8A - Thursday, April 11, 2013
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New study helps doctors see
pain inthe brain, drug effects
New study exposes if
drugs relieving pain,
opens possibilities
In a provocative new study,
scientists reported Wednesday
that they were able to "see" pain
on brain scans and, for the first
time, measure its intensity and
tell whether a drug was relieving
it. Though the research is in its
early stages, it opens the door to
a host of possibilities.
Scans might be used some-
day to tell when pain is hurting
a baby, someone with dementia
or a paralyzed person unable to
talk. They might lead to new, less
addictive pain medicines. They
might even help verify claims for
disability.
"Many people suffer from
chronic pain and they're not
always believed. We see this as
a way to confirm or corroborate
pain if there is a doubt," said Tor
Wager, a neuroscientist at the
University of Colorado, Boulder.
He led the research, published
in the New England Journal of
Medicine: So far it is only on
pain felt through the skin - heat
applied to an arm. More study
needs to be done on more com-
mon kinds of pain, such as head-
aches, bad backs and pain from
disease.
Independent experts say the
research shows a way to mea-
sure objectively what is now one
of life's most subjective experi-
ences.
Pain is the top reason people
see a doctor, and there's no way
to quantify how bad it is other
than what they say. A big quest
in neuroscience is to find tests or
scans that can help diagnose ail-
ments with mental and physical
components such as pain, depres-
sion and PTSD, or post-traumatic
stress disorder.
Although many studies have
found brain areas that light up
when pain is present, the new
work is the first to develop a com-
bined signature from all these
signals that can be used to mea-
sure pain.
"This is very exciting work.
They made a huge breakthrough
in thinking about brain patterns,"
said Dr. David Shurtleff, acting
deputy director of the National
Institute on Drug Abuse, which
helped sponsor the research.
"We need a brain-based signa-
ture for pain. Self-report doesn't
cut it. It's not reliable, it's not
accurate."
The research involved four
experiments at ColumbiaUniver-
sity approved by a panel to ensure
no participants were harmed. In
all, 114 healthy volunteers were
paid $50to $200 tobe tested with
a heating element placed against
a forearm at various tempera-
tures, not severe enough to cause
burns or lasting damage. Some of
the experiments required them
to stand it for 10 to 20 seconds.
"It's like holding a hot cup of
coffee that you really want to put
down but can't quite yet," Wager
said.
Functional magnetic reso-
nance imaging, or fMRI scans,
which don't require radiation
as X-rays do, recorded changes
in brain activity as measured by
blood flow. Computers were used
to generate signatures or pat-
terns from these readings.
The first set of experiments on
20 people developed signatures
for pain versus the anticipation
of it or mild warmth on the arm.
The second experiment validat-
ed these signatures in 33 other
people and found they predicted
how much pain they said they
felt.
"It's really what seems to be a
true measure of the experience
that the patient's having," and
it gives a number to pain sever-
ity that can guide care, said one
expert with no role in the studies,
Dr. Costantino Iadecola, director
of the Brain and Mind Research
Institute at Weill Cornell Medi-
cal College.
Researchers took their work
a step further with the third
experiment, which involved
40 people who recently lost a
serious love relationship and
were feeling intensely rejected.
Besides the heat tests, they had
scans while being shown a pic-
ture of their former partners and
then a picture of a good friend.
Researchers found the brain sig-
natures for social or emotional
painwere different fromthe ones
for physical pain.
"That's very provocative," said
Dr. Allan Ropper, a neurologist
at Brigham and Women's and
Harvard University who wrote a
commentary in the journal. The
signatures seem highly accurate
and able to distinguish physical
pain from other kinds, he said.
In the fourth experiment,
researchers gave 21 participants
two infusions of a morphine-
like drug while they were being
scanned and having the heat
tests. The first time, they knew
they were getting the drug. The
second time they were told they
were getting dummy infusions
but in fact got the drug again.
Brain signatures showed their
pain was being relieved both
times in proportion to how much
drug was in their systems.
"This is beginning to open a
new wedge into brain science,"
Ropper said. "There may be com-
pletely novel ways of treating
pain by focusing on these areas of
the brain rather than on conven-
tional medications which block
pain impulses from getting into
the spinal cord and brain."
Shurtleff, of the federal drug
abuse agency, also said he hoped
the research would lead to newer
drugs.
"We want medications that
can reduce this signature and
don't show a signature for addic-
tion," he said.
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ALErrO IVA .C i enTErA/r
Syrian citizens searching for bodies on the rubble of damaged buildings that were attacked by Syrian forces airstrikes, at
al-Ansari neighborhood, in Aleppo, Syria. More than 70,000 people have died since Syria's crisis erupted in March 2011.
Alance between Al- Qaida
and Syrian rebel grws tense
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Syrian rebels not
consulted before
Iraqi group merger
BEIRUT (AP) - Tensions
emerged Wednesday in a newly
announced alliance between
al-Qaida's franchise in Iraq and,
the most powerful Syrian rebel
faction, which said it was not
consulted before the Iraqi group
announced their merger and only
heard about it through the media.
Al-Qaida in Iraq said Tues-
day that it had joined forces with
Jabhat al-Nusra or the Nusra
Front - the most effective force
among the mosaic of rebel bri-
gades fightingto topple President
Bashar Assad in Syria's civil war.
It said they had formed a new
alliance called the Islamic State
in Iraq and the Levant.
The Syrian government seized
upon the purported merger to
back its assertion that it is not
facing a true popular movement
for change but rather a foreign-
backed terrorist plot. The state
news agency said Wednesday
that the union "proves that this
opposition was never anything
other than atool usedby the West
and by terrorists to destroy the
Syrian people."
Talk of an alliance between
Jabhat al-Nusra and al-Qaida
in Iraq has raised fears in Bagh-
dad, where intelligence officials
said increased cooperation was
already evident in a number of
deadly attacks.
And in Syria, a stronger Jab-
hat al-Nusra would only further
complicate the battlefield where
Western powers have been
covertly trying to funnel weap-
ons, training and aid toward
more secular rebel groups and
army defectors.
* Washington has designated
Jabhat al-Nusra a terrorist orga-
nization over its links with al-
Qaida, and the Syrian group's
now public ties with the terrorist
network are unlikely to prompt a
shift in international support for
the broader Syrian opposition.
Earlier this year, the U.S.
announced a $60 million non-
lethal assistance package for
Syria that includes meals ad
medical supplies for the armed
opposition. It was greeted unen-
thusiastically by some rebel lead-
ers, who said it does far too little.
Washington's next step is
expected to be a broader pack-
age of non-lethal assistance,
expanding from food and medi-
cal supplies to body armor and
night-vision goggles. However,
President Barack Obama has not
given final approval on any new
package and an announcement is
not imminent, a senior adminis-
tration official said.
Secretary of State John Kerry,
who met with Syrian opposition
leaders in London on Wednesday,
hinted at the new non-lethal aid
package this week, saying the
administration had been hold-
ing intense talks on how to boost
assistance to the rebels.
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