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Proper Management of Medicare/Medicaid Overpayments to Limit Risk of False Claims
2015-01-28    
1:00 pm - 3:00 pm
January 28, 2015 Web Conference 12pm CST | 1pm EST | 11am MT | 10am PST | 9AM AKST | 8AM HAST Topics Covered: Identify [...]
EhealthInitiative Annual Conference 2015
2015-02-03 - 2015-02-05    
All Day
About the Annual Conference Interoperability: Building Consensus Through the 2020 Roadmap eHealth Initiative’s 2015 Annual Conference & Member Meetings, February 3-5 in Washington, DC will [...]
Real or Imaginary -- Manipulation of digital medical records
2015-02-04    
1:00 pm - 3:00 pm
February 04, 2015 Web Conference 12pm CST | 1pm EST | 11am MT | 10am PST | 9am AKST | 8am HAST Main points covered: [...]
Orlando Regional Conference
2015-02-06    
All Day
February 06, 2015 Lake Buena Vista, FL Topics Covered: Hot Topics in Compliance Compliance and Quality of Care Readying the Compliance Department for ICD-10 Compliance [...]
Patient Engagement Summit
2015-02-09 - 2015-02-10    
12:00 am
THE “BLOCKBUSTER DRUG OF THE 21ST CENTURY” Patient engagement is one of the hottest topics in healthcare today.  Many industry stakeholders consider patient engagement, as [...]
iHT2 Health IT Summit in Miami
2015-02-10 - 2015-02-11    
All Day
February 10-11, 2015 iHT2 [eye-h-tee-squared]: 1. an awe-inspiring summit featuring some of the world.s best and brightest. 2. great food for thought that will leave you begging [...]
Starting Urgent Care Business with Confidence
2015-02-11    
1:00 pm - 3:00 pm
February 11, 2015 Web Conference 12pm CST | 1pm EST | 11am MT | 10am PST | 9am AKST | 8am HAST Main points covered: [...]
Managed Care Compliance Conference
2015-02-15 - 2015-02-18    
All Day
February 15, 2015 - February 18, 2015 Las Vegas, NV Prospectus Learn essential information for those involved with the management of compliance at health plans. [...]
Healthcare Systems Process Improvement Conference 2015
2015-02-18 - 2015-02-20    
All Day
BE A PART OF THE 2015 CONFERENCE! The Healthcare Systems Process Improvement Conference 2015 is your source for the latest in operational and quality improvement tools, methods [...]
A Practical Guide to Using Encryption for Reducing HIPAA Data Breach Risk
2015-02-18    
1:00 pm - 3:00 pm
February 18, 2015 Web Conference 12pm CST | 1pm EST | 11am MT | 10am PST | 9am AKST | 8am HAST Main points covered: [...]
Compliance Strategies to Protect your Revenue in a Changing Regulatory Environment
2015-02-19    
1:00 pm - 3:30 pm
February 19, 2015 Web Conference 12pm CST | 1pm EST | 11am MT | 10am PST | 9am AKST | 8am HAST Main points covered: [...]
Dallas Regional Conference
2015-02-20    
All Day
February 20, 2015 Grapevine, TX Topics Covered: An Update on Government Enforcement Actions from the OIG OIG and US Attorney’s Office ICD 10 HIPAA – [...]
Events on 2015-02-03
EhealthInitiative Annual Conference 2015
3 Feb 15
2500 Calvert Street
Events on 2015-02-06
Orlando Regional Conference
6 Feb 15
Lake Buena Vista
Events on 2015-02-09
Events on 2015-02-10
Events on 2015-02-11
Events on 2015-02-15
Events on 2015-02-20
Dallas Regional Conference
20 Feb 15
Grapevine
Latest News

Researchers discover the brain cells that make pain unpleasant

brain cells

Pain sensation and the emotional experience of pain are not the same, and now, in mice, scientists at Stanford have found the neurons responsible for the latter.

If you step on a tack, neurons in your brain will register two things: that there’s a piercing physical sensation in your foot, and that it’s not pleasant. Now, a team of scientists at Stanford University has identified a bundle of brain cells in mice responsible for the latter — that is, the negative emotions of pain.

Pain research has traditionally focused on the neurons and molecules at the frontline of pain perception — the cells in nerves that process stings, cuts, burns and the like — and ultimately convey a physical threat message. What Grégory Scherrer, PhD, assistant professor of anesthesiology and of neurosurgery, and Mark Schnitzer, PhD, associate professor of biology and of applied physics, are studying goes one step further. “We’re looking at what the brain makes of that information,” Scherrer said. “While painful stimuli are detected by nerves, this information doesn’t mean anything emotionally until it reaches the brain, so we set out to find the cells in the brain that are behind the unpleasantness of pain.”

Backed by animal-brain imaging and molecular testing, the researchers have found an ensemble of cells in the amygdala, a region of the brain classically associated with emotion and fear, that seems to specifically function as an on-off switch for pain aversion. And although the finding was made in mice, there’s reason to think it could one day serve as a therapeutic target for human pain, since the mouse and human amygdala aren’t so different in function.  Researching this group of cells could reveal a potential treatment for chronic pain, the scientists hope.

The idea is that patients suffer from the emotional unpleasantness of pain, rather than pain sensation itself. If there’s a way to dull the emotional hurt, rather than the physical sensation of pain, that could be big for chronic pain patients.

A paper describing the results of the study were published Jan. 18 in Science. Scherrer and Mark Schnitzer, PhD, who is also a Howard Hughes Medical Institute investigator, share senior authorship. Postdoctoral scholar Gregory Corder, PhD and former graduate student Biafra Ahanonu, PhD, are the co-lead authors.

Peeping at pain neurons

The amygdala seemed to the researchers a logical place to start, since it’s a well-established hub for emotion in the brain. Within the amygdala, they narrowed their search by looking for neurons in mice that were active during brief pain stimulation — such as a drop of hot, but not scalding, water applied to a paw. Neurons that are active express more of a specific gene called c-Fos, and indeed, a sea of c-Fos-expressing neurons flared after this stimulus.

“But that really only tells you that those neurons were active at some point, and it’s not specific enough,” Scherrer said. “What we wanted was to look at the neurons of freely moving animals.”

To observe the deep-seated wiring of a mouse’s brain, Scherrer partnered with Schnitzer, who had developed a “miniscope” — a microscope about the length of a small paper clip, which could be affixed to a mouse’s head to record activity in its brain. They positioned the device strategically to visualize the amygdala. The mouse, alive and well, could stroll as it pleased, while the miniscope recorded calcium flux in the neurons, a proxy for cell activity.

The scientists monitored the mouse brains with the microscope, watched the mice detect something uncomfortable, observed the aversive reactions and then checked which neurons were active. “With this setup, we identified a set of neurons in the amygdala that selectively encodes signals related to the emotional aspects of a painful experience,” Schnitzer said.

When the mice touched a drop of uncomfortably hot or cold water (neither of which were severe enough to injure the mice) they withdrew, signaling to the scientists that the rodents were not pleased. Upon this withdrawal, the microscope’s recording showed a bundle of neurons firing in the amygdala — specifically in the basolateral region — suggesting that these neurons were specifically responsible for the emotion of pain.

It was, however, still possible that this basolateral ensemble was simply firing to relay general emotion, rather than specifically the unpleasantness of pain. So, the researchers fed the mice sugar water — a sweet treat known to bring joy to any mouse — and kept an eye on the collection of neurons suspected to relay displeasure. As expected, those neurons stayed silent.

“There’s also a difference between experiencing pain and experiencing something annoying, so we further wanted to test if the amygdala neurons active during pain were also associated with overall negative emotion, rather than pain particularly,” Scherrer said.

What miffs a mouse? The same things that might bother a sibling: tiny puffs of air to the face, an unappetizingly bitter taste or a very bad smell. While bothering the mice, the researchers again monitored the basolateral amygdala pain ensemble, and here, too, the neurons remained subdued.

Tracking the perception of pain

“After all of that, we concluded that this ensemble of neurons selectively responds during pain,” Scherrer said. “But it still didn’t fully demonstrate that they underpinned the emotional response.”

To investigate that question more deeply, the researchers set up a walking track with three invisible lanes: On the far left was a cold strip, on the right, a hot one; and in between the two was a temperate middle ground. (For context, walking in the two outer lanes was comparable to briefly walking barefoot on pavement in the midst of winter or summer, respectively — uncomfortable, but not permanently damaging.)

Patients who take opioids for pain report that they can still feel the sensation of pain but say it’s less bothersome — the emotions of pain are different.

Normal mice that walked on the track gradually learned that the middle lane was tolerable, while the outer two were unpleasant. But in a select group of mice, the researchers temporarily disabled the bundle of amygdala pain neurons thought to relay feelings of physical discomfort. These mice — free of pain-incited unpleasantness — skittered around the outer regions, undeterred by the extreme temperatures.

What’s intriguing about this, Scherrer said, was that these mice weren’t bereft of physical feeling. “Pain was just no longer unpleasant for them,” he said. The rodents could still feel and respond to physical sensations, but the stimuli they once perceived as unpleasant (hot or cold drops of water) were no longer bothersome. When exposed to a drop of hot water, for example, the mice with a muted basolateral neural ensemble would move their paw away from the dropper, signaling that they felt the stimulus — but they would move their paw back to its original position, something that normal mice did not do. This is a crucial part of harnessing the ensemble as a tool in pain therapy, Scherrer said, as an animal, or human, without the ability to physically feel anything at all leaves them vulnerable to injury.

Long term, Scherrer aims to confirm that the function of the basolateral ensemble in mice is the same as it is in people, and then down the line, find a safe and effective way to silence the ensemble’s function without interfering with other neurons.

“There’s really no good treatment for chronic pain in humans, and that’s a major driver of the opioid epidemic,” Scherrer said. “But you’ll notice, patients who take opioids for pain report that they can still feel the sensation of pain but say it’s less bothersome — the emotions of pain are different. Our big future hope is that the cells in the basolateral ensemble could be a tactic to curb the ailment of pain without causing addiction and thus, ideally, act as a possible substitute for opioid treatment.”

Other Stanford authors of the study are former Stanford postdoctoral scholar Benjamin Grewe, PhD; and research scientist Dong Wang, PhD.

Scherrer and Schnitzer are members of Stanford Bio-X and the Wu Tsai Neurosciences Institute at Stanford.

The study was funded by the National Institutes of Health (grants R00DA031777, R01NS106301, K99DA043609, F32DA041029 and T32DA35165), the New York Stem Cell Foundation, the Rita Allen Foundation, the American Pain Society, the National Science Foundation, the Howard Hughes Medical Institute, the Bill and Melinda Gates Foundation and the Swiss National Science Foundation.

Stanford’s departments of Anesthesiology, Perioperative and Pain Medicine, of Neurosurgery, of Biologyand of Applied Physics also supported the work.

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