What Part of the Brain Does Pain Come From?

Researchers are making progress in determining the areas of the brain that pain is modulated. They are figuring out the neural mechanisms underlying modulation of cognitive acute pain and have demonstrated the involvement of the dorsal anterior cingulate cortex (dACC), which could have important implications for future research targets. The studies have been looking for the area specifically involved in cognitive modulation of pain.

In studies being conducted, the involvement of the ACC in cognitive modulation of pain is not surprising, because it is a region that shows up often in relation to pain, cognitive control, and self-regulation. The new aspect of this research was that a different area of the ACC was associated with pain perception during pain modulation.

One study conducted included 15 healthy men and women, who were able to modulate acute heat pain by at least 30%. The process included delivering moderate heat pain stimulus to the participant’s left inside forearm. They were then asked to use whatever cognitive strategies they wanted to increase and decrease pain, such as visualization strategies. During this process, the participants underwent fMRI that consisted of an initial 30-second stimulation block followed by 5 30-second increase and decreased modulation blocks. Each modulation block was followed by 10-second rating period and a 40-second rest period.

The conclusion showed that pain modulation was associated with activation in areas related to body awareness and cognitive regulation and deactivation in areas related to sensation and emotion. Activation differences were found in areas related to pain processing, self-regulation, and cognitive function. Midline frontal areas and rostral anterior cingulate showed greater deactivation during increase of pain; dorsal ACC and presupplementary motor areas showed greater activation during decrease pain; and signal increases in prefrontal cortex,  dACC, and thalamus predicted decreased pain ratings. Results showed that successful cognitive modulation of pain involves brain areas associated with pain processing and cognitive control. It was also shown that the dACC may be a key component in modifying pain perception. It was correlated with pain ratings and showed a difference in activation between conditions.  

Researchers now want to study the dACC in neuromodulation by using real-time fMRI to train participants to modify pain experience by directly controlling neural processes related to pain. This information could be used to develop new medications that act on specific parts of the brain that modulate pain and ideally be able to control pain more effectively.

Source: American Academy of Pain Medicine (AAPM) 29th Annual Meeting. Poster 227. Presented April 12, 2013.

  

Visit us at The Center for Medical Healing for more information.  Relieving your pain.....Restoring your life!

Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain

Recent studies conducted evaluated the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy for chronic low back pain.

A double-blind design was used to study OMT and ultrasound therapy for short-term relief of nonspecific chronic low back pain. Six treatment sessions were provided to patients over 8 weeks. Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12. Five secondary outcomes, safety, and treatment adherence were also assessed.

There were no statistical interactions between OMT and ultrasound therapy. Patients receiving OMT were more likely to achieve moderate and substantial improvements in low back pain at week 12.

Patients in the OMT group were more likely to be very satisfied with their back care throughout the study and used prescription drugs for low back pain less frequently during the 12 weeks.

The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe and well accepted by patients. 

Source:John C. Licciardone, DO, MS, MBA, Dennis E. Minotti, DO, Robert J. Gatchel, PhD, Cathleen M. Kearns, BA, Karan P. Singh, PhD. Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain. Annuals of Family Medicine.

Visit us at The Center for Medical Healing for more information.  Relieving your pain.....Restoring your life! 

Best Options for Preschool Children at Risk for ADHD

Parent behavior training has shown to be more effective than medications and other interventions for preschool children at risk of ADHD (attention-deficit/hyperactivity disorder). Eight studies conducted of parent behavior training produced the best and most consistent results. Only one study of medical treatment with methylphenidate showed positive results, with combined home and school/daycare intervention results being inconsistent.

Parent behavior training improves parenting skills and children’s disruptive behavior, including core symptoms of ADHD. Family doctors play an important part in guiding this type of treatment, initiating required assessments, guiding parents to evidence-based programs, monitoring these conditions, and advocating for increased community resources.

Studies conducted evaluating interventions for these children where guided by a single question: "Among children younger than 6 years with ADHD or disruptive behavior disorder, what are the effectiveness and adverse-event outcomes after treatment?" The study was also limited to children younger than 6 with clinically significant disruptive behavior as determined by referral for treatment; reliable and valid screening instruments; and a diagnosis of ADHD, oppositional defiant disorder, or conduct disorder.

Interventions reviewed included pharmacologic and nonpharmacologic treatment and excluded alternative/complementary interventions. Reviewed interventions were parent behavior training, psychostimulants, and combination of parent behavior training and day care or school-based interventions. A majority of the studies that have been conducted yielded positive results for parent behavior training and less positive results were achieved with pharmacological management. 

 Source: Charach A, et al "Interventions for preschool children at high risk for ADHD: a comparative effectiveness review" Pediatrics 2013; DOI: 10.1542/peds.2012-0974.

 

Visit us at The Center for Medical Healing for more information.  Relieving your pain.....Restoring your life!