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Transcript – Programme 112: Measuring Pain, Reading the Brain

How pain’s sub­jec­tiv­i­ty makes it dif­fi­cult to mea­sure, rewiring the brain and new research that allows patients to visu­alise their pain

To lis­ten to this pro­gramme, please click here.

This edi­tion is fund­ed by the Plum Foundation.

In this edi­tion of Air­ing Pain, return­ing con­trib­u­tor Mark John­son, Direc­tor of the Cen­tre for Pain Research at Leeds Beck­ett Uni­ver­si­ty, speaks to Paul about the exper­i­men­tal meth­ods used in their lab to mea­sure how pain is expe­ri­enced. Pro­fes­sor John­son empha­sis­es the dif­fi­cul­ty in com­mu­ni­cat­ing one’s pain, as it is entire­ly con­text-dri­ven and based on the expe­ri­ences of the patient.

Paul then heads to Man­ches­ter Uni­ver­si­ty to speak to Pro­fes­sor of Neu­ro-Rheuma­tol­ogy Antho­ny Jones. Paul learns about the dif­fer­ent tech­niques used to mea­sure the alpha waves pro­duced by the brain when pain occurs, how the antic­i­pa­tion of pain is as impor­tant as pain itself and the dif­fi­cul­ties that sci­en­tists encounter when try­ing to emu­late these sig­nals. We also hear about the brain’s ‘plas­tic­i­ty’ – its abil­i­ty to rewire con­nec­tion based on sen­so­ry experience.

Anthony’s research team are devel­op­ing a ‘smart neu­ro-ther­a­pies’ plat­form (which you can get involved in, see ‘More Infor­ma­tion’ below), a way for patients to mea­sure their brain’s alpha waves, which are impor­tant in con­trol­ling sen­so­ry expe­ri­ences. The research could have sig­nif­i­cant impli­ca­tions in pain man­age­ment. The team are employ­ing a unique col­lab­o­ra­tive the­atre piece, Pain, the Brain and a Lit­tle Bit of Mag­ic, to help patients, health­care pro­fes­sion­als, and the pub­lic to under­stand these com­plex systems.

Issues cov­ered in this pro­gramme include: Brain imag­ing, brain sig­nals, com­mu­ni­cat­ing pain, elec­troen­cephalog­ra­phy, fibromyal­gia, neu­ro-rheuma­tol­ogy, neu­ro-ther­a­py, neu­ro­path­ic pain, research, rewire the brain, sleep and trigem­i­nal neuralgia.

Paul Evans: This is Air­ing Pain, the pro­gramme brought to you by Pain Con­cern, the UK char­i­ty that pro­vides infor­ma­tion and sup­port for those of us liv­ing with pain and for health care pro­fes­sion­als. I’m Paul Evans and this edi­tion of Air­ing Pain has been fund­ed by the Plum Foundation.

Mark John­son: I’m a pain sci­en­tist, I’ve been in the field for well over 20 years. And the longer I’m in the field, the more I become uncer­tain about how we try to doc­u­ment pain in research settings.

Evans: How do researchers mea­sure some­thing as sub­jec­tive as pain? On a stan­dard pain rat­ing scale, that is where zero is no pain and ten is extreme pain, some­one might rate today’s pain at eight, but a much bet­ter, more bear­able five the fol­low­ing day. It might be the same lev­el of pain, but the expe­ri­ence of it is dif­fer­ent. Mark John­son is Pro­fes­sor of Pain and Anal­ge­sia at Leeds Beck­ett Uni­ver­si­ty. He’s also direc­tor of its Cen­tre for Pain Research.

John­son: One of the things we do in our lab is to use exper­i­men­tal pain tech­niques that are, in the main, non-inju­ri­ous. So these are what we would call tran­sient, tem­po­rary inter­ven­tions where­by, for exam­ple, we might press a pres­sure probe on to the skin and keep press­ing it until the per­son says that it’s become painful. And then we mea­sure the pres­sure that it took for the per­son to first expe­ri­ence the pain from the pres­sure probe, and we call that pain thresh­old. But as soon as you remove the probe, then the per­son­’s pain dis­ap­pears, pret­ty much immediately.

Our oth­er tech­niques involve, for exam­ple, plung­ing a hand into a buck­et of icy water, and the per­son has to keep the hand in the water, tell us when they first feel the expe­ri­ence of pain, which we mea­sure as pain thresh­old, and then we may well ask them to keep their hand in the buck­et as long as they pos­si­bly can. And to take it out when they can no longer bear the pain from the ice water. And when they take their hand out, then we mea­sure that time as the time-to-pain tol­er­ance. And of course, when they take their hand out, then the pain starts to dis­ap­pear quite, quite rapid­ly, and there’s no last­ing dam­age from that type of technique.

Evans: It’s quite inter­est­ing because pain is sub­jec­tive, and even from a day to day point of view, pain is dif­fer­ent. I can remem­ber being asked for years and years ‘Are you in pain?’ and you say ‘No, I’m not in pain, I’m aching’, but aching is pain.

John­son: Yeah, yeah. Pain is exact­ly what the per­son says it is. Pain is sub­jec­tive. So we’ve got no objec­tive mea­sure of pain. There’s no probe that we can put on some­body that will iden­ti­fy that that per­son is or is not in pain. So as a con­se­quence, pain is very much about a per­son­’s abil­i­ty to com­mu­ni­cate their sen­so­ry expe­ri­ence, the sen­sa­tions that they’re feel­ing at that moment in time. For them to do that is real­ly all about when they decide to use par­tic­u­lar words to describe those sen­sa­tions. Whether it’s an ache or a pain is real­ly deter­mined by that per­son and the con­text in which the ques­tion has been asked.

I’ve always been con­cerned about scal­ing pain. Often patients are asked ‘Can you tell me on a scale of one to ten, how much pain you’re in at this moment in time? Where one’s min­i­mal pain and ten’s the worst pain imag­in­able?’ And that’s actu­al­ly quite hard to do. I don’t con­vert my pain into numbers.

Evans: It’s very difficult.

John­son: Absolute­ly. And there’s a lit­tle bit of an assump­tion that that scale is lin­ear. Cer­tain­ly, we know that if you com­pare some­body’s pain inten­si­ty rat­ing of five with some­body else’s pain inten­si­ty rat­ing of five, you can­not say that those two peo­ple are expe­ri­enc­ing the same inten­si­ty of pain, because pain is per­son­al to them.

I pre­fer using scales that are more descrip­tive. My pain’s mod­er­ate, my pain’s severe, my pain’s mild. I think you get a bet­ter insight into what the per­son is expe­ri­enc­ing when they’re using those sorts of terms.

And yes, when do you con­vert an ache into the sen­sa­tion of pain? Well, again, it’s the con­text. If you’re in a pain clin­ic, and you’re try­ing to explain to a physi­cian, for exam­ple, that you’re expe­ri­enc­ing some­thing that is real­ly quite dis­tress­ing, you might use the word pain. But if you’re in a, I don’t know, a social set­ting, you might just use the word ache. So pain’s very much depen­dent on the con­text in which you’re express­ing it.

Evans: So what sort of exper­i­ments are you doing in here?

John­son: We’ve got two main themes. We look at fac­tors influ­enc­ing an indi­vid­u­al’s response to a nox­ious stim­uli. We call it pain sen­si­tiv­i­ty response and that’s things like the age of the per­son, the gen­der, the sex of the per­son, eth­nic­i­ty, and body fat com­po­si­tion, for exam­ple. So that’s one strand that we look at. And anoth­er strand is the fac­tors that influ­ence a per­son­’s response to treat­ments, most­ly non-phar­ma­co­log­i­cal treat­ments. I’m par­tic­u­lar­ly inter­est­ed in TENS, acupunc­ture, things like kine­si­ol­o­gy taping.

Evans: What sort of results have you found?

John­son: With respect to the fac­tors influ­enc­ing indi­vid­ual response to nox­ious stim­uli, painful stim­uli, we found that gen­der role does seem to have an influ­ence. So it’s well-estab­lished in the field that the pain thresh­old of women tends to be low­er than the pain thresh­old of men. And there’s been a debate of whether that’s just that women are more like­ly to report pain more read­i­ly than men, or not.

Ani­mal stud­ies sug­gest that actu­al­ly, there’s a bio­log­i­cal under­pin­ning to that find­ing. In our stud­ies, we have found exact­ly the same, that women express pain more read­i­ly than men in lab­o­ra­to­ry set­tings and that their pain thresh­old and pain tol­er­ances are low­er than men.

And what’s quite inter­est­ing about our work is that we found that that seems to link into what’s called gen­der role. It’s a soci­etal view and in cer­tain soci­eties, that men need to be tough. For exam­ple, they need to be able to with­stand pain and sit­u­a­tions in which they’re expe­ri­enc­ing pain. We’re find­ing that that sort of plays out in the stud­ies that we’ve been doing in the lab. And that seems to go across cul­ture as well. We do quite a lot of work on peo­ple from Arab coun­tries, from the Mid­dle East­ern, North African coun­tries. We found that that gen­der role seems to play across into those cul­tur­al set­tings as well.

Evans: Some peo­ple might be sur­prised that wom­en’s pain thresh­old is low­er than men. Par­tic­u­lar­ly in the UK, where we have this thing called man flu, just any­thing will send us to bed in agony, where­as women car­ry on.

John­son: Yeah, but as I said ear­li­er, pain’s all con­text-dri­ven. So I think it’s the con­text in which you’re express­ing how you feel. So in a lab­o­ra­to­ry set­ting, the sub­jects do know that it’s an exper­i­ment that will be com­par­ing men against women. So I think there’s a whole load of fac­tors that play out in that setting.

Men will express their man flu more read­i­ly, per­haps in a soci­etal set­ting because they’re want­i­ng sym­pa­thy from their wives, their part­ners, their friend­ship group. Men tend to not express (I find being a cyclist), those sorts of ail­ments as much when they’re with their fel­low sport­ing col­leagues. Now I’ve got no research to back that up. But I think it’s just that idea that con­text real­ly dri­ves the way that we express how we feel.

Evans: Men maybe don’t want to show oth­er men that they’re in pain, the alpha male of the group and things like that, I suppose.

John­son: Yeah, yeah, yeah. I think there have been stud­ies done but they’ve looked at these sorts of set­tings where you’re doing, say, the cold plunge exper­i­ment. When there’s been a female observ­er and a man par­tic­i­pant, and a man observ­er and a man par­tic­i­pant and play­ing that dynam­ic out, the investigator’s gen­der and sex is also quite impor­tant, I think.

Evans: Pro­fes­sor Mark John­son, direc­tor of the Cen­tre for Pain Research at Leeds Beck­ett University.

So there are many vari­ables to take into account when one is mea­sur­ing pain. Would­n’t some form of diag­nos­tic read­out like we have in the motor indus­try be very handy?

Antho­ny Jones is Pro­fes­sor of Neu­ro-Rheuma­tol­ogy at Man­ches­ter Uni­ver­si­ty where he leads the Human Pain Research Group.

Antho­ny Jones: We call all the dif­fer­ent ways of try­ing to get a read­out of what the brain is doing ‘func­tion­al brain imag­ing’. So that’s just a col­lec­tive term for dif­fer­ent types of ways of mea­sur­ing what the brain is doing. There are a num­ber of dif­fer­ent tech­niques. Elec­troen­cephalog­ra­phy, which we use a lot, which is record­ing elec­tri­cal sig­nals on the sur­face of the scalp. So this is a non-inva­sive tech­nique and that’s able to pick up con­ver­sa­tions that are going on in the sur­face of the brain.

Evans: Hang on, now, what do you mean [by] ‘con­ver­sa­tions that are going on in the brain?’

Jones: The way that the brain com­mu­ni­cates with itself, and dif­fer­ent parts of the brain, is through send­ing elec­tri­cal sig­nals and receiv­ing elec­tri­cal sig­nals to dif­fer­ent parts. So, if you imag­ine a huge num­ber of cir­cuits, some very small, some very exten­sive, all com­mu­ni­cat­ing with each oth­er at the same time. Of course, many regions of the brain are doing many dif­fer­ent things, and doing some of those things at the same time. So it’s a very com­plex organ to try to understand.

Evans: So the brain is talk­ing to itself, if you like, or dif­fer­ent parts of the brain are talk­ing to itself?

Jones: Yes.

Evans: Is there a point in the brain that is pure­ly involved in pain? Is there a pain cen­tre in the brain?

Jones: Well, that’s a real­ly inter­est­ing ques­tion and it’s pre­oc­cu­pied neu­ro­sci­en­tists for many decades, if not a cen­tu­ry, and the con­clu­sion has to be no, there isn’t a sin­gle pain cen­tre. In fact, this is one of the pieces of work that we did right at the begin­ning of my career when we were the first group to use a tech­nique called positron emis­sion tomog­ra­phy, which is a way of mea­sur­ing blood flow, and oth­er chem­i­cal changes in the brain.

Before the advent of func­tion­al brain imag­ing tech­niques, the only way you could access how the brain might be respond­ing to pain was actu­al­ly by stick­ing elec­trodes or stim­u­lat­ing dif­fer­ent bits of the brain dur­ing neu­ro­sur­gi­cal pro­ce­dures when peo­ple have to be con­scious, awake, because you need to know whether you’re inter­fer­ing with func­tion­al­ly essen­tial bits of the brain.

So there’s a num­ber of neu­ro­sur­geons, main­ly in Cana­da, who are very painstak­ing­ly either stim­u­lat­ing dif­fer­ent bits of the sur­face of the brain, or some­times record­ing as well and they had real dif­fi­cul­ty elic­it­ing pain at all by stim­u­lat­ing dif­fer­ent bits of the surface.

[Dur­ing the] 50s and 60s there was a great inter­est in psy­chosurgery, so chop­ping out dif­fer­ent bits of the brain. So there was a great vogue for peo­ple with very seri­ous depres­sion and oth­er psy­chi­atric prob­lems, cut­ting out, chop­ping out bits of the frontal cor­tex (so the front of the brain). That obvi­ous­ly had a fair­ly major effect on peo­ple’s per­son­al­i­ty and moti­va­tion. So they start­ed chop­ping out or chop­ping the con­nec­tions to a bit of the frontal cor­tex, which is the more emo­tion­al bit of the frontal cor­tex called the cin­gu­late cor­tex. When they did that patients still felt pain, so they were able to reg­is­ter pain, but it no longer both­ered them.

Evans: So you’re tak­ing the emo­tion away from the pain?

Jones: Exact­ly. And that was the sort of first indi­ca­tion that per­haps the sen­so­ry, so the ‘Where is it?’ and the ‘When is it?’ aspects of pain might be processed sep­a­rate­ly to the emo­tion­al aspects of pain.

Evans: An exam­ple that lots of peo­ple use is that if you stamp on my foot, and I’ve just won the lot­tery, I don’t mind the pain, the pain is okay. But if you stamp on my foot and some­thing real­ly bad has hap­pened to me, I real­ly feel the pain.

Jones: Absolute­ly. The one thing that we’ve learned from three decades of func­tion­al brain imag­ing is that the expe­ri­ence of pain is a high­ly vari­able, high­ly plas­tic process that is very con­text-depen­dent. So we’re real­ly talk­ing about the psy­cho­log­i­cal con­text, which is what you were just mentioning.

A beau­ti­ful exam­ple of that is the place­bo effect, which is real­ly the abil­i­ty to expe­ri­ence some­thing com­plete­ly dif­fer­ent­ly. Not because of any­thing phys­i­cal, just because of a ver­bal or visu­al cue about what you might be about to expe­ri­ence. This is why we can be hope­ful about pain because it’s all processed in the brain. The brain is a very pow­er­ful organ and we can actu­al­ly change the way it’s processed, so there is this plasticity.

When you expe­ri­ence pain, there’s lots of dif­fer­ent com­po­nents to that. There’s the actu­al stim­u­lus that might be painful, so stick­ing a nee­dle in the skin or mov­ing a painful joint. But there’s also all the things around that. So there’s the expec­ta­tion or the antic­i­pa­tion for that stim­u­lus or that expe­ri­ence. There’s also what comes after­wards, so how you respond to that. Is it going to stop you mov­ing or is it going to make you move faster?

We’re built to – or designed to – respond in dif­fer­ent ways to pain under dif­fer­ent cir­cum­stances. So if you’re antic­i­pat­ing pain caused by a nasty ani­mal that might kill you, well, you’re going to have a very dif­fer­ent response to that [than] to antic­i­pat­ing pain that might come from a painful joint. You can inter­ro­gate that in a lab­o­ra­to­ry and look at how the brain responds both to the antic­i­pa­tion of pain and to the actu­al pain itself. What we’ve learned from study­ing that over the last few years, is that the antic­i­pa­tion of pain is almost as impor­tant as the actu­al stim­u­lus that caus­es the pain, in terms of inform­ing the expe­ri­ence that we actu­al­ly have.

Evans: But for those who have chron­ic pain, per­ma­nent pain, there’s no antic­i­pa­tion involved, we know that we’re going to hurt tomor­row. So how does the brain react to that?

Jones: You say there’s no antic­i­pa­tion, but there will always be antic­i­pa­tion because you’re always pro­ject­ing what you might be expe­ri­enc­ing into the future. In fact, a large part of our brain is geared to just plan­ning for the future, par­tic­u­lar­ly the front of the brain, the frontal cor­tex is very involved in mem­o­ry. So remem­ber­ing what hap­pened before, pro­ject­ing what might be hap­pen­ing in the future and inte­grat­ing those things into a cur­rent experience.

The brain has this job of inter­pret­ing actu­al sen­so­ry expe­ri­ences, but also inte­grat­ing that with pre­vi­ous expe­ri­ence. It’s jug­gling the actu­al sen­so­ry input, if you like, the here and now, with what’s hap­pened before, and how that might affect the cur­rent expe­ri­ence. So the brain, in that sense, is doing a kind of vir­tu­al real­i­ty job on how we feel.

In some peo­ple, their pain may be more dri­ven by what they’re expect­ing than the actu­al sen­so­ry input. Oth­er peo­ple may be much more dri­ven by just the sen­so­ry input and less influ­enced by what they’re expect­ing. So what we’ve found in patients with dif­fer­ent types of chron­ic pain, includ­ing fibromyal­gia and osteoarthri­tis, is that there’s a fine-tun­ing prob­lem in the brain in the way they do that inte­gra­tion, such that peo­ple with chron­ic pain are tend­ing to antic­i­pate more. So there’s more pro­cess­ing of that, expec­ta­tions in cer­tain bits of the brain, par­tic­u­lar­ly in a small island of cor­tex, called the insu­lar cor­tex. That increased expec­ta­tion cor­re­lates very nice­ly with the extent of their symp­toms, so how exten­sive and severe the pain is. Where­as the bits of the brain that are con­cerned with con­trol­ling those respons­es in the frontal cor­tex are less active and that cor­re­lates very nice­ly with less good cop­ing strate­gies. By that, I mean, the ten­den­cy to think things are going to be ter­ri­ble ‘Oh, my God, it’s all going to be ghast­ly’, so what we call catastrophising.

Evans: So the big ques­tion is, you talked about plas­tic­i­ty of the brain, that’s the brain’s abil­i­ty, if you like, tell me if I’m wrong, to rewire itself. How do you rewire the brain or can you rewire the brain?

Jones: Well, that’s a real­ly good ques­tion that we don’t real­ly know the answer to. We know the brain can rewire itself in terms of remak­ing con­nec­tions. If the brain is dam­aged, it can remake con­nec­tions, although we don’t real­ly under­stand that process very well. That’s very impor­tant to patients who have chron­ic pain as a result of dam­age to the brain, such as patients who have post-stroke pain, for instance.

But it can also vir­tu­al­ly rewire itself by just chang­ing the strength of those con­nec­tions in the brain. One very famous exam­ple of that is if you look at Lon­don taxi dri­vers. The bit of the brain called the hip­pocam­pus, which is con­cerned with learn­ing about spa­tial things, such as streets and where streets are, is big­ger than nor­mal. If they stop dri­ving taxis or stop learn­ing about dri­ving taxis, then that changes and it goes back towards the nor­mal. So the brain is con­tin­u­ous­ly chang­ing in that way, rein­forc­ing con­nec­tions for some things, reduc­ing the strength of those con­nec­tions for oth­er things. That’s what we call plasticity.

Evans: So if we know that we are cat­a­strophis­ing, that the worst is going to hap­pen, ‘I’m going to get up this morn­ing, and it’s going to be absolute­ly grim’. If you could change the way, or if I could change the way I think about things. I wake up in the morn­ing and the sun is going to be shin­ing and why should I cat­a­strophise in the first place, that might rewire a lit­tle bit of my brain to make me feel less pain?

Jones: Yes, and there is some quite good evi­dence that hap­pens both func­tion­al­ly and struc­tural­ly. A few years ago, we looked at the effects of a kind of cog­ni­tive ther­a­py or talk­ing ther­a­py called mind­ful­ness-based cog­ni­tive ther­a­py. We found that if patients just got a short course, so an eight-week course, of this kind of ther­a­py, these fine tun­ing prob­lems that we’ve dis­cov­ered in the brain could be par­tial­ly, not com­plete­ly, but very sub­stan­tial­ly improved.

Func­tion­al­ly, we know we can change and those changes, cor­re­lat­ed with reduc­tions in the unpleas­ant­ness of the pain, but we also know that struc­tural­ly sim­i­lar things can occur, and that they can also be reversed. So a num­ber of peo­ple, includ­ing researchers in Oxford, have found changes in the struc­ture of the brain in rela­tion to the grey and the white mat­ter and that, if the pain improves, then some of those struc­tur­al changes can be reversed. So again, it’s this idea that although chron­ic pain is dif­fi­cult to treat, a lot of the process­es that seem to be impor­tant in per­se­ver­at­ing that pain are actu­al­ly, or poten­tial­ly reversible.

Evans: That’s Pro­fes­sor Antho­ny Jones, who is Pro­fes­sor of Neu­ro-Rheuma­tol­ogy and leader of the Human Pain Research Group at Man­ches­ter Uni­ver­si­ty. The group are still look­ing for vol­un­teers. Vol­un­teers, that is, who have chron­ic pain, and those who don’t have chron­ic pain, to take part in their study to devel­op and test a ther­a­py for chron­ic pain that increas­es pain resilience. For more infor­ma­tion, just check out their web­site, which is and look for the drop-down link that says ‘Want to vol­un­teer?’ Now if that’s all too much to remem­ber, just con­tact Pain Con­cern and we will put you in touch.

I just need to remind you that whilst we in Pain Con­cern believe infor­ma­tion and opin­ions on Air­ing Pain are accu­rate and sound, based on the best judge­ments avail­able, you should always con­sult your health pro­fes­sion­al on any mat­ter relat­ing to your health and well-being. He or she is the only per­son who knows you, your cir­cum­stances and there­fore the appro­pri­ate action to take on your behalf. You can down­load all edi­tions of Air­ing Pain from Pain Concern’s web­site, which is, where you will also find a wealth of mate­r­i­al and infor­ma­tion about liv­ing with and man­ag­ing chron­ic pain, includ­ing our new­ly devel­oped Nav­i­ga­tor Tool to make con­sul­ta­tions between you and your doc­tor much more effective.

Now, cre­at­ing greater under­stand­ing of pain is at the heart of what we do at Pain Con­cern and bridg­ing a com­mu­ni­ca­tion gap, per­ceived or oth­er­wise, between patients and health­care pro­fes­sion­als, is some­thing that more and more doc­tors and researchers are try­ing to do. No more ivory tow­ers where, in days of yore (well, hope­ful­ly any­way), patient involve­ment was­n’t seen as part of the med­ical solu­tion. And, in that spir­it, Pro­fes­sor Antho­ny Jones uses the pow­er of pub­lic per­for­mance for chron­ic pain suf­fer­ers and the peo­ple who sup­port them, med­ical pro­fes­sion­als and absolute­ly any­body who wants to know more about what makes the brain tick. In his show Pain, the Brain and a Lit­tle Bit of Mag­ic, he col­lab­o­rates with Naive The­atre Com­pa­ny, using poet­ry, music and a bit of stand-up and an over­sized inter­ac­tive mod­el of the brain, to bring what’s described as an opti­mistic mes­sage of how chron­ic pain may be bet­ter under­stood and treated.

Jones: We thought of it orig­i­nal­ly as just a way of bridg­ing the knowl­edge gap. But now we’re think­ing about it a lit­tle bit dif­fer­ent­ly, and per­haps a way to real­ly bring togeth­er the pain com­mu­ni­ty and all the peo­ple that are involved in that. So what’s made us think about that a lit­tle bit more is that we’re now devel­op­ing some new brain-based ther­a­pies to treat chron­ic pain more effec­tive­ly. So we’re doing that in quite close col­lab­o­ra­tion with our patients. We’re now think­ing actu­al­ly that Pain, the Brain and a Lit­tle Bit of Mag­ic could not just be a vehi­cle for explain­ing about that, but actu­al­ly as a kind of cat­a­lyst for bring­ing these groups togeth­er in a sort of col­lab­o­ra­tive way.

Evans: What sort of ther­a­pies are you devel­op­ing from this then?

Jones: Main­ly based on the work we’ve done over the last three decades. We’ve done a lot work on exper­i­men­tal place­bo, and dis­cov­ered doing that process that when we’re expect­ing to have a pos­i­tive response from a place­bo inter­ven­tion, the brain express­es more alpha waves, par­tic­u­lar­ly in the frontal and insu­lar cor­tex. We did­n’t real­ly know what that meant, then one of our PhD stu­dents, Kathy Ecsy, did a whole PhD on whether this was impor­tant or not. And she did that by apply­ing an alpha rhythm to either a visu­al or audi­to­ry stim­u­lus. To cut a long sto­ry short, we found that if you do that, you get a painkilling effect on nor­mal volunteers.

Evans: Let me see if I can get this right. There are alpha waves involved in a par­tic­u­lar stage of sleep and they are the restora­tive, the heal­ing waves, if you like. Some­times, (you must tell me if I’m wrong here), some­times those alpha waves are miss­ing in sleep?

Jones: We don’t real­ly know exact­ly what the role of all these dif­fer­ent waves, includ­ing alpha waves, are in sleep. But cer­tain­ly alpha waves are asso­ci­at­ed with sort of ear­ly stages of relax­ation and, as you say, restora­tive sleep. We know that patients with chron­ic pain par­tic­u­lar­ly com­plain about poor sleep [but] we don’t real­ly know what the rela­tion­ship is between the sleep and the chron­ic pain. Some of my col­leagues think that it’s the poor sleep that gen­er­ates the chron­ic pain. The nub of it is, we don’t real­ly know.

There is also quite a lot of evi­dence from oth­er sources that alpha waves may be impor­tant in con­trol­ling aspects of sen­so­ry expe­ri­ence. What we now think is that alpha is prob­a­bly quite impor­tant in the kind of top-down con­trol of how we feel. So we’re devel­op­ing a plat­form. It’s a tech­ni­cal plat­form and the idea is that patients will be able to use this in their own home. The actu­al plat­form will be down­loaded on either a lap­top or their smart­phone. They will also have an indi­vid­u­alised EEG cap, which they’ll be able to just plonk on their head. Because there’ll be wire­less com­mu­ni­ca­tion between their smart­phone and their brain, they’ll be able to see how much alpha they’re express­ing in their brain. If they look on their pain diary, and they notice their pain is pret­ty bad, has real­ly been get­ting worse and worse in recent times, then they might decide to engage with a num­ber of options, which will be avail­able on this pain platform.

At the moment, the two main options are one prob­a­bly more for acute, so recur­rent acute pain that a lot of these patients expe­ri­ence. They’ll be able to plug into an alpha entrain­ment pro­gramme that will just allow them to expe­ri­ence alpha either visu­al­ly or with an audi­to­ry input. They will choose how long they want to engage with that, prob­a­bly twen­ty min­utes at a time. So if they’re get­ting par­tic­u­lar­ly bad pain that’s inter­rupt­ing their read­ing or watch­ing tele­vi­sion or what­ev­er, they’ve got some­thing that they can engage with for a short peri­od of time. So we’re just test­ing out whether that actu­al­ly works for chron­ic pain patients at the moment.

The oth­er aspect is to try and train the brain in a more long-term fash­ion to express more alpha. With that, they’ll be able to look at what’s going on in their brain on their smart­phone again, and then train them­selves to actu­al­ly express more alpha waves them­selves over a peri­od of weeks or months. We’ve got ideas about kind of doing more sophis­ti­cat­ed things beyond that. So it’s a kind of gener­ic plat­form that allows us to allow patients to inter­act with their brains in a pos­i­tive way.


  • Pro­fes­sor Mark John­son, Pro­fes­sor of Pain and Anal­ge­sia and Direc­tor of the Cen­tre for Pain Research, Leeds Beck­ett University
  • Pro­fes­sor Antho­ny Jones, Pro­fes­sor of Neu­ro-Rheuma­tol­ogy at Man­ches­ter Uni­ver­si­ty, Human Pain Research Group Lead, cre­ator of Pain, the Brain, and a Lit­tle Bit of Mag­ic.

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