researchers forsee images that prove unexplained pain

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Researchers Foresee Images That Prove Pain

*December 19, 2006*

(The New York Times News Service) -- Researchers foresee a day when people

tortured by chronic, unexplained pain will be able to prove that they really

hurt -- evidence that could help sufferers be taken more seriously and could

even lead to better treatments.

Recent studies suggest that prolonged, ongoing pain leaves a signature in

the brain that can be detected using advanced imaging techniques.

In other work, researchers at Massachusetts General Hospital and elsewhere

have found that excruciating nerve damage can be detected in bits of skin

the size of a pinhead. And genetic tests may someday prove useful,

researchers believe: Certain genes appear to be linked to lower pain

thresholds and a tendency to develop chronic pain.

Most of the research remains years from helping patients, but as it comes to

fruition, " what it means is that no longer can they say, 'it's all in your

head, " ' said Jim Broatch, who leads an advocacy group for people with a

specific chronic pain disorder.

Clinical proof of pain could make an enormous difference for patients -

emotionally, with unsympathetic relatives and colleagues, and legally, in

battles with insurers and employers, researchers say.

And as science uncovers more of the objective signs of pain, that knowledge

may help with diagnoses, treatment, perhaps even the development of drugs,

they say.

Late last month, German researchers reported that they had turned up

microstructural changes in the brains of people who had suffered for years

from lower back pain.

The study of 40 patients, presented at the Radiological Society of North

America conference in Chicago, used a type of brain scanning called

Diffusion Tensor Imaging, which can detect long-term changes in the nerve

pathways in the brain.

The scan identified three areas involved in pain processing that showed

signs of heightened activity. It was as though pathways that had started as

single-lane roads had been expanded into four-lane superhighways, as more

and more signals traveled along them, said researcher Juergen Lutz.

" With these objective and reproducible correlates in brain imaging, chronic

pain may no longer be a subjective experience, " Lutz said in a press

release.

Other work focuses on the theory that people who have chronic pain may have

something wrong with their pain-killing system.

Last month, University of Michigan researchers reported findings that

patients with fibromyalgia, a chronic pain disorder, have abnormally low

levels of natural opiate-like painkillers in parts of their brains.

The study, presented at a rheumatology conference, " also just validates that

these people are in pain, " said researcher E. .

" They're trying to turn on their analgesic system but it's not enough to

reduce the pain. "

Brain imaging of pain is still too experimental for clinical use but that is

coming, said. " I'd say it will probably be five or 10 years until we

can have a patient walk into a doctor's office and say, 'I have pain,' and

the doctor says, 'I want to refer you out to a specialist who does imaging

to verify that or find out where your pain is located, " ' whether in the

brain, spinal cord, or elsewhere, he said.

Proving the presence of pain through genetic testing is probably even longer

away, and others said. Several studies have established a link

between a gene known as " COMT " and pain disorders, including one that can

affect the jaw; a mutation in that same gene seems to predispose people to

low pain-killing opioid activity in the brain and low pain thresholds,

published research suggests.

Other work is much further along. At Mass. General, for example, Dr. Anne

Louise Oaklander is already measuring " the objective correlates of pain " by

counting the numbers of pain-sensing nerve endings in tiny skin samples from

patients with unexplained pain. Paradoxically, patients with previously

unexplained pain tend to have fewer such endings.

Such skin biopsies allow researchers to diagnose " small fiber neuropathies, "

the nerve damage that is sometimes a side effect of diabetes and other

diseases. The nerve endings are so tiny that they have been largely

invisible, Oaklander said, but skin biopsies are " opening a window into the

pain system, allowing us to see when it is damaged. "

Oaklander's work recently helped a college athlete who suddenly began

experiencing an unbearable burning sensation in his palms and on the soles

of his feet, according to a paper slated for publication in the February

issue of the journal Anesthesia & Analgesia.

Greg Palladino, a lacrosse goalie at Southern New Hampshire University, was

on a team trip to Bermuda last year when he began suffering a pain that only

submersion in ice would alleviate. It was as though broken glass were

running through his veins, he told his doctors.

He returned home and was treated repeatedly at area hospitals for weeks.

Despite extensive tests, the doctors were baffled, said Palladino's father,

. Drug after drug failed to help, and he lost 55 pounds in a matter of

weeks.

When Oaklander was called in, she did a skin biopsy that showed conclusively

that Palladino's " erythromelalgia " -- his red, burning appendages - stemmed

from severe damage to small nerve fibers that apparently came on because of

an auto-immune reaction. For some reason, his body had started attacking its

own nerve cells.

The biopsy gave doctors the confidence to put Palladino on enormous doses of

steroids to stop the auto-immune attack, and he has almost completely

recovered, his father said.

Palladino was - in a way -- lucky that he had tissue damage that could be

detected; many patients, Oaklander said, have very real pain that is caused

by undetected problems in their nervous system, afflicting them with " an

invisible disability that leaves no traces. "

" It's a wiring problem, " she said. " It's like when your oil light on your

dashboard goes on, and you think, 'My car must be low on oil,' but you pull

over and check your oil and it's fine, and you realize it's an electrical

problem. These are people who have electrical problems in their pain system,

and their neurons are firing as much as if they had a broken leg, only their

leg is fine. "

For patients with chronic unexplained pain, the lack of physical proof of

their suffering compounds it, pushing some as far as suicide.

" You feel like you're malingering, you feel like you're crazy, " said

Beth Ludington, patient representative for Jim Broatch's group, the Reflex

Sympathetic Dystrophy Syndrome Association, which helps people with pain

disorder. " I used to feel like a wimp until I was diagnosed. Then it was,

'Hallelujah! I'm not crazy and I'm not a big wimp! There's a reason for

this, and a name.' It really validates the suffering that a lot of people go

through. "

*Copyright 2006 The New York Times News Service. All rights reserved.*

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