THE BEAUTIFUL BRAIN (how it may help us to understand complex pain conditions)

Transcription

1 THE BEAUTIFUL BRAIN (how it may help us to understand complex pain conditions) Dr Gary S Lee Consultant Clinical Psychologist Pain Management Alistair Day Superintendent Radiographer MRI Dr Stephan Voigt Consultant Radiologist

2 Themes for the Evening Complex pain How do we understand pain? How can we see the brain? Brain connections- connectome How does this help us understand the problem? Wider clinical application

3 Complex Pain

4 Simple Pain

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6 Fibromyalgia, chronic widespread pain, central sensitivity syndrome.

7 The Strange World of Pain reconceptualisation separation of injury and pain

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9 The assumed direct association with damage and Pain Ouch!

10 Damn that smarts!

11 Sh**t that hurts!

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14 but, of course, it is not that simple Rugby Players Violinist s finger Last night s Horizon programme War Stories My DVT Irene s hand map Mum s Friend Paper cuts Phantom Limb

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16 Pain Summary Pain = conscious correlate (experience) of the perception of a potential or actual threat to body tissue Cut finger in office Cut finger crossing the road

17 Pain is conscious - Processing is unconscious

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20 Implications are Liberating

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22 1.5 Tesla superconducting magnet Permanently on! 65,000 times stronger than the earths magnetic field Produces images using just the magnet radio waves and Hydrogen protons within the body No known side effects and considered very safe But! Potentially the most dangerous room in the hospital

23 Missile effect Paperclip terminal velocity of approx 60mph Larger the mass the greater the attraction Very careful with all surgical implants

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27 Finger Tapping

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30 Pain Sensory Threat Matrix

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33 The Connectome

34 100 Billion neurons: 100 Trillion connections! Dynamic, connections (made, lost, changed) Genetic Blue print + experience = unique connectome A mind boggling rock

35 Human Connectome Project Human Connectome Project Connection Mapping (lots of fun!)

36 Human Connectome Project

37 Human Connectome Project

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39 So, how does this all help us solve our problem Bringing the elements together Our hypothesis What we re going to do

40 The Elements Pain is a brain generated experience Unconscious sensory process Crudely divide this into two systems Immediate threat detector Slower, more ponderous evaluator/context Part of a Saliency System (int/ext threats) Still more of this story to come, but what we think is

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42 Clinical use of DTI Good agreement for major fiber bundles Sensitivities to fiber crossings and small fiber bundles Generally interesting for anatomical atlases, e.g. parcellation of striatum, thalamus Segmentation of MS lesions Neoplasm, preoperative planning Demyelinating and neurodegenerative diseases Normal brain development and aging Congenital anomalies and diseases of white matter Traumatic brain injury Ischaemia and stroke Epilepsy Dementia Schizophrenia

43 Clinical use of fmri Functional MRI (fmri) has had a major impact in cognitive neuroscience fmri now has a small but growing role in clinical neuroimaging, with initial applications to neurosurgical planning Clinical research has emphasised novel concepts for clinicians, such as the role of plasticity in recovery and the maintenance of brain functions in a broad range of diseases Wider potential for clinical fmri in applications ranging from presymptomatic diagnosis, through drug development and individualisation of therapies, to understanding functional brain disorders

44 Pictures courtesy of Achala Vagal, MD, University of Cincinnati Department of Radiology

45 Pictures courtesy of Achala Vagal, MD, University of Cincinnati Department of Radiology

46 Pictures courtesy of Achala Vagal, MD, University of Cincinnati Department of Radiology

47 Summary These beautiful images of the brain might help us understand complex pain Translational work i.e., apply clinically here on the Island Wider use as we have seen Cutting edge stuff, so we have reasons to be proud!

48 Member of the PAT Dr Gary S Lee Dr Isobel Rice Dr Michael Luckmann Dr Stephan Voigt Ashlyne Buchan Alistair Day Lucy Cowans Isle of Wight Patient Research Collaboration Generous academic support from Professor Basant Puri Imperial College Dr Matt Garner- Southampton Isle of Wight NHS Trust R & D

49 Interesting References Sebastian Seung (2012) Connectome: How the Brain s Wiring Makes Us Who We Are Sebastian Seung TED Talk on YouTube Moseley, L., & Butler, D. Explain Pain