Photo of Dr. Scott Fishman Scott Fishman, professor and chief of pain medicine

Pain, especially chronic pain, is the consummate mind-body disease where sensation and emotion become inextricably intertwined, says UC Davis pain specialist Scott Fishman.

A person in pain may be unable to sleep, eat or complete other daily functions normally. Pain can cause depression, anxiety, fear and distress, affecting a person's ability to be happy and to maintain good relationships. And it can even influence a person's spiritual well-being.

"Pain is not a sensation, but an experience," says Fishman. "The brain is critically important to any experience of pain, and pain is a normal alarm system that is adaptive and helpful. The architecture of the brain is such that we have internal controls that help us know when we are potentially going to be harmed, or to protect ourselves when we have been harmed."

A brain disease

The science of pain medicine is really neuroscience, according to Fishman, who is chief of the Division of Pain Medicine and a professor in the Department of Anesthesiology and Pain Medicine at UC Davis Health System. An internist, psychiatrist and anesthesiology-trained pain specialist, Fishman is the author of "The War on Pain" and has previously served as president of the American Academy of Pain Medicine.

"Pain is not a sensation, but an experience. The brain is critically important to any experience of pain, and pain is a normal alarm system that is adaptive and helpful."
— Scott Fishman, UC Davis pain specialist

"What we've learned from neuroscience and the focus on brain medicine is that when the symptom that is pain, or the alarm that is pain, becomes broken, that's a disease state in itself," he says.

"The brain is a critically important organ of the body that's now been injured, and that's when the symptom of pain becomes the chronic disease of pain."

Where the neuroscience of pain has "skyrocketed" is in the area of neuroimaging – looking at the brain experiencing pain and blocking pain with different drugs, he says.

"Over the last 10 years, we have amassed a library of functional images and functional magnetic resonance studies that look at the brain in pain in many different states, from acute pain to chronic pain."

Research using functional MRI to scan patients in chronic pain or after pain relief has shown that the activated centers of the brain are not necessarily what researchers would expect, Fishman notes. The parts of the brain that are consistently activated are less the sensory areas and more the areas tied to emotion, which accounts for the suffering.

Toughing out pain

"From a neuroscience perspective, we can now explain to people why you don't just ‘tough out pain'," he says. "We're seeing consistently from the neuroimaging data that this suffering component is what colors patients' lives in either pleasant or unpleasant colors. It also gives us the opportunity to target those." activated centers and use neuroscience and neuroimaging to guide new treatment."

Dramatic breakthroughs in neuroscience, such as neuroimaging, have and will continue to revolutionize understanding of the way people's brains process sensation and emotion, Fishman says, noting that the brain and the mind work together as a symphony.

"The mind is a very powerful entity, and we know that the mind can create pain and the mind can take pain away. Neuroscience is helping us now bring the mind and brain together and understand this profound interplay. We're on the verge of understanding things we never dreamed we could imagine before."