One night in 2000, Allan Basbaum was at the Pierre Hotel on Central Park, wearing a tuxedo after presenting a neuroscience award to one of his colleagues before a roomful of scientists, Nobel laureates among them. His wife, Carol, a cancer biologist, had accompanied him from San Francisco, where they both ran laboratories at the University of California. Late that night, he was struck by agonising stomach pain. Alarmed, they went to the emergency room at Lenox Hill Hospital, where the waiting area was jammed and hours passed before anyone could see him.
‘So I’m out in the waiting room; I’m periodically screaming,’ Basbaum says. After two hours, Carol went to the bathroom, leaving him alone. Finally, a man came over and began speaking to him, gently prodding him. ‘He checks my pulse, he asks: “Does this hurt?”’ Basbaum says. As the man attended to him, ‘the pain really started to get much better,’ and Basbaum relaxed. When Carol returned, he told her about the long-awaited treatment. ‘She says: “Allan, he’s one of the patients. He’s been doing that to everybody here.” But finally, someone was taking care of me.’ And that brought relief.
By then, Basbaum had spent three decades studying the physiology of pain, mapping the neural circuits that carry signals from the body toward the brain. He wanted to understand how those signals become pain. His experience brought to life the questions he’d been marvelling at for years: how do fear, context and expectation shape the body’s most urgent alarm? How do placebos work? And how could someone relieve his pain, just by paying attention?
Basbaum understood the Gordian knot at the heart of pain: the brain could influence pain before a person consciously felt it. His work over the past 50 years has been to untangle that loop, following signals through the spinal cord to the brain and back again.
Basbaum likens pain to the experience of beauty. Take Piet Mondrian. One person sees a painting of coloured bars and squares, and thinks: I could do that. Another, steeped in the history and meaning of the work, is moved to tears. The image on the retina may be much the same; the experience is not. Pain, Basbaum argues, works in a similar way. There is no such thing as an inherently painful stimulus, only stimuli that, in most people, under most conditions, will produce pain.
A truly subjective experience, pain can seem ephemeral. Yet, like all bodily sensations, it arises from the interactions of molecules and cells. At age 78, still at the University of California, San Francisco (UCSF) leading one of the nation’s most prolific pain research groups, Basbaum’s aim remains unchanged: unravel the signal to find ways of treating pain.
The brain is not where Basbaum wants treatment to begin. ‘My bias is to understand how the information gets to the brain and look for places along the way, preferably way out in the periphery, that I think are important drivers to initiate the whole process,’ he says.
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