The science of pain

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.

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5 Responses to The science of pain

  1. steve martin says:

    Thanks for the great post concerning ‘pain’.

    I have a chronic nueropathic pain that is now under control with 500mg of Lyrica per day.

    It is an amazing drug, and one that I could not live without.

    My doctor couldn’t even explain to me (very well) how the drug works. But it does!

  2. Rick Ritchie says:

    Good subject. I like reading in this area. Not just pain, but neurological differences among people. As I discover a new spectrum in these areas, I often find that even if I am somewhere in the middle of the spectrum, people on either end can be blissfully unaware that there is a spectrum. (e.g. Morning people and night owls often travel in completely different circles. I am in the middle, but when I was on prednisone for a time, I remember getting up for early service without an alarm clock after four hours of sleep. And looking around at the people during coffee hour, I realized that many were like that all the time.)

    As to pain itself, I know that some go through pain-free lives. One friend told me he had had perhaps five headaches in his entire life. I’ve had some weeks where for sinus pain I took enough Benadryl to kill a horse. But I have other friends who live in chronic pain where each day is almost unbearable. But I have had weeks and months where there was no interference whatsoever in daily living.

    In any case I know that some imagine that with a little change in attitude, this should all be no problem. While I have times where I can imagine that and project it as a reality for everyone, I know better. And those who have experienced terrible pain may take measures to avoid it that few could understand. Well, I’m glad the issue is getting attention. The problem is, these self-protective mechanisms are there for a reason. They do keep people from flourishing, but they also keep them alive. And our wiring is more attuned to prolonging life than making it more enjoyable, even if our stated philosophies would have us do otherwise.

  3. Rev. Alex Klages says:

    To some extent, this is why pastors have long been charged with visiting the sick and injured… talking, empathizing, etc are all part of the healing process. Brings God back into the mix.

  4. steve martin says:

    “… talking, empathizing, etc are all part of the healing process. Brings God back into the mix.”

    We should never forget that! Even in our pain..especially in our pain.

  5. A ICU nurse I know will rant at the drop of a hat that “Pain can kill! Just pain! Can kill!!!” She quotes (at length) studies showing that patients whose pain is not controlled are, all other aspect of their condition being equal, more likely to die.

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