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Scratching An Itch Affects The Brain

Using imaging technology for the first time to investigate the phenomenon, US researchers have revealed what goes on in the brain when we scratch, giving new clues about why the behaviour brings relief and is hard to stop.

The study is the work of researchers at Wake Forest University Baptist Medical Center in North Carolina, and is published in the 31st January early online issue of the Journal of Investigative Dermatology.

Lead author and dermatologist specializing in itch-related conditions, Dr Gil Yosipovitch said:

"It's important to understand the mechanism of relief so we can develop more effective treatments."

"For some people, itch is a chronic condition that affects overall health," explained Yosipovitch.

He and his colleagues wrote that imaging studies had looked at how the brain reacts to pruritis or itching conditions, but not what happens when the behavioural response, scratching, is going on.

The researchers recruited 13 healthy participants to undergo functional magnetic resonance imaging (fMRI), a type of scan where you can see different areas of the brain light up when the volunteer is doing different things, for instance when using limbs, thinking or talking.

A small brush was used to scratch participants on the lower leg for 30 seconds, then stopped for 30 seconds, then started again, and so on, for five minutes altogether.

The researchers found, to their surprise, that during the 30 seconds of scratching time, parts of the brain normally active when aversive emotions and memories are experienced, became signiificantly less active.

The parts of the brain showing reduced activity during scratching were the anterior cingulate cortex, which is linked with aversion to unpleasant sensory stimuli, and the posterior cingulate cortex, which is associated with memory. Lowest activity in these areas coincided with times when the participants felt the scratching to be most intense.

Yosipovitch said:

"We know scratching is pleasurable, but we haven't known why. It's possible that scratching may suppress the emotional components of itch and bring about its relief."

He said sometime patients find intense scratching, sometimes so hard that the skin bleeds, is the only way to relieve chronic itching.

"This is the first real scientific evidence showing that itch may be inhibited by scratching," said Yosipovitch.

He was keen to point out that scratching is not recommended because it damages the skin, but it is important to find out what is going on when people feel relief from scratching so new treatments can be developed, such as drugs that target the relevant part of the brain to produce the same effect.

As well as finding that some parts of the brain became less active during scratching, Yosipovitch and colleagues found that other parts became more active. This included activtation of both sides of the secondary somatosensory cortex, which is involved in pain, and the prefrontal cortex, which is linked to compulsive behaviour.

Other parts of the brain that also became bilaterally more active during scratching were the insular cortex, the inferior parietal lobe, and the cerebellum.

The activation of the prefrontal cortex, which is associated with compulsive behaviour, might explain the compulsive nature of scratching behaviour - the urge to keep on scratching, said the researchers.

There is one limitation to the study which could be significant, and that is the scratching was not done when itch was present. The scientists are carrying on with the research to see if they get the same results with chronic itch. They suggested that:

"Future studies that investigate the central effects of scratching in chronic itch conditions will be of high clinical relevance."

The researchers said it was important to find new treatments because moderate to severe itch bothers many people, for instance anyone with eczema, which in American alone affects 30 million people.

Another group that will benefit from new treatments are over 40 per cent of kidney dialysis patients, who have a 17 per cent higher risk of dying, probably because of lack of sleep, if they have itch.

Medical crisis

The humanitarian disaster in Iraq is being compounded by a mass exodus of their medical staff fleeing chronic violence and lawlessness. A report by Oxfam International shows the lack of doctors and nurses is fracturing a health system on the brink of collapse.

The research revealed that many hospitals, and medical teaching facilities in Baghdad have lost up to 80 per cent of their teaching staff. The dossier says Iraq is suffering from an appalling and largely hidden humanitarian crisis, away from the daily bombings, with millions of people in desperate need of help.

Medical staff received a large pay rise in the aftermath of the war with average salaries rising from as little as $25 (£12.50) a month to $ 300. But the lack of security and the ever-present threat of kidnappings and bomb attacks have persuaded an increasing number to seek safety abroad.

The children, as is the case in most conflicts, are among the worst-affected. Child malnutrition rates already as high as 19 per cent before the US led invasion, are now 28 per cent. More than 11 per cent of babies are born underweight, a rate tripled since the war.

Hospitals in the main cities face further security issues. The Yarmuk, in Baghdad, is regularly forced to treat members of the police and army, as well as militias, before seriously injured and ill civilians.

But, while international focus has been on the immediate and relentless violence, the country has been plunging into destitution with an internal and external exodus and entire communities suffering severe hardship.

The Oxfam dossier shows that four years after "liberation" by the US and Britain, more than 43 per cent of Iraqis suffer from "absolute poverty" and about half the population is unemployed. Of the four million dependant on food aid, only 60 per cent have access to the government-run distribution system, a dramatic decline from 96 per cent three years ago. A further sign of a society in disintegration, is the sheer numbers of refugees who have fled the country, and internally displaced people.

Four million Iraqis have fled homes, with half managing to escape abroad. The rest are in camps for the internally displaced which are often short of the most basic amenities. The latest figures show 32 per cent of them have no access to food rations and 51 per cent are fed intermittently.

Many of those who have fled are the very professionals who the US and Britain had claimed would build a democratic, stable, post-Saddam Iraq.

They include thousands of doctors and nurses, university and school teachers and business people. Also among them are water engineers who had helped maintain Iraq's crumbling sanitation infrastructure since the first Gulf War and the long years of American- and British-inspired United Nations sanctions. The number of Iraqis without access to adequate water supplies has risen from 50 to 70 per cent in the past four years and 80 per cent lack adequate sanitation.

The Tigris and the Euphrates, two of the great rivers of the Middle East and previously the source of sustenance to large tracts of the land, are now deeply polluted due to the discharge of untreated sewage. As a result, there has been a significant increase in the numbers affected by diarrhoea diseases, with the young, again the main sufferers.

Oxfam says: "The people of Iraq have a right, enshrined in international law, to material assistance that meets their humanitarian needs, and to protection, but this right is being neglected.

Billions of dollars are being spent on military operations by American and British forces in the country, but aid organisations complain of an acute shortage of funds.

But, although development aid, mainly concentrating on reconstruction projects, has undoubtedly risen, there has been a steep fall in funds for reconstruction. The report says "international donors have been slow to recognise the scale of humanitarian needs. Development aid from the Organisation for Economic Co-operation and Development (OECD) donors increased by 922 per cent between 2003 and 2005, funding for humanitarian assistance fell by 47 per cent."

Some aid agencies have refused to accept money from states which have troops in Iraq, because they feel this would compromise the security of their staff.