Toronto neuroscientist getting closer to tailored treatments for chronic pain

Daily tasks most people don't think too much about, such as eating breakfast, drinking water or even sitting too long, are always top of mind for Jermaine O'Connor.

The 26-year-old has sickle-cell anemia, a genetic blood disorder that can lead to a number of complications, and not taking care of his health can exacerbate his condition, including his chronic pain.

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"It can always feel like a very solitary experience," he said. "It actually spills over into sort of everything you like to do or want to do."

O'Connor has had chronic pain since childhood. He'll typically feel it in his hands, arms and legs, but it's hard to predict, and can last from hours to days.

"You wake up with pain, you go to work with pain, maybe you work out with pain, you're with your kids with pain, you relax in pain," he said.

"You're dealing with something that you think no one else has or at least can understand."

But new research at the University Health Network's Krembil Brain Institute is getting closer to giving relief to people like O'Connor, and the more than six million other Canadians experiencing chronic pain.

Using the latest imaging technology, the Institute is finding ways to use brain signals to tailor treatments to an individual's specific needs.

Mapping the brain

It all starts with creating a map of the brain using magnetic resonance imaging (MRI) and magnetoencephalography (MEG).

Dr. Karen Davis, senior scientist and division head of brain imaging and behaviour systems neuroscience at the Krembil Brain Institute, uses the techniques to identify markers in the brain denoting pain, and just as important, the brain's response to certain treatments.

"These technologies are now able to show us with pinpoint timing and accuracy where something is happening in the brain, how it's happening in the brain and when it's happening in the brain," she said.

"Both the location of the activity, the timing of the activity, synchrony of the activity and the communication between brain activity in different areas ... is now being linked to various aspects of both the pain experience but also the amount of relief that somebody is experiencing due to a particular type of treatment."

Though promising, developing the personalized solutions to pain is not an easy task.

There's no specific area of the brain to look for pain, Davis said. The pain system is interwoven, sitting atop other parts of the brain.

So, a loud noise may light up many of the same areas pain would.

On top of that, every experience of pain is different, Davis said.

"There are emotional components, there's the unpleasantness. some types of pain have certain qualities to it. There might be burning or stinging," she said.

"The trick is to be able to find the biomarkers that will help us target which treatment will work better."

Part of the solution, Davis said, will be paying close attention to the details of their research.

"For instance, some drugs might work better in men or better in women, and if we don't look at the data in that way we may kind of throw out a perfectly effective solution for a segment of the patients."

In the same way, some treatments may work for a particular group of people whose brains work in a similar way, but not for others.

"Everybody's circuitry is slightly different," she said. "We might be able to develop an approach that produces fewer side effects because they're targeting a specific aspect of the pain."

Finding solutions is important, not just to solve people's suffering, Davis said, but also because chronic pain creates an economic impact of close to $40 billion on the Canadian economy because people can't, or have difficulty, working.

It's something O'Connor faces on a daily basis. Sometimes, he said, it's hard to even get out of bed.

"I've definitely had to sort of advocate for myself," he said, meaning sometimes he'll just ask for the day off.

"You can't do the things that you may like to do to your best ability."

But with customized care on the horizon, he's hopeful that may change, and that more people will understand the unique toll chronic pain can have on each person.

"It'll help with understanding that it's as equally mental and physical, they're more connected than people assume or can see."