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Most people pop a pill when they’ve got a headache. But what if you could think that pain away? Researchers at Stanford University have developed a brain imaging technique that allows patients to take charge of their pain. The technology isn’t yet ready for the clinic, but researchers say it could one day be applicable to many brain disorders, such as depression, anxiety, and dyslexia.

“This is the first study to show that patients can learn to take control of a specific region of their brain and better control their pain,” says Sean Mackey, associate director of the Pain Management Division at Stanford University in Stanford, CA, and head scientist on the project research.

Mackey and collaborators used a technique called real-time functional magnetic resonance imaging (rtfMRI) where both subjects and researchers can look at the brain’s activity as the person thinks. In this case, researchers broadcast the activity from a part of the brain involved in pain processing – the anterior cingulated cortex – into the scanner. Patients watched the activity and tried to decrease it by doing mental exercises, such as focusing on a part of the body where they did not have pain. The process is similar to biofeedback, where people learn to control blood pressure or heart rate by getting constant feedback on their vital signs.

Eight patients with chronic pain that wasn’t adequately controlled by more conventional means reported a 44 percent to 64 percent decrease in pain after the training, a benefit that was three times larger than the pain reduction reported by a control group. Those who exercised the greatest control over their brain activity showed the greatest benefit in pain reduction. The results were published last week in the Proceedings of the National Academy of Sciences.

“I look forward to seeing if this result could be replicated in larger numbers of patients,” says Richard Gracely, a neurologist who specializes in pain research at the University of Michigan Medical School in Ann Arbor, MI. “It could be very promising for providing another method for control over pain in clinical conditions, especially where there are no other effective means in reducing pain.”

Mackey and his collaborator, Christopher deCharms, of Omneuron in Menlo Park, CA, are running a long-term clinical trial with chronic pain patients to determine if imaging therapy could really be a useful alternative to drugs or surgery. But they caution that the technology is not ready for clinical use – they don’t know how long the effect lasts and say some people learn the technique easier than others.

“It’s not an approach that’s suitable for everyone. Patients have to be motivated, which not all pain patients are,” deCharms says. “But if you could sustain a 50 percent decrease in pain, it could change the life of a person with debilitating pain.”

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