Part C

In this part of the test, there are two texts about different aspects of healthcare. For questions 1-8, choose the
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answer (A, B, C or D) which you think fits best according to the text. B
C
Fill the circle in completely. Example: D

Text 1: Advances in the assessment of pain

The experience of pain remains poorly understood by scientists and clinicians because each individual’s
experience of pain is unique, making it very hard to treat. This explains why health professionals still rely on

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subjective ratings, like asking patients to rate their pain on a scale of zero to ten. Pain is variable by definition.
The International Association for the Study of Pain defines it as ‘a personal, unpleasant sensory and emotional

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experience that is influenced by biological, psychological and social factors.’ Pain often differs in quality – patients
use words like dull, sharp, stabbing, throbbing to describe it – and yet the exact feeling is often hard to recall and

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describe with any level of accuracy. To complicate matters, although nociception - the unconscious processing of
unpleasant stimuli - usually leads to pain, research shows that one can exist without the other.

M
If there was an objective marker of pain, one that could bypass the distortions caused by cognitive and social
factors, this would help us treat patients unable to communicate their experience of pain, like those in a vegetative

A
state, as well as young children. And, over the past few decades, technological advances have given researchers
the opportunity to start developing some kind of objective measure. In the early 1990s, neuroimaging techniques

S
such as PET scans and fMRIs became a popular way to study pain, leading to a focus on physiological measures
of brain activity. Scientists became distracted by the idea that it might be possible to locate some sort of ‘pain
centre’ or ‘pain network’ within the brain, but no such feature was ever identified. Indeed, studies of pain activation
during experiments showed that even harmless stimuli, like unexpected warmth, touch or vibration, can activate the
brain in a similar way to painful stimuli.

There is growing evidence that the brain’s response to pain doesn’t always have a meaningful relationship to the
level of pain a person is experiencing – heightened brain activity doesn’t always mean heightened pain - and other
factors, like the biological differences between people, can affect brain activity. Studies have also shown that the
brain’s response to certain painful stimuli, for example painful heat, is strongly influenced by the individual’s level of
alertness and how much attention they pay to it. Both the brain’s response and the conscious perception of pain by
the individual are influenced by this factor.

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 08/16

 So, it became clear that technology alone wouldn’t give us an objective measure of pain, and researchers needed
to understand more about the brain’s response to stimulation. Decades of research have shown the type of
brainwave called gamma oscillations are a good measure of human response to sensory stimuli in general, not just
pain. In the 2000s, experimental work showed that gamma oscillations increased in amplitude following both brief
and prolonged thermal painful stimuli in healthy volunteers. Research carried out with patients to record electrical
activity within the brain has been promising, seeming to support the idea that gamma oscillations could reflect the
perception of pain better than any other response to pain in the brain.

Recent work by Valentini and Schulz has demonstrated how the gamma oscillations synchronised with painful

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heat stimulation are unique to each person. In one experiment, they briefly induced pain using a thermal laser in

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twenty-two healthy male volunteers in their twenties and thirties, then recorded their gamma-wave responses. This
not only pinpointed the extreme variability in different people’s gamma oscillations, but also showed that a person’s

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response pattern is stable across time. The team’s analysis of a separate study published in 2021, independent of
their own but using similar methodology, also demonstrated this variability between participants in their gamma-
wave response.

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The team’s findings suggest we must rethink our interpretation of the relationship between pain and gamma

A
oscillations, though they rightly point out that it’s still too early to formulate general rules, as some people will
feel pain and have no gamma response, while others will show a large response. It’s important to remember,

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however, that brain mechanisms triggered by experimental pain in healthy people won’t necessarily be replicated
in people who have been experiencing pain over long periods of time. For example, people with chronic pain may
well have experienced changes in their brain structure and response to pain as a result. It’s an issue that remains
unaddressed by the current study.

As yet, no clinical trials involving gamma waves have been carried out, perhaps due to technical and ethical
challenges involved in experiments that study patients with chronic pain. But if gamma waves can reliably predict
pain in a substantial percentage of the population, this could potentially be used in the diagnosis and management
of a range of conditions. The more we understand about each of our patient’s individual response to pain, the
closer we can get to giving the most appropriate form of pain relief.

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 09/16