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13 Advanced neuroimaging of pain, analgesia and anaesthesia induced altered states of consciousness
  1. MA Irene Tracey1,2
  1. 1Head of Department and Nuffield Chair Anaesthetic Science, Nuffield
  2. 2Department Clinical Neurosciences, University of Oxford, England UK

Abstract

Professor Irene Tracey holds the Nuffield Chair of Anaesthetic Science and is Head of the Nuffield Department of Clinical Neurosciences, a 500-person world-leading basic and clinical research department, at the University of Oxford. Irene did her undergraduate and graduate studies at Oxford from 1985–1993, graduating with top-First, and then held a postdoctoral position at Harvard Medical School until 1996. In 1997, Irene helped to co-found the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, and was its Director from 2005 until 2015 alongside other senior leadership roles within the University. Irene has served and continues to serve on many national and international committees, and is currently on Council of the Medical Research Council. In 2008 she was awarded the triennial Patrick Wall Medal from the Royal College of Anaesthetists and in 2009 was made an FRCA for her contributions to the discipline in the field of pain neuroscience and mechanisms of anaesthesia. In 2015 she was elected a Fellow of the Academy of Medical Sciences and in 2017 was awarded the Feldberg Foundation Prize. Irene is married to Professor Myles Allen, a climate physicist, and they have three fabulous children: Colette (19), John (15) and Jim (11).

The ability to experience pain is old and shared across species. Acute pain is the body’s alarm and warning system, and as such a good thing. Chronic pain is the system gone wrong and now one of the largest medical health problems worldwide. The brain is key to these experiences and relating specific neurophysiologic measures from advanced brain imaging to perceptual or non-perceptual changes in pain perception induced by peripheral or central sensitisation, psychological or pharmacological mechanisms has tremendous value. Identifying non-invasively where functional and structural plasticity, sensitisation and other amplification or attenuation processes occur along the pain neuraxis for an individual and relating these neural mechanisms to specific pain experiences, measures of pain relief, persistence of pain states, degree of injury and the subject’s underlying genetics, has neuroscientific and potential diagnostic relevance.

As such, advanced neuroimaging methods can powerfully aid explanation of a subject’s multidimensional pain experience, analgesia and even what makes them vulnerable to developing chronic pain.

Relatively far less work has been directed at understanding what changes in the brain occur during altered states of consciousness induced either endogenously (e.g. sleep) or exogenously (e.g. anaesthesia). However, that situation is changing rapidly. For example, our recent multimodal neuroimaging work explores how anaesthetic agents produce altered states of consciousness such that perceptual experiences of pain and awareness are degraded. This is bringing us fascinating insights into the complex phenomenon of anaesthesia.

References

  1. . Bingel U, Wanigasekera V, Wiech K, Ni Mhuircheartaigh R, Lee MC, Ploner M,Tracey I. The effect of treatment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil. Sci Transl Med2011Feb 16;3(70):70ra14.

  2. . Denk F, McMahon SB, Tracey I. Pain vulnerability: a neurobiological perspective. Nat Neurosci2014Feb;17(2):192–200.

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