by Dr Y.L.M
I was always curious about pain. Why do we suffer pain?
Pain is a sensation that is triggered by your nerves. It is extremely subjective. The International Association for the Study of Pain defines it as an 'unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage', although some experts argue that 'pain is whatever the patient says it is'.
Pain actually serves as a warning to the brain that some type of stimulus is causing or may cause damage to tissues or organs, and you should do something about it. Pain of this type is helpful.
But sometimes pain can be debilitating and taxing – especially when you already know what is causing it and are already in the process of treating it, and yet the pain is there – niggling at you, wearing it down. This is more common in chronic pain.
How do we feel pain?
Pain perception is called nociception (noci = Latin for 'hurt').
The stimulus that causes pain can be a cut, puncture, pressure, or burn, either from an external or internal source (your bodily organs). Examples include a cut from a knife, scalding from boiling water, labour pains, gastric pains, and so on.
A nerve ending embedded into the place of contact in your tissue or organs then senses the pain. Pain receptors relay signals through the pain nerve pathways to your spinal cord via their dorsal roots.
In the spinal cord, the sensation is transmitted to the brain via special tracts.
The part of the brain called the thalamus receives the information for further processing and action, and will further relay the message to various parts of the brain.
Do we react subconsciously or consciously when we feel pain?
We do both. The pain impulses conveyed to the brain can cause your muscles to subconsciously contract, thus distancing the organ from the painful stimulus. You can also consciously distance yourself away from the stimulus, e,g. quickly withdrawing your hand from a boiling kettle.
It is believed our brains can influence how we perceive pain. Your brain, for example, can reduce the pain from a cut to a lower 'perceived' intensity.
You can even consciously 'not think about the pain'. And people who are given placebos sometimes say their pain diminishes, as do people who do meditation and breathing exercises for labour.
What types of pain are there?
There is acute pain, usually caused by an injury. It is useful because it warns of potential hurt to your body and you have to do something about it quickly. It can develop slowly or quickly and usually goes away when the injury heals. Examples include fracture pain, and gastric pain.
Chronic pain is pain that persists for longer after the initial trauma has healed. This usually lasts 6 months or more. Cancer pain is associated with cancer growth.
I have read of people who are unable to feel pain. Is there such a thing?
A lot of people with advanced and uncontrolled diabetes have 'peripheral neuropathy', which means their pain nerve fibres have been affected and have ceased to function as well as they should. Because these people are unable to feel pain, they are prone to ulcers (diabetic ulcers), and subsequently gangrene.
If you are unable to feel pain, you would not be able to take your foot out of a hot water tub if it is too hot for you. You would not be able to jump away if a nail was sticking into the bottom of your soles. There will be plenty of ways for you to incur an injury that you are not aware of.
There is also a condition called congenital analgesia. It is very rare and genetic in origin. Here, the patient is unable to feel pain at all. This is not a good thing!
How do we treat pain?
There are plenty of drugs that can do this. Even in prehistoric times, man has always been on the lookout for herbs or leaves to alleviate pain.
From the willow bark extract, we get one of our earliest commercial painkillers – the NSAIDS (Non-Steroidal Anti-Inflammatory Drugs). Then in the last decade, the COX2 inhibitors came in without the gastric effects.
Even more powerful are the opioids (pethidine, morphine) and opioid derivatives (codeine), though people tend to prescribe them with care because they are addictive.
Physiotherapy can also help alleviate pain, as well as acupuncture – which seems to work wonderfully for people suffering with chronic pain, but have been pooh-poohed by the West because of lack of evidence.
Psychological techniques have also been used to help patients live with chronic pain.
More info on PAIN here.
by Dr Y.L.M