Pain--old and new methods of study and treatment.

In the last 5 years several remarkable methods for localizing precisely a wide range not only of specific motor and sensory functions but as well of more complex mental phenomena in the domain of cognitive functions have been demonstrated to evoke sharply localizable responses. In pain, positron emission tomography (PET) scanning has been used to show that the anterior gyrus cinguli is an integral component of the pain system. The PET technique suffers from a limitation of both spatial and temporal resolution, which permits only accurate center of mass coordinates of activated regions. Functional mapping of the brain by nuclear magnetic resonance has been achieved with techniques depicting specific brain areas in action during a mental process. These techniques open up an entirely new domain for study and treatment of many problems linked to cognition including many in whom pain is a central feature. The many cerebral cortical areas involved in pain make it unlikely that any ablative procedure will achieve long sustained pain relief. The dual objective of relief of both pain and suffering is probably going to be attained only by activation of pain suppressor mechanisms. This may well require the added knowledge accessible only by functional magnetic resonance imaging.