Caught up with a couple of old podcasts at the weekend, including a December edition of Scientific American’s Science Talk, on “The Science of Pain”. This feature an interview with (and excerpts from a talk by) Sean Mackey, a former engineer who is now the director of the Stanford Systems Neuroscience and Pain Lab.
The SciAm link includes a transcript of the episode, but it’s worth listening to the MP3 just to hear the audience reactions when Mackey plays video clips of sportspeople suffering horrendous injuries. (He doesn’t show a particularly famous clip, of Joe Theismann suffering a compound leg fracture, because “Too many people have seen it, they have become desensitized”.)
The purpose of this was to illustrate Mackey’s studies into empathy. His team found that watching other people suffer pain engages some of the same parts of the brain that are engaged when we suffer pain ourselves. In other words, there is a strong scientific basis behind the exclamation, “Oof! I felt that!”
What I found especially interesting – and the reason why I highly recommend listening to the podcast – was Mackey’s emphasis on the need to treat pain, not just as the byproduct of underlying physical causes, but as a disease in itself.
When we suffer an injury, the resulting pain causes “neuroplasticity”. In other words, the experience of pain involves a change in the brain and nervous system: “networks and neurons rewiring and changing their function”. As Mackey explains, in most circumstances this is a good thing:
We sprain an ankle, we cut our hand, after a period of time, over period of hours of a course of the day, we get neuroplastic changes and it sends a signal to us to protect that injured limb; and it’s highly beneficial because if we didn’t have that message, that signal, that behavior that was being generated, we would go out and continue to injure that limb over and over again.
In most cases, these neuroplastic changes are reversed once the physical injury has healed. However, in chronic pain the neuroplastic changes are not reversed, and may even continue to spread through the body.
This has an importance consequence in terms of how pain is treated:
We realize more and more that it’s better to prevent the pain rather than to try to treat it after the fact […]. And there are a number of studies now that show the preventative measures can have a big impact in reducing the number of people who go on to have chronic pain.
In other words, if we suffer pain (e.g. following an injury or surgery), treating that pain quickly and aggressively will not only ease the immediate symptoms of pain, but make it less likely that the pain will become chronic. So it may be a mistake to forego painkillers out of a desire to “tough it out”: those painkillers are not just masking the immediate feeling of pain, but may be helping avoid longer-term effects.
Mackey also observes how the “softer” side of pain treatment can have a beneficial effect on patients. Merely treating pain as a disease in itself “has helped a lot of patients from a validation standpoint”: those suffering pain without any apparent physical cause no longer feel it is just something “in their heads”, and are empowered to seek treatment for their pain condition. And Mackey describes how his experience of dealing with patients has changed his own attitude:
I was a believer in the biomedical model that you find the disease, you find the source of injury or pathology, you give the pill, you reverse the condition and the person is cured. And it took me a long time to realize just how terribly wrong I was. I learned that through spending time with patients. In working in the pain clinic and seeing that it wasn’t so much that the injection, the needle, the procedure, the pill that I was giving them that was making them better. It was actually talking with them. It was understanding their painful condition, where were they coming from and what were the factors that were influencing their pain, and it was important then that that we may need to understand that.
A fascinating interview, and one with a very direct practical application next time any of us suffers an injury or goes in for an operation. And if you know anyone suffering from chronic pain, this may encourage you to suggest they ask their doctor to refer them to a specialist pain clinic.