What in the world?
Pain – it’s all in your head.
Science without all the scientific jargon
“A human female, extremely cautious, and given to oppositional behavior, was questioned as to the dynamic state of her cultivated tract of land used for production of various types of flora. The tract components were enumerated as argentous tone-producing agents, a rare species of oceanic growth and pulchritudinous young females situated in a linear orientation.” *
The previous was, of course, a popular nursery rhyme composed as if a scientist had written it. The following article about the complexities of pain will not be written in such a fashion.
We will discuss pain in layman’s terms, such as that used with friends while waiting in line at the IGA. And when the use of a fifty-cent medical term is necessary, I will call my friend, Dr. Janet, and de-technicalize it.
A painful story.
As a child in grade school, I would occasionally sprain my left ankle while playing games on the playground. The school nurse always reminded me that I had a “weak” ankle.
Unfortunately, my teachers used the very same word to describe my learning abilities.
There came a point in my life where every time I caused the slightest bit of pain to the left ankle, I instantaneously saw an image of a city street with large buildings rising along both sides. This photo-like image never varied through the years.
A specific and vivid mental image concurrent with pain made no sense to me until one day, several years ago.
I was visiting friends in Columbus, Ohio, a city where I had once lived. One of my friends needed a lift downtown to her job. I had not been downtown in many years as most of my friends lived in the suburbs.
After dropping off my friend, I began searching for a street that would return me to the inner-belt and came upon Fourth Street. Shortly after turning onto Fourth Street, I started to feel intense pain in my left ankle, so I pulled off and parked the car.
Sitting in that car and looking down that city street reminded me of an incident when I was a 19-year-old surveyor’s assistant. I got out of the car and walked south on Fourth Street until I found what I was looking for.
A concrete wall rose eight-feet above the sidewalk, enclosing the Greyhound Bus Station. I was at that exact same spot in 1969 when the bus station was under construction. Furthermore, I was on top of that wall setting a benchmark on the capstone.
Rather than use the ladder to get back down to the sidewalk, I foolishly jumped. I landed on the sidewalk facing north as a shocking pain took hold of me. Once again, I had injured my left ankle.
Somehow the image of that city street and the pain associated with a sprained ankle became entangled in my brain’s circuitry. Ankle pain brought forth the image, and the image brought forth ankle pain.
That single image was hard-wired into my brain in a split-second incident that took place 47 years earlier. And that episodic memory was tied to the sensation of pain thereafter.
I wonder; if I had been listening to Bad Moon Rising by CCR when I hurt my ankle, would it be prudent to avoid listening to the Top Ten Hits of 1969? Perhaps!
What is pain and how does it work?
According to the International Association for the Study of Pain, it is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.”
Let’s say you stubbed your toe on a bed leg as you returned from the fridge with a midnight snack of ice cream, chopped pecans, and sprinkles. The resultant pain would be picked up initially by receptors in the skin at the end of your big toe. And we have about 200 such receptors for every square centimeter of the skin surface.
The pain message transfers to fast nerve fibers that send it up the leg to the spinal cord. From there, it goes to the brain, where several areas of the brain are alerted. These neural functions conclude that, indeed, the tip of your big toe on the left leg has come into contact with an unmoving object.
The brain has determined that you should know this piece of information – by way of pain.
About the same time, other receptors in the area of impact send a somewhat slower message to spinal nerve fibers, and this message is then transferred on to the brain.
Neural functions in the brain deduce that there is danger present at or near the big toe and that you should probably do something about it. Pain serves as our protector, at least initially.
Meanwhile, you are hopping around the bedroom, calling forth words seldom used in the presence of your loved ones. You are in pain, and no amount of ice cream or colorful language will help you now.
A very short history of pain management
As late as a few decades ago, pain was treated as a way to make patients feel better, not to get better. Treatment of pain was predicated on the use of pain-blocking drugs.
We know what can happen when addictive drugs are the standard treatment for pain, especially long-term pain. People become addicted without resolving the pain.
Dr. John J. Bonica is recognized as the founding father of the discipline of pain treatment. As late as 1970, he noted that after carefully reading more than 14,000 pages on the medical treatment of injuries, only 17 pages even mentioned the word pain.
Today, neuroscience is making great strides in understanding the complexities of pain. We are just now beginning to understand how chronic (persistent) pain works. As we shall see a little later in this article, when pain becomes chronic, we must look to the brain for answers.
And to make functions of pain even stranger, those answers may not reside in the conscious mind.
Acute or persistent pain?
What we think of as physical pain is not actually situated at the injury site. As the old phrase goes, “It’s all in your head.”
Most injuries heal, particularly those such as stubbed and broken toes. As the injury heals, we experience a gradual reduction in pain until we are pain-free. This is called acute pain.
In other cases, the brain goes into an overprotective mode, often long after the initial injury has healed. This painful condition is referred to as persistent or chronic pain.
In a real sense, persistent pain becomes a disease in its own right.
Throughout much of medical history, pain has not been fully understood. We now know there are multiple inputs from areas other than the original injury.
A 2016 Centers for Disease Control and Prevention bulletin estimates that 20.4% of U.S. adults have chronic pain and 8% of U.S. adults have high-impact chronic pain. High-impact pain means that pain is restricting or interfering with work and other activities for six months or more.
The cost of pain in the U.S. is staggering, some $635 billion per year. Pain is costlier than diabetes, cancer and heart disease combined.
In next week’s Watoga Trail Report, we will examine new treatment methods for chronic pain. We will also explore “phantom pain” syndrome, pain that we feel is coming from an amputated body part.
We will also talk about an experience of being bitten by the second deadliest snake in the world and how that moved the victim, a doctor, to make new inroads into clinical pain management.
Warning: If you are a tourist wandering around the streets of Paris and you see a sign over a shop door saying PAIN, do not run the other way thinking it is one of those kinky sadomasochism joints. Pain is the word for bread in French, and a baguette has never caused pain to anyone – yet.
Here’s wishing you a pain-free week,
*Oh yeah, the nursery rhyme at the start of this piece? None other than “Mary, Mary, quite contrary…” But you knew that!