Mind-Based Pain Management Should Play a Bigger Role in Treatment, Researchers Say

Guided imagery, meditation, and other relaxation-based pain management techniques should play a bigger role in treating arthritis, a study suggests, based on findings that arthritis aches and pains are processed in the pain matrix, areas of the brain that also control emotions, including fear and distress. The findings appear in the April 2008 issue of the journal Arthritis and Rheumatism.

The Study

Researchers at the University of Manchester Rheumatic Diseases Centre in Manchester, UK, used high-tech brain imaging scans to monitor brain activity in 12 people with knee osteoarthritis (OA) as they experienced OA pain, pain caused by heat, and no pain whatsoever. Each patient also rated their perceived pain intensity and unpleasantness on a 0 – 100 rating scale at 10-minute intervals.

The OA and the heat-induced pain activated a network of brain structures known as the pain matrix. The pain matrix contains two parallel systems: the medial pain system, which processes the emotional aspects of pain including fear and stress, and the lateral system, which processes the pain’s physical location, intensity, and duration.

Medial System Lights Up

The OA pain caused heightened activity in the medial pain system. This suggests that arthritis pain may have more of an emotional impact and a stronger association with fear and distress than the experimental, heat-induced pain. For all 12 patients, both types of pain activated both pain systems, but activity within the medial system was much greater when the patients were experiencing arthritis pain.

“The present study demonstrates the importance of the medial pain system during the experience of arthritis pain and suggests that it is a likely target for both pharmacologic and nonpharmacologic interventions,” study lead author Anthony K.P Jones said in a press release. Arthritis pain also prompted heightened activation of the prefrontal cortex and the inferior posterior parietal cortex.

These are areas of the brain that are instrumental in the supervision of attention. Their activation during arthritis pain may reflect the patients’ concentration on coping strategies, the study authors suggest.

New Class of Analgesics Needed

“Considering the recent concerns about the long-term safety of cyclo-oxygenase inhibitors (such as Celebrex and Vioxx), we hope that our current findings will stimulate partnerships between academia and the pharmacological industry to develop a new class of analgesics for arthritic pain that specifically target the medial pain system,” Dr. Jones said.

“Larger studies of the relationship between arthritis pain and the medial pain system are critical, particularly for exploring the effect of variables, from depression and anxiety to guided imagery, meditation, and other mind-based pain management techniques.”

The View from Duke

"Pain has traditionally been thought to be a simple sensory event warning of tissue damage or injury," says Francis J. Keefe, PhD, director of the Duke Pain Prevention and Treatment Research Program. "The findings reported in this article are important and fit with newer theories that view pain as a complex sensory and emotional experience.

"This study found that arthritis pain has a unique influence on brain centers responsible for attention and emotion. These findings have important clinical implications and fit with the growing evidence that pain-coping-skills interventions that teach patients strategies for controlling thoughts, feelings, and behaviors can reduce pain, disability, and suffering in many persons with disease-related pain."