Pesach Feldman, 76,
takes a break from a
swim in Tel Aviv, Israel.
Bypass surgery and 15
stents didn’t relieve
the former paratroop-
er’s chest pain from
refractory angina,
caused by poor blood
circulation in his heart.
He underwent a sim-
ple procedure per-
fected by cardiologist
Shmuel Banai. A cath-
eter with an inflatable
balloon and a stainless
steel mesh Reducer
(top right) is inserted
through a vein in the
neck, and the balloon
is inflated in the heart’s
main vein, called the
coronary sinus. The
Reducer restricts the
blood flow leaving the
heart, forcing it into
areas of the heart mus-
cle that aren’t getting
enough nourishment.
“I got my life back,”
Feldman said.
FAR RIGHT: DAVID GUTTENFELDER
NEAR RIGHT TOP: LIOR ZUR, TEL AVIV
SOURASKY MEDICAL CENTER
NEAR RIGHT BOTTOM: SHMUEL BANAI,
TEL AVIV SOURASKY MEDICAL CENTERuse to numbing patients temporarily. Drug com-
panies are searching for compounds that might
be able to block Nav1.7 without disabling other
sodium channels, but success has been elusive.
Even so, Waxman is optimistic that the
research eventually will lead to better drugs.
“I’m confident there will be a new and more
effective class of medicines for pain that are not
addictive,” he says, his eyes brightening. Then
he pauses for a moment and tempers his enthu-
siasm. “But I can’t begin to attach a time line.”
WHILE THE SEARCH for new drugs continues, cli-
nicians and researchers are investigating ways to
deploy the brain’s intrinsic abilities to modulate
pain and lessen the suffering associated with it.
And those abilities are impressive. After all, our
minds and bodies have been coping with pain
for a lot longer than we’ve been studying it.
Take, for example, a recent British study of
more than 300 patients with a type of shoulder
pain thought to be caused by a bone spur. To
relieve the pain, the spur is often removed in sur-
gery. Researchers randomly divided the partic-
ipants into three groups. One group underwent
the surgery. A second group was led to believe
it had, but it hadn’t. A third group was asked to
return in three months to see a shoulder special-
ist. The group that had the operation and the one
that thought it did reported similar relief from
their shoulder pain.
“What it showed is that it’s just a placebo. The
surgery is not mechanistically doing anything
for the pain,” says Oxford’s Irene Tracey, one of
the study’s authors. “The pain relief the patients
are getting is just driven by a placebo effect.”
But to Tracey, the outcome isn’t any less
important because it shows the placebo effect
worked. On the contrary, she says, the study
reveals the force of a patient’s belief in the treat-
ment. “What it’s powerfully saying is expectations
shape pain,” Tracey says.
Other studies have uncovered how a patient’s
expectation of reduced pain can translate into
actual relief. It seems to activate the brain’s
descending pain pathway, leading to the release
of opioids synthesized inside the brain that
impede the incoming pain signals from the body.
“This is not just pretend,” Tracey says. “The
placebo mechanism hijacks this very powerful
system in the brain.”
Our perception of pain isn’t limited to merely
sensing it. The feelings of unpleasantness, fear,
and anxiety that accompany the sensation
are an integral part of experiencing pain. In a
trial at the Cleveland Clinic, researchers led by
neuro surgeon Andre Machado used deep brain
stimulation (DBS) to target this emotional com-
ponent of pain in 10 patients who had chronic
neuropathic pain after suffering a stroke. The
researchers implanted tiny electrodes in a part of
the brain involved in processing emotions. Wired
to an electronic device inserted in the chest, the
electrodes delivered mild shocks to the implan-
tation site at a rate of nearly 200 a second.
“In several patients, we saw an improve-
ment in their quality of life, in their sensation
of well-being, in their independence—without
improving the amount of pain,” Machado says.
Patients who had scored their pain as a nine
on a 10-point scale, for example, continued
to give it the same score but reported being
able to function better. One of the study sub-
jects, Linda Grubb, describes the treatment as64 NATIONAL GEOGRAPHIC