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Published On Feb 17, 2016

Clinical Research

Second Opinion Winter 2016

Readers weigh in on a national pain strategy and innovative new technologies that could help the blind see.

Painfully Mistaken

I’ve seen the “Politics of Pain” (Fall 2015) stall advancements and impede numerous useful therapies during my 35-year nursing career. Access to necessary treatments for the one-third of Americans affected, including 25 million with severe disabling daily pain, is increasingly denied despite being a greater burden to patients, families and societies than cancer, heart attacks and diabetes combined. The Centers for Disease Control and media focus more on opioid overdose deaths than on the plight of this silenced majority, despite most overdoses occuring among nonmedical drug users. Focusing on misuse, addiction and overdose deaths is important but doing so using mistaken facts disregards lives destroyed by untreated pain while vilifying compassionate professionals. One misleading chorus—that prescription opioids now kill more than car accidents—is untrue, as 2013 mortality data show motor vehicle accidents (37,938 deaths) claim far more lives than prescription opioids (16,235 deaths). No overdose death is acceptable, but the CDC’s opioid deaths per prescription data indicate barely 0.01% of prescribed opioids are fatal. The National Pain Strategy contains the specific tactics the Institute of Medicine called for to fix what is viewed “worldwide as poor medicine, unethical practice, and an abrogation of a fundamental human right.” We just need the political will to implement that plan.

Paul Arnstein // Adjunct Associate Professor, Nurse Practitioner Program, MGH Institute for Health Professions

 

Look at the Lifespan

I have recently been offering advice to Giles Hamilton-Fletcher, an outstanding young scientist working in the field of “Sensory Substitution” (Fall 2015), about his “hearing eye” device for blind individuals that translates the visual environment into sounds. These sounds can then be used to get a visual impression of the contents of, say, a room. How is this related to my specialty of synesthesia? Synesthesia has been aptly described as “a condition in which the senses cross their typical boundaries,” and some forms cause sounds to be “seen” as colors. Research has shown that these synesthetic sensations tend to be systematically related to the stimuli that produce them (e.g., high sounds produce lighter colors, as do pointed objects). Hamilton-Fletcher has taken such “rules” and applied them to his sensory substitution device in the understanding that any species whose brain is capable of synesthesia might also be capable of using those same underlying “rules” to compensate when vision is absent. The next frontier will be to better understand how these rules develop throughout the lifespan (looking at young versus older synesthetes) and how cross-sensory sensitivity might vary for early versus late-blind individuals. Only then might we better understand the roots of these phenomena, which marry the senses in remarkable ways.

Julia Simner // Director, MULTISENSE Synaesthesia Research Lab, University of Sussex

 

A New Type of Rehabilitation

In the Visual Prosthesis Laboratory at Massacusetts General hospital (MGH), we have used virtual reality techniques to study how normal, sighted individuals are expected to adapt to the use of visual prostheses (devices that provide restoration of sight). We find not only a rapid, nearly immediate adaptation, but evidence for a much, much slower effect that may take many months to years to stabilize. We liken the second kind of learning to sophisticated skill training found in other fields, like learning to play the piano or, perhaps like Pat Fletcher, learning to see through a new sensory modality with The vOICe.

As our group, along with others across the world, begins to have a good handle on the more immediate technical aspects of creating artificial vision through implanted devices, we are starting to look to the post-implant rehabilitative training that recipients will require. It seems reasonable to ascribe some of the disappointing early results across the field of visual prosthetics to the simplifying assumption that we could just plug into the visual system and expect everything to work just fine. Regrettably, it appears that the brain isn’t quite as plastic on the short time scale as had been thought.

Now, inspired in part by the research in sensory substitution, we have begun to grapple with designing post-implantation regimens, with a growing understanding and appreciation of the importance that rehabilitative training plays in vision restoration. Whether the users of sensory substitution devices (SSDs) or recipients of visual prostheses actually see, from a philosophical perspective, after such training is a difficult question that perhaps has no clear answer. From an external, functional perspective, however, such people behave as if they do see.

We expect that the broad spectrum of potential therapies from assistive devices to synthetic, and perhaps ultimately biological, implants will find applicability across the wide range of causes of blindness. But it appears that, all such aids or treatments will certainly require substantial effort by the recipients to achieve full benefit.

John S. Pezaris // Assistant in Neuroscience, Department of Neurosurgery, MGH

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