Summer 1995 Volume 4, Number 3

One of the main purposes of the Institute is to communicate to the public the advances in neuroscience research. We have never been closer to where results in a laboratory can be extrapolated, with relative ease, to the bedside. It becomes very important for everyone, scientists and laymen alike, to make an effort to understand what we are about.

Pain has been described as an epidemic of silent suffering. It is the most common reason that individuals seek help from a physician, and the cost each year in dollars as well as suffering is enormous.

It's a sensation that shuts out all else. It's easy to describe certain sensations, such as touch and hearing and sight, but in the face of intense pain, which strikes at the very identity of the sufferer, one is at a loss for words. Chronic pain and its treatment are among the most profound - and misunderstood, in my book - problems in medicine today.

Stroke is the third most common cause of death in this country. The important genetic diseases of the nervous system are minor in terms of numbers, compared to the suffering, disability and death caused by vascular accidents in the brain. Some estimates are as high as a half-million people a year will undergo stroke in this country.

Many of you are familiar with the human nervous system and brain, but many are not. So, let me take a few minutes to introduce the subject.

This organ does not weigh any more than your liver; it's about three pounds. Yet, it holds the secret to everything we consider to make us human and different from other animals.

We know a lot about this brain: Certain regions in the brain are involved in processing visual information; certain regions are involved in processing explicit memories, memories for places and faces and facts; other regions are involved in the fine coordination of motor control. But, really, we are at the dawning of a clearer understanding of how this organ works.

There are some estimates as high as one hundred billion elements, or nerve cells, within the brain. These little working elements need and use an enormous amount of energy. That places them at tremendous risk for anything that cuts off their oxygen supply. They can't go very long without oxygen and other crucial nutrients.

Each nerve cell is endowed with a very elaborate arbor, or "processes," where they reach out and communicate with one another. These contacts are specialized. They are called synapses, which, in Greek, means to clasp.

The cells communicate with one another via brief electrical impulses, conducted at about two hundred miles an hour - not the speed of light, but over these short distances, that's pretty fast - from one cell to another.

Once an impulse arrives at a synapse, it triggers the release of one or more chemicals, which then influence the next cell in line and either stimulate it to fire, or inhibit it, to remain silent.

If this is a nerve cell sensitive to painful stimulus, it becomes very important to know how that impulse is conducted along the process, exactly which chemicals are released at these contacts, or synapses, and how the whole cycle might be interrupted before this chain of events emerges into consciousness, with a blinding, incapacitating, painful sensation.

The contacts between cells contain chemicals, wrapped up in small packages, which are released into a small gap between the sending cell and the cell receiving the information. Many of us feel that, at these synapses, effective therapies will be developed, both for pain and for the diagnosis and treatment of stroke damage.

The chemicals involved are extremely critical. Acetylcholine and glutamate are small molecules that are powerful transmitters in the brain. They may well be involved in pain and stroke damage. Serotonin, dopamine and norepinephrine are other transmitters that may be involved in emotional and cognitive disorders.

The challenge in basic science labs is to try and understand more about the various chemicals involved here - about fifty of them are known at present - and to understand how their actions can be enhanced or inhibited.