Understanding and overcoming chronic pain
“One in five people in Europe suffers of a pain that cannot be cured but can only be carried.
Chronic pain is not just a symptom, it is a disease. It can affect the ability to carry out simple activities, like walking or concentrating on a job. The societal cost of chronic pain is huge: higher than heart disease and cancer [1]. The incidence (and cost) of chronic pain are likely to increase as longevity increases: we want to live longer, but not in pain. Thus, we must find better solutions to the growing problem of chronic pain.
We are not even near an effective solution. Several drugs developed in rodents do not work sufficiently well in humans, and treating the cause of pain does not always get rid of the pain. This is because pain is influenced by many factors, including the psychological state of the person who suffers pain. Anxiety and fear amplify pain, and recent research has suggested that they can also contribute in maintaining pain [2, 3].
“The solution to the problem of pain will not come from a single biomedical discipline. It will require the integration of basic and clinical research in different disciplines, spanning molecular biology, neuroscience, medicine, psychology, and engineering.
We first need to understand which neural circuits transmit noxious signals and generate the conscious experience of pain. Then, we need to determine how these circuits are affected by injury and inflammation, and how they are modulated by stress, fear, and anxiety. This is where we are heading to, although the road is still very long.
In my research, I use neuroimaging and computational methods to study brain activity and structure in vivo in healthy people experiencing acute pain and in patients with chronic pain (such as neuropathic pain and musculoskeletal pain). Much of my past work has contributed to determine the neural and computational substrate of pain perception in healthy people. For instance, I have shown that a brain region called primary somatosensory cortex contains neurons that respond to noxious stimuli to the skin. These neurons are arranged in a very precise way, “a cortical map”, that allows to localise pain on our body [4, 5]. These cortical maps are rather resilient to nerve injury: they do not change after nerve injury or resection, but can change during motor training [6]. My main interest now is to study the neural changes caused by inflammation and injury, and to understand why some people are more at risk of developing chronic pain than others.
Flavia Mancini
Bye-Fellow in Pain Neuroscience
References
1. Gaskin, D.J. and P. Richard, The economic costs of pain in the United States. J Pain, 2012. 13(8): p. 715-24.
2. Ren, W., et al., The indirect pathway of the nucleus accumbens shell amplifies neuropathic pain. Nat Neurosci, 2016. 19(2): p. 220-2.
3. Baliki, M.N., et al., Corticostriatal functional connectivity predicts transition to chronic back pain. Nat Neurosci, 2012. 15(8): p. 1117-9.
4. Mancini, F., et al., Whole-body mapping of spatial acuity for pain and touch. Ann Neurol, 2014. 75(6): p. 917-24.
5. Mancini, F., et al., Fine-grained nociceptive maps in primary somatosensory cortex. Journal of Neuroscience, 2012. 32(48): p. 17155-62.
6. Makin, T.R. and S.J. Bensmaia, Stability of Sensory Topographies in Adult Cortex. Trends Cogn Sci, 2017. 21(3): p. 195-204.