Here is an attempt to use an analogy to make the words, “central pain”, more understandable. After all, there is no valid vocabulary where there is no shared human experience to give meaning to the words. Computers have something analogous to CP.
Central Pain is “Copy and Paste” gone mad in the genes of the pain neurons. Cancer is when cells don’t know to stop from dividing. Central Pain is when the genes don’t know to stop making pain proteins. The pain proteins are assembled and spewed out in what becomes a huge war effort to warn the body, even if no injury, nor even any external stimulus, is occurring. The homepage of our consciousness has been hijacked by a “virus”. The pain message is always displayed on the “screen” of the awareness. This virus is not just in the registry of our thalamus, it is embedded down in the pain nerves where a “soup” of pain chemicals and abnormal ion channels is always brewing. Translated: Severe CP is very painful, in fact, it is the most severe pain state known to mankind.
The spontaneous pain of CP is automatic. It requires no input from the external world, no new injury beyond that which has already occurred to the nervous system. The evoked pain, the really devastating pain of CP requires some stimulus, however minor. When something benign, such as light touch, is actually occurring, then the system goes completely beserk.
The gene factories in the chromosomes of the neuron are converted to manufacturing plants of acidifying chemicals, to send an “urgent” pain signal, to make sure the neurons cannot ignore the fact that the sky is falling in. It is a pain system run by “the Chicken Little virus”. The control apparatus is almost irrelevant, since the inhibitory wing of the neuron is more fragile and has been disabled by the failure of the ability to move negative ions such as chloride to the cell membrane. (Negative ions are inhibitor, positive ones are excitatory) A neuron which is not under control of the brain is not really a true neuron. It is an entity unto itself, something new and frightening, and it does not know how to behave. It is a life form which produces pain chemicals. Without control, that is a useless function.
More than useless, it is destructive, as we know meaningless pain to be. Confused by the verbal descriptions, and assuming that “pain” means “pain” as it is commonly known, some centers shunt such subjects off to conversation groups, but this will not change the ongoing chemical process. Lab animals given CP do atrocious things such as chewing off affected limbs (autotomy). Treating central pain like a mood disorder trivializes it. Those who reject such nostrums are labeled as uncooperative. That presumes the pain chemistry is under control of the will, and that is exactly what is missing in CP. The brain cannot get to the severed neurons to tell them to shut down.
Pain “Pop Ups” continually fill the screen. Opioids usch as oxycontin may help lancinating and muscle pains, but they do not generally touch the dysesthetic burning. The CP sufferer can then only attempt to quiet the Central Nervous System generally. Avoidance of stress is still the best coping mechanism. It cannot be called a remedy.
CP makes one a slave to the past, an event of nerve injury. Control has been taken away from their lives. It is difficult to form a new plan, one which society cannot provide because it has no knowledge, and lack even the imagination of central pain. We all know how public typically reacts to the unreal and indescribable.
CP is not really in this category, however, since it is easily induced in lab animals (from rodent to primate) by lasering or striking the cord, where its consequences may be observed. These effects are not pretty and the examiner risks the uncomfortable feeling they have committed a monstrous act to the animal. What kind of disease is it in which mute animals must do the speaking for us. This is largely avoidable if the public would simply listen, but they will not. Humans with CP owe a debt to the Sprague Dawley lab rat,as do those with many other illnesses. A minor form of nerve injury pain can also be induced by injecting capsaicin under the skin. This lacks the MIX of pains of true CP but it gives a vague idea of the burning involved.
It is amazing the eloquence of injecting a little capsaicin SubQ in one little area of the skin in a grad student. It takes CP out of the unreal and places it into the unthinkable. Or course, real CP subjects have the same thing and more, sometimes everywhere in the body, and nearly always much more severely. We talk and so the examiner assumes that is what CP is like. But the really severe cases resent being classed as mreely “painful” and say little or nothing. They are waiting for someone to listen, with ears to hear, someone who realizes that horror invests the pain, that the CP patient really belongs in a hospital.
The good life is said to be the maintaining of freedom, unrestricted by oppressors, bad habits or illness. Some call this the “freedom to be me”. The “Most Unkindest Cut of All”, Central Pain severs a great deal of free choice. Do life and the shape of life progress gradually, one step at a time; or do the big days and events explain nearly everything? The recent movie, “The Final Cut” deals with the impact of a single day on an entire life. Few with central pain would disagree with the premise.
Evidence is mounting that the brain is quantal. There are steps us and steps down, which reflect at the finest level, synapses which have formed between neurons.
Is life made of bricks and blocks and prestructured panels, or is it made of stucco? Based on current brain research, it is coming up packaged, compartmentalized, sometimes frighteningly so. For example, POW’s with harsh treatment may never get over it. Although there were some who came out of the Bataan Death March relatively whole, there were also those of whom it was said, “It would have been better had they not survived.” All probably came out of the prison camp packaged, but some of the packages did not work. It is not clear whether these individuals who struggled on were altered by vitamin deficiences (some were rendered blind by it) and the effects on the brain or whether it was the harsh treatment. Whatever it was shaped, imprinted, routed and almost scripted the remainder of life. This is frightening. We want to feel free, not scripted. We want to feel life is full of continual choices, not fixated and frozen. We do not want our lives to be constructed of one experience.
However, there is mounting evidence that the brain is not forever young and actually may “set up” or “harden” in a harmful way. The old dog may not actually be able to learn new tricks. In recent years, there has been near unanimity on the idea of synaptic strengthening. This is the process of enhancing certain brain functions and locations through use. The synapses or connections with other neurons, probably number about six thousand per cell in the brain. Since there are trillions of brain neurons, and since any brain cell can theoretically and actually does connect to EVERY OTHER NEURON IN THE BRAIN the number of potential synaptic pathways is a number greater than the number of atoms in the known universe, according to Scientific American. Packaging makes most of the potentials irrelevant. Why would the brain be designed this way. One reason is for efficiency and speed.
As you read this article, you are not actually reading each letter. As you begin to see a word, the brain completes it for you. You think you have read each letter, but there is a gestalt feature to seeing words. The brain apparently also sees things according to packages it has learned. Certain memories and ideas can become tyrannical dictators of feelings and behavior. Central Pain itself may represent just such a preemptive group of overdone pathways, unstoppable, dominating, and embedded in brain structure and function. This routing through the thalamus may instruct the brain to pay attention to the action potentials coming up through THESE particular nerve bundles and give it the highest priority. In a way, priority is everything. With CP, pain is always at the top of the agenda of duties to be performed, visitors to be entertained, and entities to be listened to. It is part of every time slot on the daily planner of the brain, and anything else must be “fit in”. Pain has built a freeway through the thalamus, and the neuronal chemistry maintains the route through continual outpouring of pain chemicals. The membrane of the neuron itself is studded with Nav1.8 ion channels to make sure firing is at “condition red”. How did the brain become fanatically obsessed with pain.
There appears to have been an aberration in the detection system. It cannot distinguish between touch and actual injurious stimulation. In severe cases, the brain cannot distinguish between touch and non-touch since spontaneous dysesthetic burning requires NO input stimulus, no touching, to be read as pain by the brain. When examined at the molecular level, the flood of prostaglandins, leukotrienes, arachadonic and other fatty acids, the pain kinases, CREB, and other acidifying chemicals make those who understand the effect of these acidifiying chemicals on neurons wince.
The pain molecules come boiling up the nervous system like a gusher, putting every pain synapse on edge. They become hypersensitive and irritated. Give them half a chance and they will fire rapidly. Many will fire without input. We are talking about spontaneous firing, an automatic signal in neurons, which have become independent of controls. The engine cannot be shut off. They are “dieseling” pain all the time, too hot to stop. In ordinary circumstances,the brain would inhibit such activity, but since these injured neurons cannot move chloride to the cell membrane, they cannot generate inhibitory signals. They are envenomized by pain chemicals, manufactured in their own gene protein factories, not unlike the way a virus converts our genes into protein factories of its own using, to make more viruses. Central Pain is a virtual virus.
The neurons don’t stand a chance. The pain system, designed to signal a warning, appears to have gone mad. The individual, not surprisingly, burns. She may also have jolts of shooting electric pains rocket through the muscles. The gut and bladder cannot tolerate distention. Movement is perceived as painful. And like any painful area, keep irritating the area of the body in pain and it becomes even more hyperalgesic. No wonder that rest and prevention of stress are essential. Exhaustion and confusion set in. Before long, the subject is not capable of rational explanation of what is being perceived. They are merely suffering. How can someone who cannot remember normal explain what is different? If I do not remember how skin which is not burning feels, can I explain the nuances of the pain changes?
The continual use of certain pathway recruits more synapses to devote themselves to the accomplishment of that thought, attitude, movement, or act. This process is termed “synaptic strengthening”. It gets mixed up in the debate of nature vs. nurture all the time. If you could erase the memory of an antisocial murderer, would he then have equal odds of shaping a normal life as any other person? We do not know at all the answer to this question and it raises questions about accountability for acts committed. If you do not know you are a murderer, would you then BE a murderer? This line of questioning leads to a dead end, since we simply do not know. There are of course the theologicans who feel a soul has intrinsic characteristics and that a depraved person would likely use whatever body or mind presented to them to recreate vile acts. Again, this is speculation.
The disturbing feature about the brain which is emerging is how it can become “fixed” in certain patterns. Even more disturbingly, these patterns may not involve choice. Pavlov’s dogs are a good example, as is the extinction of their salivation at the sound of Pavlov’s bell after they went through a trauma of near death from drowning. is life a step from one big deal to another, or is it s continual flow, a plastic event laden with choice?
Such brain constructs may be consequences of happenstance. Childhood temperament is now said to be largely fixed by age two. Of course a child has little or no voice in what happens to them at that time. It would appear that life and behavior are not “going with the flow”. It is more likely that the big days, the big events do most of the shaping and the intervening days mainly deal with what the big life-shaper days have wrought. At least the potential is there for this to occur in a person’s life.
When in college, one of my classmates came from the deep south with an easy going, slow speaking, open hearted personality. One day while returning to his apartment from campus, some men attacked him and robbed him. They beat him severely, fracturing bones in his face, beating him over the head and making off with the thirty dollars he had in his pocket. The criminals were never caught. Identification of the perpetrators was hampered by the fact he could hardly remember them, except that there were three in number.
This young victim had to drop out of school for the rest of the semester. During that time, it was obvious that his personality had changed. He was afraid, fearful, timid, closed off, and unable to function. Was this brain damage or psychological trauma? His intelligence held, makig one suspect he had been through a genuine event of damage which his mind could not handle and by which it was shaped. He was not insane, but he was not himself, either. He changed majors to a more general aimless degree, dropping the demanding, rigorous program he had begun earlier. His approach to girls ended. He was alone.
Elsewhere at this site is mentioned the studies by J. Douglas Bremmer which show on MRI that those who undergo severe emotional trauma/post traumatic stress have changes in the brain. Also, it has been said that with severe pain events, the brain atrophies about 15%. These changes reflect a specific event, a package of happening, a quantum of life, which has changed the brain. And so we come back to the original question, does the brain evolve with smooth evolution or are there “leaps”, “big events”, “major days”, which shape most of life and living? How free are we to reclaim ourselve when the big days happen. How much choice? How much agency? How much room to change? What degree of freedom does life afford to the average person, and specifically, how much freedom is left to someone who suffers an event lading to severe central pain? An ever evolving, evenly spaced experience which lays down in even consistency like stucco is NOT the brain. The brain is very much shaped by big events. There are big lumps in there and some of them really matter. How much they matter is a question.
And so we come again to pain. For lack of a better term, we posit that the thalamus can be “stretched” functionally. It can lose its tone by overdistention of signal. One of the common surgeries is to tighten the urethral sling to restore bladder control for those who were “stretched” in childbirth. Sometimes a tear may necessitate a similar procedure around the rectum. The first gynecological surgery in the world was a repair of such a tear by Ephraim McDowell in early Virginia. This elderly doctor, using silver wire, restored function and control to a young relative who could not keep herself clean after a difficult birth had torn the rectal sphincter. It was a miracle.
Sometimes, we suspect that events can tear the brain, or stretch the thalamus, as it were. The course of central nerve injury suggests one cannot recover. This may be called post-traumatic stress; or, if it involves injury and rescripting of the pain pathways, we may call it central pain. It appears to be self perpetuating. The brain no longer damps or inhibits the signal. Chemically, the brain appears obligated to enhance the signal. Exciter toxins, or pain chemicals (PKC, NMDA, CREB, TNF, abnormal ion channel components, etc) pour out in the neurons, urged onward by brain connections and synaptic events which perpetuate the gain. The synapses allowing such events are clearly strengthened. Attempts to shut off this hyperalgesic force fail. The pain system is incontinent. The exciter chemicals, fatty acids of pain, kinases of pain activation, genetic protein factories to manufacture pain chemicals are united to gush the message toward the weakened thalamaus, where they pour through as signal to the brain. They go to the frontal cortex to tell us the significance, to the post central gyrus to tell us the location, to the posterior parietal cortex to tell us the orientation of the pain, and to the insular cortex to tell us the painfulness of the pain.
The pathway for pain is now open so that any touch signal (in severe cases, no generating signal at all is necessary) spills over, pours through and sustains the torment. Touch is not filtered properly. It funnels into the pain sensory apparatus, where its abnormal characterics are not damped. The brain does not recognize this inappropriate signal for what it is. It comes in as pain. A person with severe central pain cannot be said to be living out life day to day. They are instead, living out one day, the day of the original injury, over and over. The brain has been packaged. It is a quantal brain, with structured output, not a fluid, plastic, free organ. It is as if the somatosensory apparatus had become autonomic.
This past week, the story was reviewed of a young man who fought in the Battle of the Bulge. His right hand had been blown off by shrapnel, a fact he claimed he did not notice until later. He claimed to have continued firing his rifle, which means he would have had to shift his gun to the left hand. LATER, in the field hospital, he required morphine. All this suggests that the brain may prioritize. The thalamus does this work. However, thalamus may fail but may also heal over time, unless the damage is too great, in which case it may become packaged into an engine of pain. Once this resulting event has occurred, one cannot count on the same thalamus as before. There is insufficient evidence to support the notion that one can consciously ignore central pain as normal pain might ignored, presumably via the thalamus. Initial rioritizing by the thalamus seems set for survival, to feel pain when it would enhance survival and to ignore it when survival requires it, but the system is not impervious to injury. Chronic pain, the pain which develops after the initial shock does not respond to the suppressive events. It is foolhardly to cite such events as proof that chronic pain may be shut off with the will. This soldier eventually was no longer in the Battle of the Bulge, no longer laying on frozen ground fighting for his life. If his injury had caused phantom pain, the will would have had little to do with eliminating such pain. Central Pain from SCI can be compared to phantom pain via cutting of the cord. Because the upper cord is global in the sensation received and includes the face via descending tract of C.N. V, the central pain of such an injury may be global.
When life reverted to normal for the soldier, so did the pain system. It is silly and unrealistic to ask someone with severe nerve injury pain to impose battlefield mentality on themselves when they are not on the battlefield. The body could not endure or sustain such a state of stress for very long anway. In fact, as thw warning by the National Institutes of Health states, since there is no good treatment for central pain at the present time, it is essential that the person’s life be as free of stress as possible. This is the polar opposite what of what blocked the soldier’s pain. Thus, it is easy to understand the public’s mistake about central pain. Would they put us in life threatening battle for the rest of our lives and see if this works. The stress of that would surely kill us.
And so, most of the “helpful advice” goes by the wayside, as the exact opposite of what is really needed to endure constant severe central pain. We may expect to be misunderstood by others, but it is important that we understand oursevles as best we can. We do not relieve central pain by stressing ourselves out. We try to prevent it at the outset by keeping our lives as free of stress as possible. This is not laziness. it is obedience to the divine command to preserve life. WE have been packaged wrongly, but we deal with that as it is, not as others imagine that it is.
One theologian has suggested that “big sins” are those which change us. Certain types of acts may make it hard or impossible to regain our footing. Certain choices may greatly restrict our freedom to think or act. He defined such a state as a degree of “damnation”, a stopping of the will, or loss of choice. If the analogy if valid, central pain would be a sensory damnation, by any definition. It is not so much a thing to be overcome as a a thing to be accomodated to. It is helpful if those around us can accept this, but whether or not they do, it will not change the fundamental approach necessary to survive it. Our lives have been put ia different “spin”. We now take that for what we can do with it, but it appears the brain pain apparatus spins as it has been spun. The question is what we will do with the degree of choice left to us, however constricted it may be.