Saturday, August 13, 2011

Killing Pain Part II

Yesterday I wrote a florid limbic account of my episode of "frozen shoulder", experiencing the crippling, spreading sort of pain for the first time in my life, how I coped with it, and managed to get my brain back on track, so it could defend properly and not give me a lot of pain noise I didn't need, that no one needs. 

Today, I thought I'd deconstruct it all.
Here is what I've got so far:

This is a slide I made a few months ago for a presentation on the Neuromatrix model of pain. The overall gist of the presentation was rostral mechanisms and how they are involved in pain production and reduction. The subtopic for which this slide (and the next) was used, was Sensory-Discriminative; Descending Modulation.

Here we see flight/fight reponse, whereby an animal, or any vertebrate for that matter, including human, can defend itself to the death by deliberately ignoring cuts/bites/scrapes, with resolve fueled by noradrenaline. I really don't know that it's completely analgesic, but it likely allows the animal to ignore all the nociception with which it is being flooded in the moment. If it's being attacked (e.g., for food), it will try to escape. It still needs its wits to do that.

This descending modulation is activated by the hypothalamus based on input from more rostral centers which are reporting to the animal's brain about the direct context, what's going on in the environment in the moment - the dorsolateral portion of the periaqueductal grey is activated. 

Here, we see a different kind of response, passing out completely.
This is activated when all hope is lost. Much more conserving of the organism's energy.

The ventrolateral part of the PAG is activated instead. The animal "escapes" by going unconscious. I guess enough possums have lived on to reproduce by doing this, that they've evolved this tactic as their primary defense.

Here are the thoughts about the encounter with pain that I've entertained today.

1. I needed a fight/flight response to kick in ("Kill" or "be killed"). My dorsolateral prefrontal cortex knew that I wasn't in any actual danger. It had to access this system however, even in the absence of any real danger.

2. I was in complete control of the process. I had complete locus of control of the event. I directed my therapist and she adapted herself to me.

3. I had a lot of pain education - i.e., I knew pain wouldn't actually kill me, regardless of how threatening it felt.

4. It was, actually, a novel experience to have this magnitude of pain. I'd never experienced anything like it in severity and pain restriction, especially this awful spreading quality. I think the spreading quality concerned/scared me the most.

5. I managed to take fear and change it to fighting fury (elicited a noradrenergic response). I asked the therapist to treat what I figured was the core of the physical bit of the whole problem (exerted locus of control). The pain spread like wildfire - I could feel it but I did not let it deter me (noradrenergic resolve). Then, but only then, I let the part of the threat detector/pain production system that is part of the frontal lobes (anterior cingulate cortex) take over and "run away" immediately following (permitted ideomotor movement), but only after "I" (my dorsolateral prefrontal cortex) showed it who was really boss, by controlling the timing.

6. Although I didn't collapse in an unconscious heap, some part of my brain might have, because the opioids finally kicked in. Perhaps the dorsolateral prefrontal cortex got mean enough (in a controlled environment) that both the dorsolateral part of periaqueductal grey AND the ventrolateral part of PAG were activated simultaneously: the DLPAG fought and snarled and ran, the VLPAG felt sufficiently attacked that it "fainted" and let go of a big gob of all the necessary opioids such that I got the much needed relief I wanted.

7. It all felt very life-and-death dramatic, but I entered the encounter knowing that these centers were the ones that respond to actual life and death stuff, so I didn't mind the heavy emotional powering up that occurred.

8. I was determined to come out the other end feeling better - so the dopamine was clearly flowing from the expectation, probably was a factor, may have helped via various pathways.

9. The therapist was great. No nocebo from her at all - no cholecystokinin was triggered, which would have interfered big time.

10. I was free, and felt free, to manage my PAG and stimulate it from rostral centers using
  • emotions (HATING pain, determination, focus, no-nonsense, I WON'T put up with this, I WILL construct a boundary between me and this Pain) as fuel
  • information (I won't die if I try this, pain is just my brain being freaked out about something, it's not likely any big deal, it's only pain, I didn't injure anything lately) as message containers
  • social context/therapeutic contact (I'm appalled by so much of what I see in the world, and my own body is where I should have the right to feel safe (dammit)/ my therapist is here to help me, I have locus of control) as delivery chutes
11. Even though I'd never done such a thing before, it worked. So I guess it can be done. Sample of one. Now that I've done it once, next time (should there be a next time - there may not ever have to be a next time) it should be easier. (Optimistic thought)

 I've also learned that help is there when I need it.

 Other posts on the topic:

Killing Pain

Killing Pain Part III

Killing Pain Part IV

Killing Pain Part V 

Killing Pain Part VI

Somasimple discussion thread about this post series.  

Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal. 

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