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A Painful Lesson

Before I hit the scanner at deCharms’s lab, we practice a few of the mental exercises that he routinely teaches his subjects. I imagine my brain releasing endorphins, their painkilling signals traveling down the length of my spinal cord to reach my lower back. To try to increase my pain, I imagine that my lower back is burning. (Trying to worsen the pain sounds counterproductive, but deCharms theorizes that learning to modulate pain in both directions will give patients more power over brain activity.) I’m shocked by how sharply I can make the pain flare up.

Now that I’m inside the scanner, the screen instructs me to try to increase or decrease the size of the fires representing my brain activity. I set to work, trying to focus simultaneously on my pain and on the screen overhead. The fires wax and wane a bit, sometimes smoldering, sometimes burning at a steady pace. My pain that day is mild, and it’s difficult to tell if the fires are flickering randomly or at my will. Try as I might to extinguish the flame or coax it to a roaring blaze, the fire mostly burns low.

After about 15 minutes, the technician’s voice crackles over a speaker in the scanner – my first session is over, and to my surprise, I did achieve some control. She projects onto the screen a rough graph comparing activity in the cingulate during the intervals when I tried to increase the fires with the activity when I tried to decrease them. There is a clear difference between the lines.

When the technician asks if I want to try another session, I agree, determined to do even better this time around. During this session, I switch mental strategies, which deCharms recommends as a way to find the technique that works best. Instead of imagining endorphins being released in my brain, I focus on the healthy tissue of my hand and try to imagine that my back feels just as pain-free. The fires on the screen flicker and flare, and I’m convinced I have a better handle on my neural activity. When I receive my official results several weeks later, I discover I was right. I performed best during my last session, successfully controlling the activity in my right and left insula.

DeCharms is now trying to determine the best ways to teach fMRI feedback; if long-term studies confirm his team’s initial findings, and the U.S. Food and Drug Administration approves the treatment, he eventually hopes to open treatment clinics. Like a complex dance, the technique is hard to pick up, and some people are naturally better at it than others. “We need to figure out who is good at this and how to make it easier,” says deCharms. His team is developing new ways to display brain activity to make feedback more effective. The fire graphic used in my session, for example, is a relatively new addition. The researchers are also doing extensive psychological screening to see if people who easily learn to control their brain activity have identifying characteristics. One of the biggest factors will probably be motivation. Feedback somewhat resembles exercise, albeit an odd mental form of it – so it requires willingness and effort.

My own test run is just a single afternoon, and I can’t tell if my pain is any better. But I did seem to control select parts of my brain. And for better or worse, after two hours in the scanner, I am definitely conscious of my lower back.

Emily Singer is the biotechnology and life sciences editor of Technology Review.

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