Brain chemistry is so compelling that it is hard to talk of a difference between real and perceived things. The notion that pain is a personal failure continues to fall. However, there is a group of holdouts among the behaviorists and nowhere is this more doctrinaire than in pain. A little more biology in the psychology please.
No person, or alternatively, no group of persons could lift together in one huge container the books printed and articles published on placebo effect, psychosomatic pain, and what is called “somatization”, ie. the conversion of a stressful thought in the mind into pain in the body (the mind is somehow NOT of the body in this schema, the Caresian duality idea). One standard text in psychology, in the index under Pain, says only “See somatization”. Pain itself is not worth considering in its own right. It is a subset of somatization.
Let us repeak some of the ideas and then analyze:
The idea is that pain in OTHERS, or those without degrees in behaviorist dogma, who are above such things, is imaginary. In other words, pain is ALL psychological, and the more severe it is, or is claimed to be, the more psychological it is. (As in, “The test for being a witch is to deny it. The test for pain being fictitious is to claim to have pain) Severe pain can only be perceived in some poorly understood psychological state, which is rarely if ever experienced by people of good character. Joe Brave “I only let the dentist inject for the root canal to make HIM feel more comfortable and necessary.” ANY dentist or doctor will agree that some patients with severe pain say nothing and others say a lot–verbalization is not a good measure of the degree of pain. This make sthe notion of a comment scale, the so called analogy pain scale suspect. If we do not know what we are dealing with, ie the measure of pain in a given person, how can we lump all such people together, identify a few who are faking, and attribute that trait to the entire spectrum of pain experience.
Sometimes the whole rote, regurgitated, standardized speech on pain psychology seems like a skit from Saturday Night Live, where everyone is absurd. Sweeping assumptions (what are really hunches) are always so much more effortless than that which reflects the hard work of science, which is less everlasting and more transitory in its conclusions.
The idea of pain as imagination is nuts on its face, but is nevertheless exceedingly popular with regard to pain in OTHERS, (although decidedly unpopular for one’s own gallbladder procedure, vas ligation, triple bypasses or hernia repair).
According to the cynic, it goes without saying that those little nerves which carry pain for legitimate reasons could never become injured themselves and generate pain. Such notions should be supported by research. How does the non-chemist behaviorist claim authority to make such a statement? Well, not to make too fine a point of it, but there is that piece of paper in a frame on the wall from a prestigious institution, and also because the idea of nerve injury pain would make nerves themselves subject to injury or malfunction and then what would be the whole point of the rest of the body? If a nerve fails, it must by edict of the behaviorist, fail entirely and quit working totally or more weakly. It could never malfunction. NATURE doesn’t work that way, or so the story goes.
What is that you ask? Is a chemist from the same prestigious institution qualified to speak on behavioral science? Of course not, it is said. Think of all those deadly boring and repetitiious sensitivity groups and seminars they have missed and the hours staring through the two way mirror at young children and volunteers. How could a chemist expect to know that for which they have not been trained? Behaviorists are self anointed and self scrutinizing so they need no double blind studies and no hard data.
It isn’t hard to find pain psychology. Every little kid loves band-aids. But does that really explain pain. Would you do an open heart operatioon on a child with a band-aid for analgesia. Central Pain is SEVERE. But then, we have the placebo. Why bother with anesthesia? Why not just roll out a little placebo, which is so effective. Continuing, Central Pain cannot possibly be real because you say it is severe, and severe pain that doesn’t go away doesn’t exist. If it did, I would have heard about it. (Rather a circular argument, “I don’t want to hear about it, but I definitely WOULD have heard about it” A variation on this might be that no one should ever listen about central pain who hasn’t heard about it already.)
Bouncing along on the fairy tale, things get pretty generalized. We make ourselves feel pain and we make ourselves not feel pain. Our imaginative brains have it covered from both directions. “Nothing is real…it’s nothing to get hung about…strawberry fields forever.” It is as if a REAL pain system does not exist. This is perhaps the most easily disproven fiction ever entertained by the cynical, but it persists, it grows, it takes up space in the textbooks. For every word advising the psychologist in training how to help someone with a genuine pain state, there are ten thousand on why pain should be considered somatization. Just think of all those lovely trees cut down needlessly to print such nonsense.
How long does academic dogma hold up? Let’s use the Bible as an example of how it goes. About one nundred years ago, a German named Wellhausen thought he detected different authorship in the Bible, In this collection of books, made up of collections of pieces of books, written over the aeons, didn’t all sound the same. The Bible was not even put into verses until the 16th century, but around the turn of the century, Wellhausen found changes in pace, in tone, and terminology. The conclusion was obvious. No one person wrote the Bible books. It was possible to buy Hall’s book with the different voices printed in different colors, in a show of color printing what made Andy Warhol look black and white, in order to identify the “Wellhausen” view of who was saying what, and remind the reader that it mattered, Hall’s book has to take first prize.
Not that the Wellhausen principle hung on forever. Recently, it was shown that experts given selections of Goethe to analyze with Bible techniques, they could hardly find two paragraphs in Goethe written by the same person, Of course, authors feel different on different days and during the day.
In other words, this “science” of Bible authorship is now considered to be mostly guesswork, and there are few who embrace Wellhausen uncritically any more. No one knows how the many manuscripts which make up the Bible were written, or who wrote them, or even when they were written. We cannot tell if Abraham lived nine years before Moses or whether he lived nine thousand years before Moses. (No one knows the age of the Great Pyramid of Egypt, either). Many of the events described by Moses happened nine hundred years or more before him, and some of the place names found in the five books of Moses were not created nor in use until many hundreds of years AFTER Moses lived, so we do not know if there was an oral tradition, written manuscripts or what. Editorship and copying changes are obvious. There are at least 22 “authoritative versions of the New Testament”, no two of which agree with each other.
Once the experts had agreed exactly the earliest time the Bible could have been set down, it wasn’t long before a boy in Israel broke rocks in the floor of a tourist center and there was found rolls of silver with passages of the Bible nine hundred years older than anything up to that time. A wrong opinion multiplied by a million who subscribe to it is still a wrong opinion.
No matter how many have been taught that a thing is true, it may nevertheless be wrong. Science is mainly the disproving of what everyone accepted as true only a few years earlier. If there is any doubt on this, watching astronomers revise their theories almost daily is evidence enough that knowledge is dynamic and changing. Still, on social issues, one faces an uphill battle to dispel prejudices and attitudes. “Getting new ideas into the minds of the people is like splitting hemclock knots with corbbread for a wedge and a pumpkin for a sledge hammer. The brain will stretch only so far before it flies to pieces like glass”.
What does this have to do with pain? Tradition based on lack of molecular chemistry isn’t very valuable. Are we to learn about it by talking to our grandmothers, who got their opinions from their grandmothers, or are we going to sit down and look at the molecular and anatomical nature of it? We have previously written on the BRIEF time during which an injured soldier may feel no pain. (We suspect there are plenty who felt pain, but their stories never seem to make it into press–it isn’t interesting) If the injury were to be ongoing of course, this grace period for survival would not last long, and the soldier might not feel the first hand being blown off, but over time he would begin to notice the other hand, the foot, the shoulder, the thigh, etc as they were successively removed, unless the soldier happened to be the brave Knight in Monty Python’s ‘The Holy Grail” whose stiff British upper lip never quavered as he was slowly dissected of his body parts. Vivisection is humorous only in slapstick comedy. We have also mentioned the article wherein a researcher claimed to identify some of the brain areas involved in placebo effect, claiming to see fMRI observable metabolism in certain areas of the brain drop as placebo was administered. Who funded this?
Now, we see nothing wrong with tracking, locating, and identifying any areas which help blunt pain by placebo effect, but what we would prefer is a study to target pain which is major. How is it that we know where pain is blocked but we still haven’t identified where it goes. In fact, since we don’t know what pain looks like in the brain, any claims to have found placebo effect have assumed the even toughter question of whether it is really pain that is being blocked. If you don’t know where it is, how can you say for sure that you have blocked it. Pain mapping could be accomplished two or more different ways. One would be the deliberate infliction of torture on a volunteer and then sorting out the brain areas that begin to metabolize. This approach has not so far been used. Even graduate students have their limits. The other approach would be to study those with central pain being subjected to light touch. This method has not been done. First the researchers have to be convinced that this is torture also.
There have been fMRI studies on peripheral neuropathy to track pain pathways, but Central Pain still has not become interesting enough to study.
If pain is believed to exist, and the doubters are rather easily exposed in their weakness, then perhaps it is time to get the fMRI machines going on Central Pain subjects with various pains, eg. dysesthetic burning, lancinating pain, visceral pain, muscle pain etc and after evoking or inducing the spontaneous pain, it should be easy to spot areas of reaction in CP. One problem of course is that such pain may actually reflect the ABSENCE of activity somewhere in the brain which should normally be metabolizing. MRI takes time to learn. For example, bone gives off little or not signal on MRI and so it is read by the radiologist as a “negative signal” meaning absence of anything on the film. If anatomically something should be there, but the reader can see nothing, it is a clue to the reader that bone is there, or something has calcified in that area. This seems rather obvious, but like many MRI things, it took years and many articles to get this straight. The mistake is still rather common.
And so, as the grant money pours in, we are unenthusiastic about spending a single dime on placebo effect and would like to see every penny spent on finding out where pain actually IS, in order to treat it. In case the investigators have forgotten, pain hurts and severe pain hurts severely. It is bad manners to talk about placebo when someone is dying of pain. We hope the anatomical trackers will get real and we will begin to see dynamic pain studies on Central Pain.
The radio is full of ads for volunteers to be studied for some new remedy, for bunion relief, depression relief, or whatever. So how come those with CP are not being bombarded by the brain scientists to volunteer for free studies to be performed. Do they want to know how the brain works or not? We have seen such a request on another site coming from Brigham and Women’s Hospital, which is welcome and worth supporting; but, we are hoping for some dynamic radiology. We hope no more studies will be designed around one more opiate yet to be discredited, overlooking the fact that Dejereine and Roussy discredited opiates in 1906 for CP, and S. Weir Mitchell pointed out in the Civil War that it did nothing for nerve injury pain of central origin.
A collector offered me Weir Mitchell’s autograph for sale, but what I wanted is for doctors to read his book so we don’t have to keep disappointing them by telling them “NO, the morphine didn’t do squat, NOR the methadone, NOR whatever opiate you are throwing at me. It is known that the muscle pains are sometimes relieved by opiates, but how about something for the dysesthetic burning. Let us begin by finding it in the brain and then going after it.