"Scans for Back Pain Ineffective"

Tara Parker-Pope published this article yesterday in the NYT: Scans for Back Pain Ineffective

She can say that again. Not only does the scanning or imaging process do nothing whatever for the "pain", it may result in misleading interpretations of the imaging; well-meaning people may consider or resort to treatments that reinforce the problem rather than help the pain experience to disappear.

Excerpts:

"Researchers from Oregon Health and Science University in Portland reviewed six clinical trials comprised of nearly 2,000 patients with lower back pain. They found that back pain patients who underwent scans didn’t get better any faster or have less pain, depression or anxiety than patients who weren’t scanned. More important, the data suggested that patients who get scanned for back pain may end up with more pain than those who are left alone, according to the report published this week in the medical journal Lancet."

"The problem, say researchers, is that back scans can turn up physical changes in the back that aren’t really causing any problem."

“You can find lots of stuff on X-rays and M.R.I.’s like degenerative disks and arthritis, but these things are very weakly correlated with low back pain,” said study author Dr. Roger Chou, associate professor of medicine at Oregon Health. “We think we’re helping patients by doing a test, but we’re adding cost, exposing people to radiation and people may be getting unnecessary surgery. They start to think of themselves as having a horrible back problem and they stop doing exercise and things that are good for them, when in reality, a lot of people have degenerative disks and arthritis and have no pain at all.”

I completely agree. In addition to unnecessary surgery, they may be getting unnecessary manipulation and other "treatment" which is focused on supposedly misbehaving mesodermal derivatives instead of helping the ectodermal derivatives (i.e., skin, nerves, brain, embedded "I"- illusion) all learn to get along better.

Swiss neuroprostheses explorations

Over at the BrainSciencePodcast forum, a listener, jezcentral, contributed this link:

Launching of EPFL Center for Neuroprostheses

Excerpt:

"What's a neuroprosthesis? It's a device made up of sensors, connections and electronic chips that are embedded in the body to repair certain neurological deficiencies. Recent progress in artificial retinas and man-machine interfaces that permit communication or action via thoughts alone gives us a glimpse of the possibilities the future might hold for improving the lives of the handicapped. The new Center will concentrate on six main themes: vision (retinal implants), hearing (cochlear implants), mobility (cortical and spinal implants), non-invasive man-machine interfaces (piloting at distance, robotics), the micro-and nano-fabrication of implants, and neuronal coding (signal processing, sensors).

The Center will be inaugurated on January 1, 2009, and will formally be part of EPFL's School of Engineering, in collaboration with the School of Life Sciences and the School of Computer and Communication Sciences. This project also opens the door to fruitful collaborations with other institutions in the Lake Geneva area, such as University of Lausanne and the Cantonal Hospital (CHUV)), University of Geneva and its hospital (HUG), and the regional biomedical industry."

Other posts on how prolific neuroresearch appears to be in Switzerland:
1. Virtual Body Experience
2. Something in Swiss water?
3. More from Lausanne: Mapping the structural core of the human cerebral cortex
4. Smelling someone else's alarm bells


On a related topic, related in terms of collaborative projects done by teams of people, in this case by a private backer, reader Kent sent me a link to Piece of Mind, from the Economist.

Excerpt:

"When we first put the mouse-brain atlas online free, it was met by the research world with suspicion. People wondered what the catch was. Scientific research has long been a solitary endeavour—one researcher, one microscope. Findings are protected so that discovery credit can be clearly defined and awarded. This is a successful model and will continue to be.

However, the Human Genome Project demonstrated a different path: multiple teams working collaboratively towards a common goal (...) We wanted the mouse atlas to be free and available for all to use as the basis for foundational research and discovery.

A new generation of implantable pacemakers for the brain will be widely used to treat everything from depression to addiction and Parkinson’s disease

If we thought it would be a hit right out of the gate, we were slightly wrong. It took a while for people to trust that it really was free to use. No one believed in a free lunch.

Now, things have changed. Today we have many scientists using the atlas for their research into Alzheimer’s, bipolar disorders, Down’s syndrome, Parkinson’s, fragile x mental retardation and epilepsy. The atlas is also giving scientists insight into alcoholism, obesity, sleep, hearing and memory.

The greatest testament to what we did was that researchers of spinal-cord diseases, trauma and disorders approached the institute and asked us to create a spinal-cord atlas, which is now close to completion. We will launch the first phase of a human-brain atlas, a four-year project, in 2010.

Like the Human Genome Project, the Allen Brain Atlases and Spinal-Cord Atlas have helped democratise the scientific landscape. When you can log on to a map of gene expression from anywhere in the world, more people can enter the scientific conversation. The result is a massive saving in time, since without the atlas each researcher could spend a lifetime trying to gather complete gene-expression data for his or her work."

Nothing but good will come out of this, I'm sure. Seth Grant, who recently decoded human synapse proteomics, used free genomic data bases to arrive at new perspectives on how evolution of the nervous system has proceeded. (Here is a blog post about that.) Listen to Ginger Campbell's BrainSciencePodcast #51 interview with Dr. Grant. (It was my pleasure to transcribe the interview - the transcription is linked to the podcast shownotes.)

More about Locus Ceruleus

Deric Bownds at Mindblog posted about this new article today: Modafinil Shifts Human Locus Coeruleus to Low-Tonic, High-Phasic Activity During Functional MRI. Not exactly a catchy title, but what the abstract implies is pretty exciting - LC seems to be involved in cognition.

Cognition? Cognition. Fascinating.

Here is the abstract, viewable by clicking on Deric's post, How a cognition enhancing drug works.

"Models of cognitive control posit a key modulatory role for the pontine locus coeruleus–norepinephrine (LC-NE) system. In nonhuman primates, phasic LC-NE activity confers adaptive adjustments in cortical gain in task-relevant brain networks, and in performance, on a trial-by-trial basis. This model has remained untested in humans. We used the pharmacological agent modafinil to promote low-tonic/high-phasic LC-NE activity in healthy humans performing a cognitive control task during event-related functional magnetic resonance imaging (fMRI). Modafanil administration was associated with decreased task-independent, tonic LC activity, increased task-related LC and prefrontal cortex (PFC) activity, and enhanced LC-PFC functional connectivity. These results confirm in humans the role of the LC-NE system in PFC function and cognitive control and suggest a mechanism for therapeutic action of procognitive noradrenergic agents."

Thank you so much for bringing this to this reader's avid attention, Deric. I was interested in the pain-downregulating capacity of LC, its role in sleep, and its extensive connection to everything else in the brain. Now it looks like there may be a direct link between it and actual, functional cognition, not just anatomical noradrenergic pathways between it and parts of the brain one might be forgiven for having assumed were involved in actual, functional cognition.

Here is a link to posts I made earlier in the year, about locus ceruleus.

It has become one of those brain part names that leaps out at me, as does the insula.

More about virtual bodies

In reference to More about glia, and a Neurophilosophy post on Moseley:

Today's post is short, because Mo has already written it. :-D He's called it The body-swap illusion.

In it Mo explains new work by Henrik Ehrsson, now in Stockholm, the paper If I Were You: Perceptual Illusion of Body Swapping, by Valeria Petkova and Henrik Ehrsson.

Thanks Mo, thumbs up for a great post.

I don't know what more evidence could be found to support the idea that the perceptual brain is in charge of autonomic outflow than to persuade it by means of illusion, both visual and tactile, that it was responsible for maintaining the bodily integrity of a mannequin, then physically threaten the mannequin and measure autonomic alarm as represented by evoked skin conductance response (SCR).

UPDATE Dec 16: Rubber hands feel real for amputees. Thank you again, Mo from Neurophilosophy.

More about glia, and a Neurophilosophy post on Moseley

I saw a nice post by Mo, on Lorimer Moseley's work with pain research, called Distorting the body image affects perception of pain. Well-deserved recognition in my opinion - thumbs up to Mo. Lorimer Moseley's work has been discussed on this blog, HumanAntiGravitySuit, and Neurotopian several times, as has work done by others involving virtual bodies, body maps, alteration of pain experience, mirror therapy, etc.

A poster at Somasimple contributed this rather nice, very readable, up-to-date and open access article on glia, by Ben Barres, in Neuron, called The Mystery and Magic of Glia: A Perspective on Their Roles in Health and Disease. Enjoy!

Other posts mentioning Glia:
Microglia and Pain: A Manual Therapy Perspective (series)


Posts mentioning Moseley:
1. FABQ and physical therapy
2. The devil is in the details

Posts mentioning virtual bodies:
1. Something in Swiss water?
2. Just UN-do it
3. The user illusion
4. Haptic vest
5. Visual feedback
6. Virtual body experience

Posts mentioning mirror therapy:
Look in the menu to the right side of this blog. Or go to Neurotopian and use the search function, enter "Mirror Therapy" or just click on the menu item and get Matthias' blogpost series on the topic. (While you're at it, re-read his "Pain for Dummies" series.)

Scott Mackler

The PT site Evidence in Motion posted about Scott Mackler, a neuroscientist with ALS. As it turns out, Scott Mackler is married to a PT researcher, Lynn Snyder-Mackler.

The CBS video, Brain Power, features brain-computer interface technology; Scott, unable to move anything but his mouth, eyes, and thoughts, can select letters from a screen by focusing on a particular letter that he wants: when a random flash highlights that particular letter, his thought, "That's the one I want," and whatever change in electrical potential that his selection creates, effectively communicates itself to the computer through an array of electrodes gelled to his scalp through a cap, and pegs the letter into a window. Then he can move on and peg the next letter. In this way, Scott can express himself and continue work as a neuroscientist.

(Thoughts move. Thoughts are verbs, not nouns. They move - they don't just sit there, being mere nouns. This is one good way that "feeling of certainty" discussed by Robert Burton in his book, On Being Certain, pays off! I am quite certain about that. Almost entirely certain, in fact.)

Also featured in the video we see monkey brain/robot arm interface technology, and an implant into the motor cortex of Cathy, a woman with locked-in syndrome, which gives her an opportunity to communicate with others, control a wheelchair, play music, and adjust the temperature and light level in her home, by moving a computer cursor across a screen, using only her thoughts about moving her hand.


Related blog posts:

1. Smart Prosthetics, Smart Nerves, Smart Brains
2. More Smartness
3. Monkey Robotics
4. Monkey intentions and control of a robotic arm
5. Ginger Campbell's podcast #43, interview with Robert Burton about his book, On Being Certain
6. Harriet Hall's review of the same book

November 4 Update:

7. Mo's Neurophilosophy post about this same topic - Brain Power

VIRTUAL SYMPOSIUM ON PAIN

This post is about the up-coming webinar series sponsored by the Canadian Physiotherapy Association and its new Pain Science Division (of which I am a exec. member and one of the founders). An internet approach to current, up-to-the-minute meta-education about pain is being integrated into and embraced by the PT profession in Canada, and I couldn't be more happy about it.

I've had a chance to preview the first webinar, and I can assure you the program will shine in both form and content. The content is not overly difficult - it is easy to follow if you have any medical background. Even if you do not, you can take your time with the material and look up the words you don't know with google. Enter the word "define" (but no quote marks) followed immediately by a colon (like this -> :) and the word you want to look up.

For example, if you wanted to look up the word "nociception" to find out the meaning, you would go to google and enter:

define: nociception

Google will take you to a list of possible meanings.

The technical side of the webinar series is speedy and interactive. You can click on pretty much anything from anywhere, from menus listed on the side or as new menus present themselves. Each module will be accessible for an entire week, can be viewed multiple times, and by more than one individual. A discussion forum will operate, where individuals can log in, ask questions, discuss, and help develop answers for other participants' questions, perhaps from their own specialized level of expertise.

Because this is an internet event and is mostly in virtual time, anyone on the planet can participate (if they use English). Only the last (fourth) session will be in real time, probably sometime during the last week of November.

Every conscious human awareness who is embedded in a physically alive body will have to deal with their own pain circuitry at some time or other during their life span. Pain can be hell, but the more prepared we are, the more we can do about our own response to it at the time. Anyone from any walk of life, therefore, is invited. This is the PT profession, reaching out not only to its own members but to the world, offering everyone some well-organized, coherently-presented and useful basic information on a potentially unpleasant matter that either does or will affect us all.

GO HERE TO REGISTER.