Outside neurology and his family, Sean Mackey doesn't have many hobbies. The one exception is his monstrous flat-screen television and large film collection. Driving to Stanford, California, on the day I am to visit Mackey's lab for testing, I am reminded of a scene from his favourite movie, The Princess Bride. In the film, the villain, Count Rugen, straps the hero Westley into a sinister apparatus and confesses a "deep and abiding interest in pain". Then he tortures the hero in the name of science.
It turns out that this is not far from what is in store for me.
Mackey heads the Pain Management Center at Stanford School of Medicine where, as part of his research on ways to relieve pain, he routinely inflicts it. Widely seen as one of the field's rising stars, Mackey is part of a movement to upend the way scientists look at pain, drawing the focus away from the nerves that sense it, towards the brain that processes it. His primary tool is functional magnetic resonance imaging (fMRI), which can create images of the brain responding as the body is hurting. The trick now — and one focus of Mackey's work — is to understand whether a person can consciously change the way the brain processes and perceives pain. That's where I come in. The plan is to put me inside the fMRI scanner, apply burning heat, and see whether I can train myself to regulate my pain.
As part of his studies, Mackey has found himself struggling with a question facing the fMRI field as a whole: when is the technique ready for use outside the lab? One of his former colleagues has started a company that plans to offer patients the fMRI 'feedback' pain-control technique that Mackey was involved in developing. But Mackey has distanced himself from the company in these early stages, based on what he has observed elsewhere. "I've seen too many treatments that are the next latest and greatest thing out there that people get really excited about. Everybody gets on board and initially the results are fantastic. And then as time goes by we start to see that the results are not as good as initially proposed," he says. "And then you find out that it doesn't work at all."
Walking into his office near the Stanford Hospital, Mackey is more reminiscent of a corporate executive than a brain researcher. He is a cheery, focused ball of energy, with a quick smile and a firm, reassuring handshake. He regularly wears a suit in the lab. He says it fights the stereotype that all anaesthesiologists — he trained as one — wear "pyjamas" to work.
According to Mackey, the suit also tells patients that he takes his work seriously. They may be recovering from knee surgery, they may be wounded veterans or they may have a rare neurological condition that can cause excruciating full-body pain. According to the International Association for the Study of Pain, one in five people endures moderate to severe chronic pain. "I have seen it take people who are otherwise normal and turn their lives upside down and absolutely destroy them," says Mackey. Or as his colleague Ian Carroll, another Stanford anaesthesiologist, puts it: "It's like the black hole of the brain. It dominates it and forces everything to spin around it."