Trying To Control Pain Can Be A Double-Edged Sword, Say Scientists

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Trying To Control Pain Can Be A Double-Edged Sword, Say Scientists

http://www.medicalnewstoday.com/medicalnews.php?newsid=55543

Scientists have shown for the first time why a feeling of control

helps us reduce pain. The research, carried out at the Wellcome

Trust Centre for Neuroimaging at UCL, London, has implications for

how patients with persistent pain can cope with what is often a

debilitating condition.

Using fMRI scanners, which allow scientists to examine how the brain

operates, the research, led by Dr Katja Wiech and Dr Raffael

Kalisch, showed that when people feel that they can control their

pain, an area of their prefrontal cortex associated with a feeling

of security is activated. The findings are published in the Journal

of Neuroscience today and have been welcomed by the Expert Patients

Programme.

More significantly, the team went on to show that when faced with

pain beyond their control, people who tend to feel more in control

of their own lives show a lower response in the prefrontal cortex,

indicating that they are less effective in coping with pain than

those who don't expect to have control.

" Patients with persistent pain report that often it is not the pain

itself that makes their situation unbearable, but the fact that

there is nothing they can do against it which makes them feel

helpless, " explains Dr Wiech. " Unfortunately, this feeling of

uncontrollability in turn tends to worsen the pain. On the other

hand, teaching persistent pain patients psychological coping

strategies to handle their pain usually does help reduce its

effects. "

Dr Wiech and her team set up an experiment to investigate how people

cope with pain. In the first stage, volunteers were given an

electric stimulus to the backs of their hands and told that they

could stop the pain at any point. In the second stage, they were

told that the decision to stop the pain was out of their control and

could only be stopped by a person or computer outside the room.

Using one of the centre's fMRI scanners, the researchers were able

to show that a number of areas of the brain were activated according

to whether the volunteer felt in control of the pain. Most important

was the anterolateral prefrontal cortex, which is associated with

successful coping with feelings of anxiety.

The findings may have implications for future therapeutics, believes

Dr Wiech.

" If we were able to stimulate the prefrontal cortex through

psychological intervention, medication or some other stimulus, we

could help reduce the pain felt by a patient, " she says. " However,

we are still some way of this. "

The team also analysed the subjects' outlook on life, examining

whether they felt in control of their own lives. They found that

whilst the subjects' outlook did not affect the anterolateral

prefrontal cortex when they controlled the stimulus, when they were

not able to stop the painful stimulation subjects with no control

expectations were better at activating this brain region than those

with a strong control belief.

The findings support the practice of " acceptance-based therapy "

whereby doctors focus on training patients to cope with the pain

rather than attempting to make the pain go away.

" Throughout our lives, we are taught that we should aim to take

control of our lives, to get the best job, find the best partner, "

says Dr Wiech. " But sometimes we should accept what we have and make

the most of it. Rather than constantly battling pain, our research

supports the view that it is better to provide a patient with the

tools to cope with his or her persistent pain. "

The findings are welcomed by Pete , lead trainer in pain

management for the Expert Patients Programme Community Interest

Company.

" This is interesting work by UCL. We have found that many people

with pain are over achievers and tend to do more than they have to.

This is why when people with persistent pain attend an Expert

Patients Programme they are provided with a toolbox of self-

management skills to support them to manage their day-to-day pain. "