46 | March• 2018
THE HEALING POWER OF YOU
MedicalCenterinBethesda,Mary-
land.Everydayheseesactiveservice
members and veterans with severe
injuries.
When Spevak asks patients about
themselves,hemightlearnthatin
childhood a person had a favourite
eucalyptus tree outside his house
orlovedpeppermints.IfSpevak
prescribes opioid painkillers, every
time the patient takes one, he also
haseucalyptusoiltosmellorapep-
perminttoeat–whateverstimulus
will resonate. Patients start linking
thesensoryexperiencetothedrugs.
After a while, Spevak cuts down
on the drug and just provides the
sounds or smells. The patient’s brain
cangotoan‘internalpharmacy’for
the needed medication.
“Wehavetripleamputees,quad-
rupleamputees,whoareonnoopi-
oids,”Spevaksays.“Yetwehaveolder
Vietnamvetswho’vebeenonhigh
dosesofmorphineforlow back pain
for the past 30 years.”T
WO YEARS AGO Leonie
Koban, a member of Tor
Wager’slab,testedtheef-
fectofotherbelieversonasubject’s
experiencesofpain.Theresearch-
ers delivered a burning sensation
to their subjects’ arms and asked
them to rate how strong it was.
Thevolunteersalsoviewedaseriesof
hash marks representing how previ-
ousparticipantshadratedtheirpain.
For the same stimulus, the subjectsrelief,youcan’thaveaplaceboef-
fect,” says Professor Howard Fields,
oneoftheauthorsofthestudy.
Itwasn’tuntiltheearly2000sthat
scientists could watch how these ef-
fectsplayoutinthebrain.TorWager,
then a PhD student at the University
ofMichigan,putsubjectsinabrain
scanner. He applied cream to each
subject’s wrists, then strapped on
electrodes that could deliver painful
shocksorheat.Hetoldthesubjects
thatoneofthecreamscouldamelio-
ratepain,but,infact,neithercream
had any pain-reducing qualities.
After several rounds of condition-
ing, the subjects learned to feel less
pain on the wrist coated with the
‘pain-relieving’ cream; on the last
run, strong shocks felt no worse than
a light pinch.
The brain scans showed that nor-
mal pain sensations begin at an in-
juryandtravelinasplitsecondup
thespinetoanetworkofbrainareas
thatrecognisethesensationaspain.
Aplaceboresponsetravelsintheop-
posite direction. An expectation of
healingintheprefrontalcortexsends
signalstothebrainstem,whichcre-
ates opioids and releases them down
tothespinalcord.
“Therightbeliefandtheright
experience work together,” says Wa-
ger. “And that’s the recipe.”
Therecipeisfindingitswayinto
clinical practice. Christopher Spe-
vakisapainandaddictiondoctor
at the Walter Reed National Military