Decisions about Pain, Reward Taken in Same Brain Region, Researchers Say

A file picture of an early medical model used to teach doctors the areas of the human brain. Photo: Reuters
A file picture of an early medical model used to teach doctors the areas of the human brain. Photo: Reuters
TT

Decisions about Pain, Reward Taken in Same Brain Region, Researchers Say

A file picture of an early medical model used to teach doctors the areas of the human brain. Photo: Reuters
A file picture of an early medical model used to teach doctors the areas of the human brain. Photo: Reuters

Imagine having to choose over and over between what you enjoy doing and the pain that it might cause you, whether physical or emotional. If you live with conditions such as depression, anxiety, or chronic pain, you are probably familiar with making these difficult choices on a daily or weekly basis. But surprisingly little is known about which areas of the brain are involved in decisions of this kind.

In a recent article published in the journal Proceedings of the National Academy of Sciences (PNAS), McGill University researchers show that the ventral striatum plays a crucial role when it comes to choices about future pain versus future profit.

Interestingly, this brain region has already been identified as being involved in motivation and rewards, but it has not been associated with pain until now. This discovery could advance treatments for a range of disorders.

To see which areas of the brain were activated during decisions about future pain and profit, participants in the recent study were asked to make choices, very quickly, that involved a certain (random) amount of pain in exchange for a certain (random) amount of profit – or vice versa.

As participants were asked to choose repeatedly (there were 100 trials) between succeeding offers of pain or profit, the researchers used brain scans to monitor areas of cerebral activity. They discovered that, although many different areas of the brain were associated with future pain or money offers, there was one particular region, the ventral striatum, that systematically activated or deactivated as a function of future pain or rewards.

By using machine-learning algorithms, the researchers were able to identify patterns of brain activity that allowed them not only to predict the levels of pain and reward on offer, but also whether or not the participants would accept or reject these offers. They were, in effect, watching the brain making decisions between future pain and profit.

“It was almost like seeing a dimmer switch moving up or down, depending on whether pain or profit was on offer,” said Mathieu Roy, an associate professor in McGill’s Psychology Department and the senior author on the paper.

“We found that when money was on offer, as expected, activity in the ventral striatum increased. But what was interesting was that activity in the same area of the brain decreased in proportion to the pain on offer,” he added.



Blood Tests Allow 30-year Estimates of Women's Cardio Risks, New Study Says

A woman jogs in a park in Saint-Sebastien-sur-Loire near Nantes, France January 19, 2024. REUTERS/Stephane Mahe/File Photo Purchase Licensing Rights
A woman jogs in a park in Saint-Sebastien-sur-Loire near Nantes, France January 19, 2024. REUTERS/Stephane Mahe/File Photo Purchase Licensing Rights
TT

Blood Tests Allow 30-year Estimates of Women's Cardio Risks, New Study Says

A woman jogs in a park in Saint-Sebastien-sur-Loire near Nantes, France January 19, 2024. REUTERS/Stephane Mahe/File Photo Purchase Licensing Rights
A woman jogs in a park in Saint-Sebastien-sur-Loire near Nantes, France January 19, 2024. REUTERS/Stephane Mahe/File Photo Purchase Licensing Rights

Women’s heart disease risks and their need to start taking preventive medications should be evaluated when they are in their 30s rather than well after menopause as is now the practice, said researchers who published a study on Saturday.

Presenting the findings at the European Society of Cardiology annual meeting in London, they said the study showed for the first time that simple blood tests make it possible to estimate a woman’s risk of cardiovascular disease over the next three decades.

"This is good for patients first and foremost, but it is also important information for (manufacturers of) cholesterol lowering drugs, anti-inflammatory drugs, and lipoprotein(a)lowering drugs - the implications for therapy are broad," said study leader Dr. Paul Ridker of Brigham and Women’s Hospital in Boston, Reuters reported.

Current guidelines “suggest to physicians that women should generally not be considered for preventive therapies until their 60s and 70s. These new data... clearly demonstrate that our guidelines need to change,” Ridker said. “We must move beyond discussions of 5 or 10 year risk."

The 27,939 participants in the long-term Women’s Health Initiative study had blood tests between 1992 and 1995 for low density lipoprotein cholesterol (LDL-C or “bad cholesterol”), which are already a part of routine care.

They also had tests for high-sensitivity C-reactive protein (hsCRP) - a marker of blood vessel inflammation - and lipoprotein(a), a genetically determined type of fat.

Compared to risks in women with the lowest levels of each marker, risks for major cardiovascular events like heart attacks or strokes over the next 30 years were 36% higher in women with the highest levels of LDL-C, 70% higher in women with the highest levels of hsCRP, and 33% higher in those with the highest levels of lipoprotein(a).

Women in whom all three markers were in the highest range were 2.6 times more likely to have a major cardiovascular event and 3.7 times more likely to have a stroke over the next three decades, according to a report of the study in The New England Journal of Medicine published to coincide with the presentation at the meeting.

“The three biomarkers are fully independent of each other and tell us about different biologic issues each individual woman faces,” Ridker said.

“The therapies we might use in response to an elevation in each biomarker are markedly different, and physicians can now specifically target the individual person’s biologic problem.”

While drugs that lower LDL-C and hsCRP are widely available - including statins and certain pills for high blood pressure and heart failure - drugs that reduce lipoprotein(a) levels are still in development by companies, including Novartis , Amgen , Eli Lilly and London-based Silence Therapeutics.

In some cases, lifestyle changes such as exercising and quitting smoking can be helpful.

Most of the women in the study were white Americans, but the findings would likely “have even greater impact among Black and Hispanic women for whom there is even a higher prevalence of undetected and untreated inflammation,” Ridker said.

“This is a global problem,” he added. “We need universal screening for hsCRP ... and for lipoprotein(a), just as we already have universal screening for cholesterol.”