Mackey, M.D., Ph.D.
>The Strain in Pain Lies
Mainly in the Brain:
of Engineering and Technology to Anesthesia and Pain Management
Mackey is Associate Director of the Pain Management Division at
and Co-Director of the Stanford Pain and Research and Clinical Center
Neuroscience Institute, also at Stanford University, as well as
at Stanford University in the Departments of Anesthesia and
Mackey has authored over thirty scientific papers, book chapters and
His primary research interest involves the use of advanced imaging
functional magnetic resonance imaging (fMRI), to investigate the neural
of pain and the factors that contribute to our perception of pain. He
ongoing research in helping patients experiencing chronic pain “see”
own brain activity in real time, and to use this information to control
in the region associated with the processing and perception of pain.
After a few jokes to wake us up, Dr.
Mackey said that pain is the number one reason people see doctors. He quoted this
definition "Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage." Forty to fifty million Americans
are affected by pain every year. His center has studied it since the mid
1990s, working with volunteer patients and students mostly.
There are two kinds of nerve path that
transmit pain signals from transducers throughout the body to the brain. A-fibers
give you a quick jolt immediately after an experience, and C-fibers transmit
that burning sensation that doesn't go away quickly. Dr. Mackey then went into
some detail about which centers in the brain sense pain and how it is
processed. One thing he mentioned was "If you decide not to pay attention to it,
there are nerve fibers that tell your spine to "turn down that input.""
One of their big discoveries is that they
are able to see the image of pain response in the brain on an MRI machine in
real time. Apparently what happens is the brain saturates with blood in the
area where pain is being experienced, so the image of it develops a "bright
spot". They have used this feedback to learn a lot about how pain works. Several
volunteers have been able to look at the feedback from their brains and turn
down their response to pain, leading to more comfortable outcomes.
Dr. Mackey also said that many individual
factors influence a persons feelings of pain. For example, they have learned
that depression and pain are often connected, and that a patient experiencing
both will probably need pain medication and counseling for either
treatment to be effective. Cultural factors are also part of someone's
experience of pain.
During Q&A the following came up:
Dr. Mackey believes that the placebo
effect is real, and that it can be part of an effective pain management solution.
He gave an example from his own experience, where patients consistently
thought a cherry colored liquid did more pain management than pills with
exactly the same medicine content.
Dr. Mackey has noticed that different
generations have different vocabulary for discussing pain. For example, some of
today's old Americans talk of "discomfort" when they mean pain.
Dr. Mackey has not been contacted by, and
is not interested in dealing with the torture people from the U.S.
Stanford's Pain Management Center does
research with paid volunteers and patients who know what they are
getting into. Dr. Mackey doesn't do experiments on animals.
At the Pain Management Center website are
many links to articles, broadcasts, and other information from the center. For
that, please visit: