Saturday, June 1, 2013

On Measuring Pain

Maybe with the new technology we want have to ask patients, “on a scale of 1-10 how much pain do you feel?”  Maybe our machines will ask the brain and body directly and the body will express our pain ineffably.  We will get precise answers and we can judge our therapy and our medication based on what the brain/body relates.   We are just about there.

  New work at the University of Michigan has been measuring the brains of subjects undergoing pain of heat, for example.(see for example  They show a characteristic brain pattern.   Later pain shows similar patterns and provides the scientist with a measure and brain pattern of pain.  What they found is a typical neural pattern for each person’s pain.   The way they did this is by putting patients in a fMRI scanner and then added warm to very hot stimuli to see the brain response.  They also teased out emotional pain as differentiated from physical pain.  And they could then know what subject was in pain.   Something I did thirty years ago. But we will leave that for the moment.   Just to say that we could tell about patients coming in for sessions as to what level they were on.  Those heavily depressed and deeply into birth trauma had those long slow brain waves and very low body temperature.   The key index for hopelessness is those brain waves and body temp.
It is the rare depressive who doesn’t show those signs.

   The investigators then looked at painkilling drugs  (remifentanil).  It not only suppressed the neural signature but also the subjective report of pain.  Here we see that drugs can inhibit the reactions to pain but perhaps not pain itself; this may be particularly true when pain is imprinted and endures.  What they are hoping for is a reliable measure of pain so they can titrate, for example, what kind of tranquilizers to inject.  And they could measure effectiveness of drugs.  They want to take subjectivity out of the equation so that high-tech scanners could do all of the work.   Yet, they admit, they still will need patients’ reports.

Here is the dilemma: will the suppression of pain eliminate that pain?  Or will there be a rebound with more pain emerging after suppression by medication?  If we only look at current behavior and cognitive effects we may go off the rails and think that the pain has been done away with.  Or, if they rely only on the machines they may falsely see that the patient does not need painkillers when she clearly does.  Our patients descend slowly into imprinted painful memory and we know right away how much pain there is.  But we are not practicing general medicine where doctors need machines like that.  (see: The New England Journal of Medicine. April 2013).

   Our advantage here is that the patient teases out for us the difference between emotional and physical pain.   We don’t have to extrapolate from a number on the machine to the patient’s condition.   When see a patient entering a session with 95.6 body temperature we know what to expect.  And we know where the patient will be going; it is just a matter of helping her get there.  And at the end of the session when body temp goes up three degrees we see a normalization process taking place.   The patient is indeed becoming normal, not only in her “mind” but everywhere in her system.

  Here is the problem with the research: if they see big signatures of pain with no obvious pain they might refer the person for addiction help.  But suppose that pain is heavily hidden and maybe the person herself is unaware of it.  It doesn’t mean she has not pain; it means that it is buried under loads of repression and may be inaccessible for the moment.  It is not addiction; it is simply that we cannot see the pain they are in.


  1. I think I might have have commented before that we could look at measuring the brain activity of people being legally tortured in countries where it is still legal to do such things, as formal punishment. A very black way of learning, but it gives us the option of studying the brain processing traumatic-level pain nonetheless. The findings could be invaluable to our progress. And although it's bad taste - the fact is you would be doing no more harm than is being done anyway.

    1. Well you would - because instead of the resources invested in measuring the brain, you could use them to help free the people.
      "Evil prospers when good men do nothing."

    2. Well Emma, I know I sound like a Nazi doctor but, if we can demonstrate the neurological impact of trauma more clearly it might help the Singaporean government (and other) to reconsider their methods of punishment.

      Also, waving the flag of peace and thinking only politically correct thoughts, ahead or realism, is indeed "doing nothing". The road to hell is paved with good intentions, is another saying. Also, we need to think carefully if it's best to free violent offenders, of course.

  2. I find it interesting that pain can be analyzed and identified. But as Art points out, we are wired to find pain and have it come up, almost without help in ideal circumstance, which are also rare circumstances. So many ways we suffer damage makes it hard for pain to just rise.

    I still marvel that medical science can pretend not to see, know, or understand PT. I think they are faking it. They know too much about too many things. It is lamentable that people are in pain and society prevents that from being fixed when it is quite curable. What really are we as a species, when we block, hinder, and suppress our own well-being. What monsters we are, really.

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  4. Dr. Janov and all
    Maybe measuring pain via fMRI, even though it shows a characteristic brain pattern, will not really tell us where the pain originated.
    To determine if we are in pain, we can use DNA markers which tell us if we are sensitive to higher pain levels.
    But, what does it really mean?
    I remember being diagnosed with emphysema and received Albuterol while in reality it was anxiety that caused my shortness of breath. When Albuterol, a sulfa-based med, worsened my breathing (because I’m allergic to sulfa) the doctor at Kaiser Permanente indicated that I’m a hypochondriac.
    Patients are often in pain without being able to pinpoint the exact cause. For this reason doctors are reluctant to prescribe pain meds – they simply label the one in pain as 'addict'.
    Technology may indicate and support that fact that we are in pain, but what can a patient do if the doctor has not the knowledge, or is pressed by insurance companies to reduce the pain-meds.
    What we need is a clinically-trained and sensitive person who is able to interpret the pain to its origin.


Review of "Beyond Belief"

This thought-provoking and important book shows how people are drawn toward dangerous beliefs.
“Belief can manifest itself in world-changing ways—and did, in some of history’s ugliest moments, from the rise of Adolf Hitler to the Jonestown mass suicide in 1979. Arthur Janov, a renowned psychologist who penned The Primal Scream, fearlessly tackles the subject of why and how strong believers willingly embrace even the most deranged leaders.
Beyond Belief begins with a lucid explanation of belief systems that, writes Janov, “are maps, something to help us navigate through life more effectively.” While belief systems are not presented as inherently bad, the author concentrates not just on why people adopt belief systems, but why “alienated individuals” in particular seek out “belief systems on the fringes.” The result is a book that is both illuminating and sobering. It explores, for example, how a strongly-held belief can lead radical Islamist jihadists to murder others in suicide acts. Janov writes, “I believe if people had more love in this life, they would not be so anxious to end it in favor of some imaginary existence.”
One of the most compelling aspects of Beyond Belief is the author’s liberal use of case studies, most of which are related in the first person by individuals whose lives were dramatically affected by their involvement in cults. These stories offer an exceptional perspective on the manner in which belief systems can take hold and shape one’s experiences. Joan’s tale, for instance, both engaging and disturbing, describes what it was like to join the Hare Krishnas. Even though she left the sect, observing that participants “are stunted in spiritual awareness,” Joan considers returning someday because “there’s a certain protection there.”
Janov’s great insight into cultish leaders is particularly interesting; he believes such people have had childhoods in which they were “rejected and unloved,” because “only unloved people want to become the wise man or woman (although it is usually male) imparting words of wisdom to others.” This is just one reason why Beyond Belief is such a thought-provoking, important book.”
Barry Silverstein, Freelance Writer

Quotes for "Life Before Birth"

“Life Before Birth is a thrilling journey of discovery, a real joy to read. Janov writes like no one else on the human mind—engaging, brilliant, passionate, and honest.
He is the best writer today on what makes us human—he shows us how the mind works, how it goes wrong, and how to put it right . . . He presents a brand-new approach to dealing with depression, emotional pain, anxiety, and addiction.”
Paul Thompson, PhD, Professor of Neurology, UCLA School of Medicine

Art Janov, one of the pioneers of fetal and early infant experiences and future mental health issues, offers a robust vision of how the earliest traumas of life can percolate through the brains, minds and lives of individuals. He focuses on both the shifting tides of brain emotional systems and the life-long consequences that can result, as well as the novel interventions, and clinical understanding, that need to be implemented in order to bring about the brain-mind changes that can restore affective equanimity. The transitions from feelings of persistent affective turmoil to psychological wholeness, requires both an understanding of the brain changes and a therapist that can work with the affective mind at primary-process levels. Life Before Birth, is a manifesto that provides a robust argument for increasing attention to the neuro-mental lives of fetuses and infants, and the widespread ramifications on mental health if we do not. Without an accurate developmental history of troubled minds, coordinated with a recognition of the primal emotional powers of the lowest ancestral regions of the human brain, therapists will be lost in their attempt to restore psychological balance.
Jaak Panksepp, Ph.D.
Bailey Endowed Chair of Animal Well Being Science
Washington State University

Dr. Janov’s essential insight—that our earliest experiences strongly influence later well being—is no longer in doubt. Thanks to advances in neuroscience, immunology, and epigenetics, we can now see some of the mechanisms of action at the heart of these developmental processes. His long-held belief that the brain, human development, and psychological well being need to studied in the context of evolution—from the brainstem up—now lies at the heart of the integration of neuroscience and psychotherapy.
Grounded in these two principles, Dr. Janov continues to explore the lifelong impact of prenatal, birth, and early experiences on our brains and minds. Simultaneously “old school” and revolutionary, he synthesizes traditional psychodynamic theories with cutting-edge science while consistently highlighting the limitations of a strict, “top-down” talking cure. Whether or not you agree with his philosophical assumptions, therapeutic practices, or theoretical conclusions, I promise you an interesting and thought-provoking journey.
Lou Cozolino, PsyD, Professor of Psychology, Pepperdine University

In Life Before Birth Dr. Arthur Janov illuminates the sources of much that happens during life after birth. Lucidly, the pioneer of primal therapy provides the scientific rationale for treatments that take us through our original, non-verbal memories—to essential depths of experience that the superficial cognitive-behavioral modalities currently in fashion cannot possibly touch, let alone transform.
Gabor Maté MD, author of In The Realm of Hungry Ghosts: Close Encounters With Addiction

An expansive analysis! This book attempts to explain the impact of critical developmental windows in the past, implores us to improve the lives of pregnant women in the present, and has implications for understanding our children, ourselves, and our collective future. I’m not sure whether primal therapy works or not, but it certainly deserves systematic testing in well-designed, assessor-blinded, randomized controlled clinical trials.
K.J.S. Anand, MBBS, D. Phil, FAACP, FCCM, FRCPCH, Professor of Pediatrics, Anesthesiology, Anatomy & Neurobiology, Senior Scholar, Center for Excellence in Faith and Health, Methodist Le Bonheur Healthcare System

A baby's brain grows more while in the womb than at any time in a child's life. Life Before Birth: The Hidden Script That Rules Our Lives is a valuable guide to creating healthier babies and offers insight into healing our early primal wounds. Dr. Janov integrates the most recent scientific research about prenatal development with the psychobiological reality that these early experiences do cast a long shadow over our entire lifespan. With a wealth of experience and a history of successful psychotherapeutic treatment, Dr. Janov is well positioned to speak with clarity and precision on a topic that remains critically important.
Paula Thomson, PsyD, Associate Professor, California State University, Northridge & Professor Emeritus, York University

"I am enthralled.
Dr. Janov has crafted a compelling and prophetic opus that could rightly dictate
PhD thesis topics for decades to come. Devoid of any "New Age" pseudoscience,
this work never strays from scientific orthodoxy and yet is perfectly accessible and
downright fascinating to any lay person interested in the mysteries of the human psyche."
Dr. Bernard Park, MD, MPH

His new book “Life Before Birth: The Hidden Script that Rules Our Lives” shows that primal therapy, the lower-brain therapeutic method popularized in the 1970’s international bestseller “Primal Scream” and his early work with John Lennon, may help alleviate depression and anxiety disorders, normalize blood pressure and serotonin levels, and improve the functioning of the immune system.
One of the book’s most intriguing theories is that fetal imprinting, an evolutionary strategy to prepare children to cope with life, establishes a permanent set-point in a child's physiology. Baby's born to mothers highly anxious during pregnancy, whether from war, natural disasters, failed marriages, or other stressful life conditions, may thus be prone to mental illness and brain dysfunction later in life. Early traumatic events such as low oxygen at birth, painkillers and antidepressants administered to the mother during pregnancy, poor maternal nutrition, and a lack of parental affection in the first years of life may compound the effect.
In making the case for a brand-new, unified field theory of psychotherapy, Dr. Janov weaves together the evolutionary theories of Jean Baptiste Larmarck, the fetal development studies of Vivette Glover and K.J.S. Anand, and fascinating new research by the psychiatrist Elissa Epel suggesting that telomeres—a region of repetitive DNA critical in predicting life expectancy—may be significantly altered during pregnancy.
After explaining how hormonal and neurologic processes in the womb provide a blueprint for later mental illness and disease, Dr. Janov charts a revolutionary new course for psychotherapy. He provides a sharp critique of cognitive behavioral therapy, psychoanalysis, and other popular “talk therapy” models for treating addiction and mental illness, which he argues do not reach the limbic system and brainstem, where the effects of early trauma are registered in the nervous system.
“Life Before Birth: The Hidden Script that Rules Our Lives” is scheduled to be published by NTI Upstream in October 2011, and has tremendous implications for the future of modern psychology, pediatrics, pregnancy, and women’s health.