(Or how to deceive pain and live happily ever after)
My daughter is studying medicine. And like all proud fathers, I enjoy hearing and learning about what she is studying. Sometimes she sends me a PDF or an audio file that she thinks might be interesting.
As an old soldier with a diagnosis called PTSD, I am of course interested in a medical explanation for things that happens in body and soul.
Especially the soul part of the equation. The psychological aspect behind the pain experience. A science that has largely been ridiculed and marginalized because it is a science that still does not have too many definitive answers.
Table of content
A lecture on pain
The newest thing she sent me was a lecture on pain.
Previously it was thought that pain was mechanically connected to nociception, ie that in all pain there was an activation of nerve fiber which conducts pain signal to the brain
In the Enlightenment, the philosopher Descartes defended this view, and his views left deep traces in medicine in the following centuries. That misconception gave rise to pain being treated incorrectly. Attempts have been made to relieve long-term pain conditions by cutting both peripheral nerves and by cutting / damaging parts of the central nervous system.
The erroneous conclusion gave an exaggerated belief that painkillers were a central part of the treatment for all types of pain conditions.
The ability to feel pain
In medicine, one often thinks of pain as a problem that needs to be treated or a condition that should be alleviated. However, our ability to feel pain is fundamental to survival and health. People who are born without the ability to feel pain (congenital analgesia), have a very serious condition.
Throughout childhood, children need to be cared for very carefully so that they do not get seriously injured. Impaired ability to feel pain is also a central part of several diseases. The most common sensitivity to pain is peripheral neuropathy in diabetes, where the inability to feel pain gives rise to severe sores on the feet because you do not notice that you have stones in the shoe or that you are developing chafing.
In leprosy, too, a reduced ability to feel pain is a serious consequence of the disease.
It will be too extensive (and I lose you as a reader) if I am to bother you with all the details around the concept of pain and why we humans would not have survived without the opportunity to feel pain. But here I will reproduce some of what surprised me most when I read what she sent me.
Did you know that the pain experience can be easily deceived?
The nerve fibers that send the signal for pain to the brain have a certain capacity. If you exceed this capacity, the signal will not be larger in any case. It has a maximum limit. The speed at which the signal is transmitted through our nerve fibers also has a maximum speed. 60 kb per second.
It is the time it takes from the time we receive the pain in an extremity (such as a finger or a foot) and the time it takes before it is registered in our brain. You may have noticed that when you burn yourself, it takes some time, a fraction of a second, before you actually “feel” the pain. It is the speed at which the signal is transmitted that determines it.
Pain as the medical profession sees it is divided into four points.
- Perception
- Attention
- Learning
- Emotions
Perception
Perception only means that some form of information acquired through the senses is transformed into an experience. And it also tells about how we can be tricked into thinking that something is painful when it really is not.
Thermal grill is one of those methods that tricks our head.
Hot (40 ° C) and cold (20 ° C) elements alternately give a feeling of burning pain even though 40 clesius isn’t too hot, and the cold, 20 celsius is only nice, I guess. But put together, it gives a burning feeling.
Pain and attention
Pain makes us more distractible (Moore et al 2012) This may not be so surprising.
Hypervigilance: Continuous monitoring of the body (Grombez, et al 2005)
In we experience pain, we automatically begin to look for the pain in the body. And with that, we lower the threshold for feeling actual pain. The smallest little thing that we otherwise would not have considered to be painful, hurts.
Attentional bias: “Prioritizes” pain-related information (Grombez et al 2012; Brooks et al 2018)
When we have full focus on the pain, it is difficult not to feel an increase in pain.
The opposite is true of so-called learning.
Learning meaning a sensory adaptation or habituation. If we have a repeated / constant stimulation it leads to reduced synaptic efficiency. Slightly simpler said: it means that when you wear a wedding ring or a piece of jewelery or a watch strap, it can feel strange and maybe a little painful at first. But as we get used to the feeling, the experience of discomfort and pain disappears.
But it can also have the opposite effect.
Sensitization is when we have a repeated / strong stimuli and that can lead to increased synaptic efficiency. For example: increased pain sensitivity is when the pain lasts after the injury has healed.
People have a lot of emotions.
We have
What you may not know is that the spectrum of emotions we show, modulates pain.
In short: Positive emotions reduce pain.
Negative emotions increase pain with low to moderate activation.
At high activation, this changes.. In other words, you can not smile away from a gunshot wound, but you can have a positive attitude towards minor pain and lower the feeling of it.
Yeah, okay, but what does all this mean?
It’s easier than you think to get the pain distracted. For example, by blowing on a wound, you give a mixed signal to the nerve fibers (the blowing must also be sent up to the brain) The result is that you reduce the experience of pain. Blowing on a wound on a child who has been injured, actually works.
Placebo works - or smile and the pain goes away
The expectation that something will work makes it work. Experiments have been made with pills where the receivers has been aware that they were chewing sugar pills. Nevertheless, an objective improvement in the pain level was determined in those who took the pills. In other words, the body reacted to the expectation that the pills would help.
And did you know that there is a reason why doctors tell you that they give you a painkiller before they actually give you the pill?
The reason is precisely because of the placebo effect. By telling it in advance, the brain and body adjust to an expectation and this leads to an increase in the effect on the actual painkiller that the patient receives. Believe it or not, this is how our body and head work.
Although we have known about this intuitively for many centuries, we have many times dismissed it as nonsense. It still turns out that the old, wise people and medicine men / women knew what we can scientifically prove today.
For me, this means that body and soul are definitely connected. In many more ways than we think.
And that a healthy mental attitude (read: positive attitude to life) alleviates the pain.