Fibromyalgia & Chronic Pain LIFE Sep/Oct 2012, Issue 6 - Page 22

Dr. Sean Mackey, MD, PhD, began his presentation at the May 30, 2 0 1 2 , F DA wo rk s h o p w i th th a t thought, noting “the hundred million Americans that are experiencing and suffering from chronic pain, a half a trillion dollar a year problem,” before beginning a discussion of the current knowledge regarding pain and the role of the brain in perceiving it. NFMCPA President Jan Chambers attended the NIH/FDA Scientific Workshops on Pain May 28-31, 2012, in B ethesda, Mar yland, and prepared the following over view from D r. S ea n Ma ck e y ’s pres en tation, “Neuroimaging Biomarkers for Pain.” Dr. Mackey is Chief of The Division of Pain Management and A ssociate Professor of Anesthesia at Stanford University. He also ser ves as director of t h e S t a n f o rd S Y S T E M S Neuroscience and Pain L a b N nociception is really just part of the story, that it’s not until it hits the brain that it becomes our ultimate perception of pain, one that is modified, that’s amplified, and modulated by a number of other factors: things such as cognitive factors, attention, distraction, catastrophizing.” euroimag ing provides insights in brain activity where one region “is as a stronger implicator in how someone is going to experience pain and the persistence of it than any- and personality characteristics also play a role, which, Dr. Mackey said, “By the very nature defines this as a brainrelated phenomenon.” I “W hat happens when pain goes bad - and it f u n d a m e nt a l l y a l te r s t h e central nervous system?” thing else; contextual aspects, belief, placebo, whether patients are depressed or anxious. And then also many of the genetic factors also play a role as well as early-life experiences.” hese may relate to the idea of individual differences in pain perception. One study, by Kim, et al, has shown that factors such as genetics, sex, anxiety, catastrophizing, T he concept of pain began with the theory of dualism from Rene Descartes, the idea of the separation of mind, brain and body. Until now we were left with this 17th century philosophical model. Dr. Mackey explains that “we’ve now gained a greater appreciation that in fact nociception (an electrical chemical event that occurs in the presence of injury or trauma) is not equal to pain; that in actuality, T n contrast to the Cartesian model, the mind, brain, and body are not separated says Dr. Mackey, adding that, “We’ve had a particular interest in this idea of emotional distress impacting our individual differences. We’ve been intrigued by the role of fear and anxiety over the years; many, many studies showing that people w h o h ave increased fear and anxiety coming into an injury are more likely to have persistence of pa i n , a nd more likely to have worsening outcomes with pain. We took this and looked at it from an individual differences perspective, correlating the amount of fear of pain that subjects have to a specific stimulus, and find that, lo and behold, there are specific brain regions that seem to account for this.” r. Mac key continued to illustrate some of the roles D 22  Fibromyalgia & Chronic Pain Life Sep/Oct 2012