090 - How the brain can keep pain (and maybe fatigue) going

Main Ideas

Brain Networks and Ongoing Experience

The default mode network (DMN) is described as part of the brain’s baseline activity. It supports self-related thoughts, perceptions, memories, imagination, and a sense of personal continuity.

The salience network responds when something important or threatening suddenly demands attention, such as an injury.

How Pain May Become Chronic

In a typical short-term injury, the salience network becomes prominent while pain is active. When the pain subsides, brain activity can return to its usual baseline.

The speaker proposes that when pain or another unpleasant experience persists, it may become abnormally integrated with the DMN. In this account, pain-related attention and emotional responses become part of the brain’s baseline pattern—a process called pain chronification.

He cites research on chronic low back pain in which regions associated with attention to pain and emotional reactions appear to be incorporated into the DMN. If pain becomes supported by these network patterns, it may continue even after the original injury has resolved. The speaker presents this as a proposed explanation for some chronic pain conditions, including fibromyalgia and chronic low back pain.

Possible Relevance to Fatigue

The speaker suspects that similar network changes could contribute to chronic fatigue, but says the evidence is less developed than it is for pain.

Fatigue is harder to switch on and off quickly during brain-imaging experiments, making it more difficult to study with some methods used for pain. He notes that research groups are investigating DMN activity and fatigue, including in ME/CFS.

Potential Ways to Disrupt the Learned Pattern

The general goal is to separate pain-related or otherwise unwanted activity from the DMN and restore a healthier network organization. The speaker emphasizes that this is difficult because the brain may have learned a new pattern of processing.

Approaches he discusses include:

• Focused transcranial ultrasound, which could potentially target an abnormal brain region and alter its connection to the DMN.
• Modifying microglia, in an effort to change their state so they no longer reinforce the abnormal connection.
• Classic psychedelics, especially psilocybin, which may temporarily make the brain more flexible. The speaker proposes pairing this state with an intervention designed to change specific brain circuits, distinguishing his circuit-targeting approach from the more familiar pairing of psilocybin with psychotherapy.

He says no approach has been established as the best one, but considers this a promising research direction for conditions involving pain, fatigue, cognitive difficulties, or mood symptoms.

Research Update

The speaker says he is analyzing results from a completed clinical trial testing curcumin, resveratrol, and stinging nettle for Gulf War Illness. He does not yet report whether the treatments worked.

Speaker and Sources

Dr. Jarred Younger discusses his interpretation of brain-network research and potential treatment approaches. No other speakers or external sources are heard in the subtitles.