Thursday, February 4, 2010

thoughts on nociception, the anterolateral system & other such painful things...

Ironically, as I sat on my couch to study yesterday after taking a break to cry my way through ten or twelve Kleenex, I realized I was learning about pain. It’s funny how a medical neuroscience course can boil something like that down to a PowerPoint presentation. Twenty slides on pain and temperature receptors, nerve receptors, and sensitization effects. The next day, sixty slides on the anatomy of the spinal cord tracts corresponding to this system. And boom, we know everything there is to know about pain. Did you know that something stimulate pain receptors in your skin, muscles, joints, or internal organs, your body automatically activates two separate analgesic or pain relief pathways that fire neurons to release norepinephrine and opiate compounds to lessen the amount of pain you are feeling? It’s kind of amazing.

I consider myself pretty lucky that I’ve never experienced any sort of intense physical pain. I broke my arm when I was 10 or so, but I honestly don’t even remember it hurting that badly. And sure, I’ve had the occasional headache and backache or twisted ankle as much as the next guy, and I’m definitely a wimp about it, but I’ve never had to experience the physical things some people have to go through – I’ve never been shot or stabbed, never broken a major bone, never gotten struck by lightning, et cetera. So it seems really great and everything for me to sit here and talk about the body’s natural pain relief system. But what do I really know about it? And who’s to say that what is incredibly painful to one person may not be as much to another? There’s no way to quantify it. We are taught to ask patients to rate their pain on a scale of 1 to 10, but again, it means nothing. (Although here’s another pearl of knowledge: women are known to have a higher pain tolerance than men. It’s thought to be that way so we are more prepared for childbirth. Interesting, no?)

Have you ever heard of “psychosomatic” pain? Historically, patients who were depressed complained of body pains that were dismissed for years by doctors. But it is now known that depression results from a deficit in serotonin or norepinephrine, two neurotransmitters. The deficiency of these two neurotransmitters can have widespread effects on the brain and nervous system, one of which is to make the analgesic pathways less effective. The same two chemicals that put you in a good mood are the ones that alleviate physical pain.

There’s one other method your body uses for pain relief. The activation of mechanical receptors coming from the same area of skin as the pain signal actually sends your brain a signal to inhibit the pain pathway. So physically touching or rubbing an area of skin that hurts actually does make it better. Maybe the concept of “healing touch” isn’t so crazy after all.

I know you’re expecting me to make some type of elaborate metaphor comparing emotional pain and somatic pain. But does it even need to be made? Are they really that different? As I said earlier, by no means do I claim to understand physical pain. Likewise, I am not going to pretend I’ve experienced as much emotional pain and heartbreak as most people in the world probably have. I do like to think, though, that I can find some comfort from what I’ve learned about the body and apply it to the intangible as well. Because, just like a scraped knee or a punch in the gut, it’s going to heal. With time, and lots of hugs, it’s going to get better. Not right away, and there will probably be scars for awhile, but the body has a remarkable ability to keep on going even when horrible things happen to it – and I’d like to think the same is true of the person inside the body.

let me know that You hear me
let me know Your touch
let me know that You love me
let that be enough.

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