Monday, May 20, 2013

Melzack and Katz, Pain. Part 5: Pain and purpose

The paper, Pain.

Part 1 First two sentences
Part 2 Pain is personal
Part 3a Pain is more than sensation: Backdrop
Part 3b Pain is not receptor stimulation

Part 3c: Pain depends on everything ever experienced by an individual

Part 4: Pain is a multidimensional experience across time

To everyone who has hung in there with me, so far, we've made it through the abstract!
And now we continue. 
The introduction is as follows: 
"We all know that pain has many valuable functions. It often signals injury or disease and generates a wide range of behaviors to end it and to treat its causes. Chest pain, for example, may be a symptom of heart disease, and may compel us to seek a physician's help. Memories of past pain and suffering also serve as signals for us to avoid potentially dangerous situations. Yet another beneficial effect of pain, notably after serious injury or disease, is to make us rest, thereby promoting the body's healing processes. All of these actions induced by pain—to escape, avoid, or rest—have obvious value for survival."

Do we? Really? 
I dealt with this idea a bit in Part 1. Yes, chest or trunk pain will drive one off to see somebody. Is it the pain itself, though? or is it the fear that the pain gives rise to, or perhaps fear associated with unfamiliarity of a certain kind of pain, or a new place it is felt in, or the sudden intensity of it, that creates the motivation to pick up the phone? 

Trying to think back, my earliest recollection of pain: I was a child racing around on somebody's luxurious green lawn with some other children, age 5, at a large gathering of families out in the country, at a big farm, to host a political speaker. I had no prior knowledge that such a beautiful lawn had to be watered every day with underground sprinklers, or that the lawn contained depressions that housed the system. My right foot went into one of these, and I kept going, and I experienced the first truly painful and pain-sustained shock of my earthly existence. 

A howl came out of me that pierced through the entire assembly, I'm sure. Two women came straight over. One was my mother and another, an older lady who said she had nurse's training. My memory of my mother has always been that she had not been competent in containing my pain. She seemed flustered and unsure. Embarrassed. She didn't seem to know what to do. The other lady was kind, took my foot gently, asked me if I could move my toes.. held my foot for a few minutes. She talked gently to my mother, reassured her that I was going to live, that the ankle didn't seem to be broken, that I'd probably be fine. She asked me to stand up and try walking. I could walk, but every step was horrible. The ankle had already begun to swell; even on a child's slim ankle, they seemed not to see it. 

That was it. My mother seemed relieved, and from a few feet away, basically parroted back to me everything I had already heard the lady-who-used-to-be-a-nurse say. I would be alright. It was OK for me to walk around. I could go play again if I wanted to. 

This was not what I had needed from my main caregiver. I would have preferred just then, to have had an affectionate mother, a mom who acted like a bear, who would have ignored the crowd and her social role, who would have shoved all that aside with some sort of roar, who would have swept me into her arms and held me tight and said "there there, it's all going to be OK," no matter what noise I happened to be emitting at the time. But that was never my mom. She always felt exposed, needed to be on her own best behaviour, needed to interact with everyone else, absorbed any helpful psychosocial attention there happened to be available in every/any crisis situation. She couldn't ever produce any of her own child-appropriate psycho-social relational behaviour, not in public at least, and not in private either, that I recall. In public, it was always all about her, even when I was the smallest child. That is our relationship, right there. That is the core of our never-to-ever-be-healed, mother-daughter wound. My entire goal growing up was to never, ever be like her. So I chose to never, ever become an actual mother. I never wanted to inflict that sort of invisible pain on any other people, ever. 

The other lady handled me well, but I could have used a lot more contact for much longer just then. I would like to have had her hold my foot for a good hour, until it really did feel better. It was well and truly sprained. I limped for weeks, enduring the shots of pain that zapped me if I bent the ankle too much, like on stairs, the marble ones outside the hall in Weyburn, where we went as a family to even more political meetings all that fall. My mother never mentioned my ankle, ever again. Eventually the ankle got better on its own. To this day I experience tension in that foot, and it won't plantar flex as easily as does the other or as completely. I've had it treated as an adult, on occasion. I usually keep hidden all the emotional content and neurotags attached to the original injury, keep that separate while having it treated. But my brain can easily pick out who is kind and who isn't, just by how they make contact with my foot and the attached leg.

Such is the price of having a human brain attached to a critter brain in there, and having had a pain experience that wasn't particularly well-handled in the psycho-social sense, according to me. The orbito-frontal cortex is implicated in discernment of emotional aspects of physical contact. 

What did I learn as a small human having an acute pain experience? 
  • I learned that the overwhelming nociceptive barrage from an injury to a limb can and will go away eventually, but that dregs can remain in terms of motor output. 
  • I learned my mother was kind of useless when it came to being able to look after my sense of self with her sense of self. In all the other ways that mothers are mothers to other humans, she did just fine. But from that day, some little part of me felt like an orphan. Then got used to the feeling. 
  • I learned to hate pain. It may have even been then that the seeds were laid for a lifetime of becoming some kind of official pain-buster. I knew it would involve touching and handling and presence
  • I still hate pain. I learned that lesson very very well. 
I feel, in many ways, at the far end of a life lived peacefully as a human primate social groomer, that I dodged all sorts of bullets that ordinary life offers those whose eyes aren't very wide open. So yes, I feel that pain ripped a hole through previously unconsidered existence, that my brain learned a lot from that pain experience, and with its its own inherent confirmation bias, learned to make lemonade from sour lemons. 


The introduction, continued:
"Despite these beneficial aspects of pain, there are negative features that challenge our understanding of the puzzle of pain. What is the benefit of chronic phantom limb pain to an amputee whose stump has healed completely? The pain, not the physical impairment, prevents them from leading a normal life. Likewise, most backaches, headaches, muscle pains, nerve pains, pelvic pains, and facial pains serve no discernible purpose, are resistant to treatment, and are a catastrophe for the people who are afflicted."

I am of the opinion that pain is right there, right at the top of the heap of other useless crap our human brains churn out as symbolic content that has nothing whatever to do with anything.  See Sapolsky.
In my opinion pain is useless persistent human existential angst.
"Pain may be the warning signal that saves the lives of some people, but it destroys the lives of countless others. Chronic pains, clearly, are not a warning to prevent physical injury or disease. They are the disease—the result of neural mechanisms gone awry... In this section, we review past and current theories of pain, including the Neuromatrix theory which suggests brain mechanisms that may underlie some kinds of chronic pain and points to new forms of treatment."

You can say that again.
You can say that again. 

There are problems inherent in classifying chronic pain as a "disease,"  however. The debate rages on. But that is for some future blogpost. 

UPDATE: May 21
Check out the video, Dacher Keltner on Touch, about 8 minutes. Remarkable.

Here are some papers he has been involved in:
Hertenstein MJ, Keltner D, App B, Bulleit BA, Jaskolka AR; Touch communicates distinct emotions. Emotion. 2006 Aug; 6(3):528-33. (abstract)

A list of 65 papers he is involved in. Eight are full text.

Thank you to Tsvetan Vassilev for the find. 

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