Apkar V. Apkarian, PhD, a trailblazer in neurochemistry at Northwestern University, discusses the fascinating dynamics of pain and the placebo effect. He delves into how pain perception is influenced by brain processes and environmental factors. The conversation highlights the use of meditation in pain management and the remarkable ability of placebos to deliver real relief. Dr. Apkarian also shares ambitious goals to develop new pain relief medications while championing open science, ensuring transformative research is accessible to all.
Chronic pain is primarily influenced by emotional and psychological factors rather than solely by physical injuries, necessitating a holistic treatment approach.
The placebo effect can result in significant pain relief, highlighting the importance of belief and expectation in patient outcomes and pain management.
Deep dives
Understanding Pain Processing in the Brain
Pain processing in the brain is complex and evolves from a fixed perception to a dynamic, integrative experience. Traditional theories suggested that pain results from a straightforward pathway activated by stimuli, such as a pinprick, which travels from the skin receptors to the spinal cord and into the cortex where it is perceived. However, contemporary neuroscience challenges this notion by highlighting the interaction among multiple brain regions involved in pain perception, particularly emphasizing the difference between acute and chronic pain. Chronic pain, which affects about 20% of the global population, poses significant clinical challenges as treatments for acute pain often fail to alleviate chronic pain, necessitating advanced research to develop targeted therapies.
The Link Between Chronic Pain, Emotions, and Memory
Chronic pain is deeply intertwined with emotional responses and memory traces, which can exacerbate the experience of pain. Research indicates that emotional circuits in the brain play a crucial role in how individuals experience and react to pain signals. In studies focusing on chronic back pain patients, brain properties evaluated at the onset of pain could predict which individuals would develop persistent pain over time. This highlights that the risk for chronic pain is more associated with brain processing rather than just the physical injury itself, suggesting that pain management must also consider emotional and psychological factors.
The Efficacy of the Placebo Effect
The placebo effect demonstrates how psychological factors can induce real physiological changes in pain perception, suggesting that belief and expectation can influence patient outcomes. Even simple interventions, such as taking an inert sugar pill, can lead to significant pain relief, and the growing size of placebo responses in clinical trials raises questions about the efficacy of pharmaceutical treatments. Recent research aims to identify who might be more responsive to placebo effects, indicating that emotional awareness and personal attitudes can predict responsiveness. Furthermore, long-term placebo treatment might lead to persistent pain relief through potential brain reorganization, offering an exciting avenue for non-drug interventions.
Exploring Alternatives to Conventional Pain Management
As chronic pain becomes increasingly prevalent, there is a pressing need to find effective treatment alternatives beyond opioids and traditional medications. Current investigations into the development of new drugs aim to reduce pain while minimizing side effects and dependency issues associated with opioids. The research also explores the potential of integrative approaches, such as mindfulness and meditation, to modulate pain perception through improved emotional regulation and learning strategies. These findings highlight the importance of addressing both the neurological and psychosocial aspects of pain in order to enhance recovery and treatment outcomes for chronic pain sufferers.
Apkar V. Apkarian, PhD is a professor of physiology, anesthesiology, and physical medicine and rehabilitation at Northwestern University's Feinberg School of Medicine.
He has been studying pain for more than two decades and is a pioneer in the use of fMRI to study the neurochemistry of the brain. Dr. Apkarian's research has increasingly focused on chronic pain, including the strategic use of placebo treatment.
In this episode, we discuss the placebo effect, how pain works in the brain, and susceptibility to chronic pain and placebo response.