By Christopher J. Gilligan and David Borsook | Pain Medicine | July 27, 2015

The dramatic impact of chronic pain was captured in a recent European study that followed patients suffering with chronic pain for 1 year: 40% of those patients had more pain and 40% had less pain, but 100% reported major, negative impacts of chronic pain on their quality of life [1]. Half of patients believed that everything possible had been done to manage their pain. This insight into how patients with chronic pain fare reveals a number of salient points, perhaps most importantly highlighting this condition that persists without cure. Furthermore, accumulating evidence suggests that emotional processing in brain networks is more involved in chronic pain [2] alluding to the nature of the associated suffering with the condition.

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On June 30, 2015, CLBB and the Petrie-Flom Center hosted a public symposium bringing together the leading experts in neuroscience and law to wrestle with the critical question: what can, and should, the law do with what we know about pain and the brain? To answer this, panelists discussed whether brain imaging can be a “pain-o-meter” that tells courts when a person is in pain, if fMRI technologies can help give us a new perspective on intractable chronic pain, and how to understand the intimate relationship between pain and emotion, if there even is such a distinction. Together, experts and audience members explored how the law can use brain science to get smarter about a subject that touches everyone.  Continue reading »

By Vanda Faria, Nathalie Erpelding, Alyssa Lebel, Adriana Johnson, Robert Wolff, Damien Fair, Rami Burstein, Lino Becerra, and David Borsook | PAIN | July 13, 2015

Abstract:

The prevalence of migraine has an exponential trajectory that is most obvious in young females between puberty and early adulthood. Adult females are affected twice as much as males. During development, hormonal changes may act on predetermined brain circuits increasing the probability of migraine. However, little is known about the pediatric migraine brain and migraine evolution. Using magnetic resonance imaging (MRI), we evaluated 28 children with migraine (14 females and 14 males) and 28 sex-matched healthy controls to determine differences in brain structure and function between: (a) females and males with migraine, and (b) females and males with migraine during earlier (10-11 years old) vs later (14-16 years) developmental stages compared to matched healthy controls. Compared to males, females had more gray matter (GM) in the primary somatosensory cortex (S1), supplementary motor area (SMA), precuneus (PCu), basal ganglia (BG), and amygdala, as well as greater PCu functional resting state connectivity to the thalamus, amygdala and BG, and greater amygdala functional resting state connectivity to the thalamus, anterior midcingulate cortex, and SMA. Moreover, older females with migraine had more GM in the S1, amygdala, and caudate compared older males with migraine and matched healthy controls. This is the first study showing sex and developmental differences in pediatric migraineurs in brain regions associated with sensory, motor, and affective functions, providing insight into the neural mechanisms underlying distinct migraine sex phenotypes as well as their evolution that could result in important clinical implications increasing treatment effectiveness.

Read the full article here.

By Sara Reardon | Nature | 25 February 2015

This article features Amanda Pustilnik, the 2014-2015 Senior Fellow in Law & Applied Neuroscience at CLBB and The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Pustilnik’s involvement in the CLBB Pain & Suffering Working Group and their recent Symposium is cited. Nature also published an editorial on pain imaging in the same issue.

Annie is lying down when she answers the phone; she is trying to recover from a rare trip out of the house. Moving around for an extended period leaves the 56-year-old exhausted and with excruciating pain shooting up her back to her shoulders. “It’s really awful,” she says. “You never get comfortable.”

In 2011, Annie, whose name has been changed at the request of her lawyer, slipped and fell on a wet floor in a restaurant, injuring her back and head. The pain has never eased, and forced her to leave her job in retail.

Annie sued the restaurant, which has denied liability, for several hundred thousand dollars to cover medical bills and lost income. To bolster her case that she is in pain and not just malingering, Annie’s lawyer suggested that she enlist the services of Millennium Magnetic Technologies (MMT), a Connecticut-based neuroimaging company that has a centre in Birmingham, Alabama, where Annie lives. MMT says that it can detect pain’s signature using functional magnetic resonance imaging (fMRI), which measures and maps blood flow in the brain as a proxy for neural activity. Continue reading »

Pain is at the heart of legal areas from tort to torture, and yet legal decision-makers may be relying on scientifically outmoded concepts of pain and its effects. This Symposium brought together legal and medical experts to discuss:

Click to view event poster.

• Recent scientific breakthroughs in the understanding of pain, including long-term neurological changes
• The complicated relationship between pain and emotion, and how studying how physical and emotional pain are represented in the brain can help us understand their similarities and differences
• How updated understanding of the neuroscience of pain can help improve legal outcomes—and where the limits are

The conversation, presented by the CLBB Pain & Suffering working group, with support from the Harvard Mind Brain Behavior Interfaculty Initiative, was facilitated by Judy Foreman, an investigative journalist and author of A Nation In Pain: Healing Our Country’s Greatest Health Problem. Continue reading »