doctors to properly diagnose the source of the pain, sorting out the symptoms (such as swelling and color changes) which can be similar for very different pain conditions.

Prognostic Biomarkers

Prognostic biomarkers can be used to understand the progression of pain, including whether the condition will reoccur or worsen. This can be incredibly accurate. For example, one study on those with pelvic pain predicted short-term pain reduction with a 73.1% accuracy rate.

Predictive Biomarkers

Hopefully, this technology will result in more targeted treatments. This is where predictive biomarkers come in. This technology could be used in predicting how those with chronic pain respond to pain medication.

Functional MRIs and the Mind-Body Connection

Neuroimaging also reveals new insight into the mind-body connection.

It turns out that the mind-body connection that meditation focuses on can actually be observed through fMRIs. In fact, recent research has confirmed previous studies about how mindfulness helps with chronic pain.

How Mindfulness Works

If you have meditated or engaged in mindfulness before, you may have felt calmer and perceived less pain. Or perhaps you are wondering if mindfulness can help. 

Mindfulness is especially well-suited to chronic pain because, like chronic pain, it has a broad reach. Mindfulness trains the person to focus on the present and accept rather than judge sensations or thoughts. There are, of course, different kinds of mindfulness techniques, but here we’re looking at mindfulness more generally.

Through showing which parts of the brain are active and inactive, neuroimaging shows that mindfulness practice does have an effect on brain activity and on perception of pain. It is a person’s relationship to pain that is changed through mindfulness. It can dissipate the effects of fear around chronic pain, allowing people to disengage from a sense of threat related to pain. 

Mindfulness has been proven to improve one’s mood, allowing for more emotional regulation and acceptance. This all impacts how people subjectively experience pain.

Understanding exactly which neural pathways are aided by mindfulness can help to better target these therapies and fight chronic pain.

Types of Pain

You may be wondering: what kinds of chronic pain are improved by mindfulness practice?

So far, studies have looked at fibromyalgia, headache disorders, pelvic pain, irritable bowel syndrome, and chronic lower back pain

Amounts of Mindfulness

Let’s look at what neuroimaging tells us about different amounts of exposure to mindfulness:

  1. Naturally Mindful
  2. Some Mindfulness Training
  3. Lots of Mindfulness Training
  1. Naturally Mindful
  2. Put simply, the brains of those who exhibit mindfulness based on their disposition, and not any formal training, look different than other brains. The parts of the brain that process pain are less engaged, or deactivated, and their thresholds for pain are higher.

  3. Some Mindfulness Training
  4. For those who undergo brief mental training, there is much evidence to suggest that even some training can increase pain tolerance and improve attention, relaxation, and overall positive mood.

  1. Lots of Mindfulness Training
  2. If mindfulness helps with pain, does more mindfulness training help even more?

    The answer is yes. 

    Those who engaged in over 1000 hours of practice experienced even more benefits. Their pain responses were more stabilized. Pain thresholds were further increased. Most importantly, these benefits were observed even when they were not actively practicing mindfulness.

Lasting Effects

The best part is that some studies included a follow up after 8, 26, and 52 weeks (that’s one full year!) later. The benefits of their mindfulness practices endured. 

This lasting effect is really important. Why?

With traditional pain therapies, including pharmacological ones like opioids, the effectiveness tends to level off after a while. However, the existing research suggests that is not the case for mindfulness practices. In other words, you can experience increasing benefits from mindfulness practices without a definitive limit. 

MAIN TAKEAWAYS

Personalized Options for Pain Relief

As we’ve seen, the various types of biomarkers can help develop a more personalized approach to chronic pain. Neuroimaging can also help to define sub-types of pain. This is because as complex as pain is, many of the factors can be observed in neuroimaging, including psychological and physiological ones. 

We can also see how mindfulness positively affects people who have chronic pain. This all means that those suffering from pain have better options than ever for understanding and treating it.

This post is based on the July/August 2019 special issue from the International Association for the Study of Pain.

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