CLINICAL STUDIES TO ASSESS CHRONIC
PAIN MECHANISMS
Eva G. Widerstrom-Noga, D.D.S., Ph.D. • Pradip M. Pattany, Ph.D.
Brian C. Bowen, M.D., Ph.D. • Alberto Martinez-Arizala, M.D.
Robert M. Quencer, M.D. • Robert P. Yezierski, Ph.D.

Being told that the pain is ‘all in your head’ is a comment that some people with chronic neuropathic pain have heard from unknowing health care providers. It is wrong to imply that they imagine pain; only when the pain signals reach the brain can they experience pain. Thus, pain is always in the brain. The results of a study by several pain research colleagues at the Miami Project also suggest that anatomical, functional and biochemical changes occur in the brain. Using a special diagnostic study, the proton magnetic resonance spectroscopy, they looked for alterations in the thalamus, the major sensory relay station in the brain. It seems logical to focus on the spinal cord when studying SCI pain, however, until recently researchers paid little attention to the effect injury in the spinal cord has on certain regions of the brain. Defining the changes that occur following SCI may lead to a better understanding of the mechanisms responsible for the development of neuropathic pain.

As researchers work toward developing better treatments for chronic pain associated with SCI, they will need adequate ways to assess pain and its effects on life. In another study, Dr. Widerström-Noga set out to learn if a standard pain measure, the Multidimensional Pain Inventory (MPI), is adequate in measuring pain in people with SCI. Because chronic pain is only one of many consequences of SCI that affects daily activities, some questions relating to work and activity needed modification. Her results show that the modified MPI (SCI version) is a reasonable instrument for the evaluation of chronic pain in people with SCI. Tools such as these will be useful to clinicians and researchers in evaluating future treatments for pain.