Fibromyalgia & Chronic Pain LIFE Sep/Oct 2012, Issue 6 - Page 24

D sensory function, showing, once again, that chronic pain is associated with fundamental alterations in the way information is flowing within our brain.” r. Mackey seems to have high hopes that some of these changes may reversible. He told of one study in which sufferers of chronic back pain, found to have thinning of the cor tex around the dorsolateral prefrontal cortex, showed a thickened cortex after receiving spinal surger y or facet j oint i n j e c t i on s ( w h ic h, i n effect, decreased pain). They also showed some reversal of the cognitive effects of having chronic pain, which makes the future look bright. ext Dr. Mackey brought up one of the major problems in diagnosing those suffering pain- the difficulty of diagnosing the problem due to the lack of any kind of objective biomarker for measuring it. Medical professionals still rely completely on self-reported pain, for which it is almost impossible to set any kind of standard. Dr Mackey’s opinion is that the future direction of this may be neuroimaging, as they continue to build on some of the findings previously discussed. Other techniques have been tried, and eventually thrown out, so he poses the question, “can we ultimately use brain imaging to get us there?” T N he answer to that question, Dr. Mackey feels, could possibly be yes, especially considering the results of a recent study he took part in. In this particular study he described, researchers used neuroimaging to train an algorithm to detect when people were feeling pain vs. just heat. Then they tested the algorithm on a number of patients, with around “87 percent overall accuracy in determining whether or not somebody was in pain.” Results were nearly identical when the experiment was repeated. This simply means that strides are being made toward identifying objectively whether or not someone is feeling pain. D hot in the next several years” as medical professionals endeavor to “identify whether we can characterize pain versus other related conditions; whether there’s commonality in distinctions, and then also to distinguish physical pain from imagined, from empathetic, [and] from mood disorders.” r. Mackey concluded by sharing one of his primary goals, which is to ensure that this technology will be used for good and not abused. In a question and answer session with him and three other doctors, many of the questions asked were broader than Dr. Mackey’s specific topic. The first question asked by the moderator, Dr. David Thomas, is worth mentioning. He asked, “So pain a s a disease. Are we all in concurrence that it is a disease?” he immediate answer from Dr. William Maixner, was “Yes.” Later Dr. Clifford Woolf explained that answer, adding, “it is a disease in some situations.” Though pain is normally a useful warning system of the body, “I think there are clearly some states where the adaptive function of the pain system has been completely lost, that pain arises spontaneously. It no longer serves any useful adaptive function. And those extreme cases are definitely a disease state.” W hile there is still much to learn in this area, especially specific to chronic pain, Dr. Mackey says, “we’re starting to see that neuroimaging of the brain is opening windows into the brain to allow us to peer inside to investigate causal mechanisms of pain, to understand the plasticity of pain, and to be able to look at treatment responsiveness of pain; ultimately, pulling this all together into this model of personalized pain medicine.” This is an area of medicine which, he believes, is going to be “very, very T • 24  Fibromyalgia & Chronic Pain Life Sep/Oct 2012