Monday, August 17, 2026

 

Scientists identify brain’s brake that shuts off chronic pain


Finding from mouse study could lead to targeted treatments for chronic nerve pain




WashU Medicine

locus coeruleus 

image: 

A cluster of nerve cells (cyan, right) in the mouse brain (cyan, left) play a role in both pain relief and the generation of chronic pain. WashU Medicine researchers found that certain receptors on the surface of these cells can shut off chronic pain.

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Credit: Chao-Cheng Kuo





Deep at the base of the brain, a tiny cluster of nerve cells serves as the body’s natural pain reliever, dialing down pain signals traveling up the spinal cord. But nerve damage can flip this system into a hyperactive engine for chronic pain.

Now, researchers at Washington University School of Medicine in St. Louis have figured out why that switch flips, and how to shut it off. They identified, in mice, that certain receptors that reside on the surface of cells in the brain’s main alert and stress center act as biological brakes on pain. Previously known to influence stress in this region of the brain, these receptors also can turn off the pain engine to relieve chronic neuropathic pain following nerve injury.

The study, published Aug. 17 in Current Biology, opens new doors for developing therapies that specifically target this region of the brain, known as the locus coeruleus, to reduce chronic pain.

“Millions of adults live with chronic neuropathic pain caused by nerve damage,” said Jordan McCall, PhD, an associate professor in the Center for Clinical Pharmacology in the WashU Medicine Department of Anesthesiology and the study’s senior author. “The pain is difficult to treat, and traditional opioid medications bind to receptors throughout the entire body and brain, often leading to side effects, tolerance and addiction risk. Understanding how localized receptors in the locus coeruleus act as gatekeepers could lead to more targeted, effective pain therapies with fewer risks.”

A brake on pain

Neuropathic pain occurs when damaged nerve fibers send relentless, misfired signals to the brain, causing shooting, stabbing or burning sensations. The condition frequently stems from diabetes, viral infections or nerve compression, among other factors.

To understand how to stop these signals, McCall’s team, including co-first authors Chao-Cheng Kuo, PhD, a postdoctoral research associate, and Makenzie R. Norris, a former graduate student, focused on the locus coeruleus, a part of the brain that has been shown to play a role in pain regulation.

First, they confirmed that nerve injury turns this region into an active driver of pain. When they temporarily turned off locus coeruleus brain cells in mice, they observed reduced sensitivity to touch and heat among animals modeling neuropathic pain compared with healthy mice.

Next, they turned their attention to receptors on locus coeruleus brain cells that respond to opioids, and in particular, a type of opioid receptor known as mu. Mu opioid receptors are scattered throughout the brain and spinal cord. When the body’s naturally produced opioids or synthetic ones such as morphine and fentanyl land in the receptors’ pockets, pain throughout the nervous system lessens. Because the locus coeruleus is packed with these receptors, the researchers wondered if they play an important role in pain regulation.

They deleted the mu opioid receptors on only the locus coeruleus brain cells in mice with neuropathic pain. Without the receptors, the mice were even more sensitive to touch and heat compared with mice with mu opioid receptors still present in the locus coeruleus. Restoring the receptors to those same neurons reversed the hypersensitivity, effectively turning the pain off.

The result indicates that chronic pain may be impairing the ability of mu opioid receptors to tamp down the activity of brain cells in the locus coeruleus. Building on these findings, the researchers are exploring how to manipulate the locus coeruleus without affecting receptors across the rest of the nervous system. By designing therapies that specifically engage mu opioid receptors in this brain region, the researchers said they hope to pave the way for treatments that offer powerful relief for chronic neuropathic pain.

Kuo CC, Norris MR, Dunn SS, Becker LJ, Kim JR, Vazquez CR, Borges G, Thang LV, O’Brien JT, Parker KE, McCall JG. Mu opioid receptors gate the locus coeruleus pain generator. August 17, 2026. Current Biology.

This work was funded by the National Institutes of Health, grant numbers R01NS117899, R01NS135401, F31NS124301 and F31DA065440; the National Science Foundation, grant number DGE-2139839; the McDonnell Center for Systems Neuroscience; a Collaboration Support initiative for Translational Anesthesiology Research (COSTAR) award from the Department of Anesthesiology at Washington University School of Medicine; and the Rita Allen Foundation with added financial help from the Open Philanthropy Project. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.

Laser therapy offers weapon against deadly brain tumors



Large analysis of patient outcomes shows that extent of tumor ablation, treatment timing extends survival



WashU Medicine





For patients facing a diagnosis of glioblastoma — one of the most aggressive and devastating forms of brain cancer — the standard path forward has long meant an invasive open-skull surgery and a daunting prognosis.

Over the past decade and a half, neurosurgeons have incorporated another treatment approach: a minimally invasive laser treatment — currently offered to patients with recurrent, difficult-to-access, or inoperable brain tumors — that is safe and extends survival by months, a meaningful milestone for people with a terminal diagnosis. Now, an analysis of patient outcomes led by researchers at Washington University School of Medicine in St. Louis found potential ways to enhance these benefits, revealing that the extent of tumor removal by the procedure and the timing of treatment extend survival.

The analysis, published Aug. 17 in the Journal of Clinical Oncology, has the potential to improve clinical care for patients.

“Our goal is to both extend the survival of our brain tumor patients and improve the quality of their lives,” said the study’s principal investigator and lead author Eric C. Leuthardt, MD, the Shi Hui Huang Professor of Neurological Surgery at WashU Medicine and chief of the Division of Neurotechnology, who treats patients at Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine. “This analysis identifies the factors that lead to the best outcomes. This critical new information will help us find opportunities for patients to benefit the most from this therapy.”

The analysis focused on 787 brain tumor patients who were included in a prospective multicenter study that tracked patients for up to five years after undergoing the minimally invasive laser procedure. WashU Medicine led the study at Siteman Cancer Center and 24 other locations across the U.S.

Factors extending brain cancer survival

Patients diagnosed with glioblastoma and other brain tumors typically undergo an invasive surgery that involves temporarily taking off part of the skull to remove the tumor, often followed by both chemotherapy and radiation.

For those with tumors that are difficult or impossible to remove with open surgery, doctors often treat the cancer with a less-invasive intervention known as laser interstitial thermal therapy, or LITT. Neurosurgeons drill a tiny hole in the skull and insert a robotically controlled laser probe guided by real-time MRI that helps doctors steer the probe through the brain to the tumor on a path that avoids healthy tissue damage. Once inside the tumor, the laser emits heat that kills the surrounding tumor cells. The surgical tool, NeuroBlate, was developed by Monteris Medical, a neurosurgical technology company that funded the study. NeuroBlate was cleared for marketing by the U.S. Food and Drug Administration in 2009.

The researchers aimed to use the largest collected cohort of patients receiving laser surgery for brain tumors that originate in the brain or spread from other parts of the body to understand the factors driving successful patient outcomes of the minimally invasive surgery. The study provides actionable data to help physicians determine which patients may benefit most from the minimally invasive procedure.

Among patients with inoperable or recurrent tumors, the researchers found that how much of the tumor is destroyed by the laser is an important factor in how long a patient survives, especially for those with newly diagnosed glioblastoma. Their analysis showed that glioblastoma patients who had at least 91% of their tumor cleared survived 2.1 years from diagnosis. Because survival with standard open surgical resection is approximately 1 1/2 years, this provides essential information for considering NeuroBlate as a tool that can also be used to treat these tumors up front.

“By combining BJC HealthCare’s premier infrastructure with WashU Medicine’s world-class expertise, patients with brain cancer gain access to the most advanced medical technology available.” Eric Leuthardt, MD, WashU Medicine

Beyond glioblastomas, the analysis delivered insights for treating brain metastases — cancers that have spread to the brain from other parts of the body — after prior radiation therapy. The data revealed a survival advantage for patients who received laser therapy when the tumors were still small. This insight re-evaluates the common practice of watchful waiting, in which clinicians may wait several imaging cycles to confirm tumor growth. Treating earlier, when the tumor is smaller, yields better outcomes than waiting for the tumor to grow.

Some of the 787 brain tumor patients included in the analysis received laser therapy at Barnes-Jewish Hospital, part of BJC HealthCare. For decades, WashU Medicine and Barnes-Jewish Hospital have pioneered laser neurosurgery. In 2010, Leuthardt performed the nation’s first laser interstitial thermal therapy for a brain metastasis at Barnes-Jewish Hospital following the FDA-clearance of the NeuroBlate surgical tool. This milestone was enabled by early investments from BJC HealthCare in intraoperative MRI capabilities, allowing surgeons to see tissue in real time and make more precise decisions during the operation.

“By combining BJC HealthCare’s premier infrastructure with WashU Medicine’s world-class expertise, patients with brain cancer gain access to the most advanced medical technology available,” said Leuthardt.

Boosting quality of life for brain cancer patients

Aside from extending lives, the study confirmed that the laser treatment impacts the patient experience. Traditional brain surgery requires partial, temporary skull removal and weeks of recovery. In contrast, the laser procedure requires only a single-stitch incision a few millimeters wide.

Consistent with other publications analyzing data from the clinical study, the researchers, including WashU Medicine physician-scientist Albert H. Kim, MD, PhD, the August A. Busch, Jr. Professor of Neurological Surgery and director of The Brain Tumor Center at Siteman Cancer Center, showed that the procedure is well-tolerated, maintains a patient’s day-to-day quality of life and limits the average hospital stay to just 32 hours. Patients recovered quickly and most avoided intensive care and readmission. The procedure also reduced the need for anti-seizure medication compared to before the surgery.

“We are shifting the entire framework of how we handle brain tumors,” said Leuthardt. “When patients are told they have months to live, having the option of a low-risk procedure that gets them back home to their families in just over a day is profoundly meaningful.”

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