Pain is more complex than you might think


V0009352 The face of a man expressing simple bodily pain. Engraving b Credit: Wellcome Library, London. Wellcome Images The face of a man expressing simple bodily pain. Engraving by M. Engelbrecht (?), 1732, after C. Le Brun. 1732 By: Charles Le Brunafter: Martin EngelbrechtPublished: 1732 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

by Bill Adamson

Pain is useful. Pain is necessary for life. Pain is fatiguing. Pain is annoying. Pain is in your head. Pain can be emotional. Pain can be physical. Pain is misunderstood.

Pain is fascinating.

We, the collective we of science, have learnt more about pain in the last 20 years than in all the years prior, and it’s incredible.

The Ancient Greek philosophers used to discuss pain as the opposite emotion to pleasure: that enjoyable things in life were enjoyable due to the absence of pain.

They made no distinction between physical pain and emotional pain and regarded the two as opposite sides of the same coin.

Unfortunately for the people of the time the most common cure for pain in Rome and Greece was alcohol. From opium and coca leaves to cupping and meditative trance-like states, every culture has its own way of alleviating or coping with pain.

Medicine men of the Middle Ages would soak a sea sponge in a concoction of opium, hemlock, alcohol and willow bark, dry it out and sell it. The pain sufferer could then wet it and suck on it as required.

But it wasn’t until René Descartes in the 1600s that serious discussion as to the origin, purpose and mechanism of pain took place.

His theory was that when you hurt a part of your body that information would be transferred via the hollow tube of a nerve through your limb to your spinal cord and then up to the brain, notifying it that you had hurt a limb.

Not a bad theory for someone who wasn’t allowed to do much unsanctioned dissecting of bodies (the Church had a habit of burning the bodies of those that dabbled too much in dissection), but wrong nonetheless.

The problem with Descartes’ theory is that it implies that tissue damage commensurately correlates with pain. But that doesn’t explain the odd bruise that will turn up on a leg or arm that didn’t hurt at the time or now unless you poke it.

It doesn’t explain an incident when, as an eight-year-old, I returned to the barbecue from rock scrambling at the Williamstown back beach, turned my hand out to get a sausage in bread and noticed copious amounts of blood running from a rather large gash.

The story goes that I screamed and then fainted, but because I can’t remember the event it is still in debate.

Whatever happened, the tissue damage would have occurred at some point in the previous 30 minutes but I had not felt pain until sighting the wound.

So how does that work?

The analogy of neuroscientist David Eagleman is that the brain is like the boardroom of a very large company.

Like any boardroom there are differing views and standpoints on whatever issue is being presented.

As I was rock scrabbling with my mates, my brain would have been receiving a lot of information about the sharpness of the rocks I was clutching with my hands. I would have been having a great time.

At some point I must have cut myself. That information would have been transferred via some nerves to my brain and the brain would have had to assess the risk of damage.

Because that is what pain is — a projection of fear of damage by the boardroom of the brain.

My eight-year-old brain would have been receiving a lot of information about the sharp rocks. When the message of damage came in the boardroom would have looked at the message, thought about it (in less than a microsecond) and turfed it out.

“Nope, nothing about this is right, the nerve has just got confused, of course there are sharp stimuli on the hands, we’re clambering all over a bunch of rocks, you dingbat.”

But when I turned my hands up to receive the snag roll with tomato sauce, my eyes then transferred indisputable evidence that damage had occurred when rock scrambling.

The boardroom would then have very quickly done a backflip — “Many apologies, nerve, you are totally right, we’re out” — as I fainted with shock.

The message of this tale is that pain is complex. Pain is not necessarily a pure translation of tissue damage. A great many factors influence it.

If you’ve had an injury before, or a friend has suffered one, the influence on that boardroom discussion will be different.

Likewise, if you’re super-stressed and anxious about other issues, the boardroom may ramp up its perception of the threat of damage.

In practice I see a wide variety of presenting pain paradigms, the longer they are around the more factors involved. One thing that is certain is that the body is pretty clever.

No matter how long or short a time the pain has been around there is always a way to alleviate it; it is just a matter of convincing the boardroom everything is okay. This can come from surgery or from hands-on care, exercises, education and understanding, the judicious use of painkillers and, of course, a little bit of laughter.

Bill Adamson is an osteopath practising at Errol St Osteo.


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