False ideas may be attacked, no matter the occupation of the person advancing them. Theology and science both have had their weirdness in relation to pain. We do not like the murkiness of pain blessedness, nor do we care much for the condescending unscientific scientist who pontificates on “attitude” and sees pain as imaginary in us, real in them.
Truth is generally achievable when ideas are clearly expressed, but naming something as a syndrome and then using this artificial construct as an adequate descriptor of pain symptoms is getting the cart before the horse. We cannot see any more benefit to doing a neuropsych evaluation before pain is treated than doing a “neuropsych” evaluation before diabetes or high blood pressure are treated.
Shunting the nonresponsive central pain patient off to a psychiatrist is okay, if the purpose is to help the patient cope. However, too often it is because the clinician does not realize that it is impossible to put central pain into words unless a new vocabulary is provided, and that secondly, all those articles claiming central pain can be cured with opiates belong next to the old articles that said arsenicals and mercurials could cure bacterial infection. In other words, the doctor is mistaken. As Mark Twain said, “You can’t trust your eyes, if your imagination is out of focus”.
Peering through the lenses of ignorance, the doctor imagines the struggling, distressed patient before him is nuts, halting in speech over pain which is destroying him/her; when, in fact, the doctor is seeing a perfectly typical central pain patient and observing what unending terrible pain can do to a person.
If the doctor were capable of understanding the patient’s words, there would be no problem since the pain would be nociceptive pain (which the doctor has experienced) but the patient would not be talking about central pain. The inability to understand is the first clue to the doctor that he is hearing about central pain. Central pain is SYNESTHETIC, in that it mixes pain sensations (NONE OF WHICH SHOULD EVEN BE THERE SINCE THE STIMULUS IS MINIMAL OR NONEXISTENT-THE PAIN COMING ENTIRELY FROM HYPERSENSIZATION IN THE CNS), with burning predominating. The pain is very poorly localized, which further confuses the doctor. Since this pain is all the cord injured patient knows, with time, he/she forgets ordinary pain and fails to make the distinction to the doctor, assuming the doctor knows far more than he does about central pain. The electric shocks and pins and needles of the posterior column do NOT mix pains (ie. are NOT synesthetic), but the Doctor will not understand that either unless he has treated patients with neurosyphilis, who have identical “lightning” pains. (Neurosyphilis was a disease of the pre-penicillin era when syphilis had its own speciality, now known as dermatology).
If the words are coming from someone with cord injury, how smart does the doctor have to be to have a bell go off that says “bizarre pain plus cord injury or stroke equals central pain”. He doesn’t need tons of tests, MRI, CT, SSEP, EMG, EEG, neuropsych, or anything like that. NONE of these things diagnose central pain. The Doctor simply needs to read the literature. Expect gibberish from the central pain patient, but reaiize that those with central pain can understand each others gibberish. No one has to describe in detail a monster which you have already seen yourself. If you haven’t seen it, as a man of science, you aren’t going to believe it exists, UNLESS you are willing to inject a little capsaicin SubQ, that is. Never let any doctor tell you that you are nuts who has not himself injected a little capsaicin. Feel free to invite him to join you in your little pain world. He will be peering in through a very tiny hole, about the size of a skin wheal, but it is amazing what he will see. It will not be central pain, but it will be DIFFERENT, and from then on, he will understand that pain need not always be what he thought it was.
When medicine knows nothing, but thinks they do know, then any patient saying the treatment is of absolutely no benefit is in danger of winding up with a psychiatrist of the wrong bent. The only other alternative, which does not occur to the clinician, is that the conventional treatments are of no benefit in central pain, and that the original researchers were too unsophisticated to distinguish between somatic pain and central pain.
Religion also gets off the beam with regularity. Defining pain as wickedness goes nowhere, just as the scientist’s definition of pain as a failure in attitude is another way of saying pain science is difficult for the average person to grasp. The scientist wishes to appear intelligent, so will place pain he does not understand outside intelligence and put it under emotion.
Pain should be the easiest matter on earth to accept as real, but apparently not. Pain is so vivid, and all have experienced it, so they are downright insulted if someone comes along and says there is a whole NEW type of pain they know nothing about. How insulting, and how true. In whose domain does pain lie? We think pain is in the domain of the scientist, and that theologically, it should occupy approximately the same role as, say, paleontology or metallurgy. Anything else would deter research in pain, as it already has for millenia.
Severe pain is something most people imagine they apprehend, but in reality their enlightenment can be compared to one who stands on the shore and flatters themselves that they apprehend the oceans and other shores as well, touched by the same ocean. There is no shortage of thoughtless, amateurish pain advice, usually bordering on denunciation of the sufferer, should you be so foolish as to mention to a layperson that you have central pain. This problem is also not absent from certain medical clinics where amateurishness has been removed from the dictionary, and where everyone is an expert on everything. In reality, someone may be truly a genius on peripheral nerve injury pain but be completely ignorant on pain of central origin.
Pain is a terrible lord over mankind. More than Cancer, a haunting menace, and even more than Death, (a certain and looming threat), severe pain puts other major worries aside, dwarfs them as unable to command the attention. What is death to someone willing to escape the agony of physical suffering at any cost? This utter preoccupation with escaping pain is a problem for anyone attempting to maintain a conscience or even hoping to prune away a small wickedness.
Severe chronic pain does not help one become better at anything, especially religion, and it is doubtful ordinary standards of righteouness would apply to someone who is on fire. This article takes as axiomatic that meaningless pain has no meaning. False religion and false science keep trying to make pain more than it is. Central Pain is NOT the sudden placing you in Job’s role (although it is nice for the sufferer to have some scripture which applies to them, nor is it some huge demonstration of what a weak, emotional mind can produce–just how far a dysfunctional prefrontal cortex can go. It is a disorder of the genes in injured nerves which are attempting to grow back, but succeed only in pouring out pain chemicals.
In moderate doses, especially if it has a terminus, pain may have the effect of correcting the focus, but in full out submersion in unendurable, unending pain, you are lucky to get through it at all. Since the best measure of pain we currently possess is the degree of hypersensization of the dorsal root ganglia, (as measured by action potential and other currents generated at the membrane level) researchers such as Tasker are fully justified in pointing out that severe central pain can be the most severe known to man. In normal individuals ONLY the nerve ending can generate a pain signal, but in central pain, the nerve is so sensitized that the entire length of the axon generates action potentials, and with such frequency that the BURSTS of impulses can be measured in the thalamus. The pain also lights up the insular cortex, which is not part of the limbic system and is not grouped with the emotional apparatus.
You will NOT get through severe central pain with your self intact. Severe pain does not help you learn to be righteous any more than it helps you learn to play the violin. It is big trouble all down the line. Avoiding the bad is good advice for anyone, but effective bobbing and weaving takes concentration, and you may be in short supply. Supplying the needed good in the lives of others is also a big reach, but satisfying when you can remember to do it.
One of the great American religionists observed that God has always chosen the weak things of this world to lead His people, to be His prophets, to declare HIS word; and the reason is that with humble men, God can handle them. Severe pain, however, is not humility, it is destruction. The good will be destroyed along with the bad. Therefore, we take it as fully in accord with God’s will that pain be studied and cured. We tune out the thoughtless ones with long faces, long robes, and long prayers, who pretend to possess an insulation from frailty and scorn it in us, who would cringe at a little capsaicin, let alone full blown central pain. We take true religion to be a thing of sunshine, and cure of pain definitely would make our day.
Pain speaks more loudly than any other sound which the brain hears. Sometimes it shrieks, and sometimes it sits heavily on the whole being until the self gives way. Pain can nearly always be endured as a temporary and unwelcome guest, but when it comes to reside permanently, it seems able to destroy nearly everything. It can become a terror like none other. Pain scientists fight the greatest foe of mortal man. They deserve a place of honor, and their work perhaps deserves reverence. Like it or not, a scientist cannot work on pain without delighting his Maker.
The litany of pain articles at this site bears witness to two important things:
One, we have emerged from the long night of darkness where Middle Age superstition saw pain as an emission from God’s judgment and asceticism as the high road to salvation.
Two, pain has many aspects chemically and anatomically, to which serious scientific effort should be devoted immediately.
The first proposition relieves us from the deadening and stupid admonitions from misguided “religious leaders” who advise adherents to seek out pain in order to crush the “despicable” creature inside us. No doubt we are despicable, but if it must always remain so, why be despicable AND in pain? Self denial we understand. Self immolation we do not understand.
The second proposition relieves us from the ignorant and stupid admonitions of complacent, contented doctors, who hold the pain patient in even lower regard than does the Dark Ages theologian. Some blind physicians almost see pain as a word, too broad to deal with, and capable of many interpretations. most of which are best viewed as an intellectual exercise, rather than as a potential inhuman torture which irresistably commands the patients attention and deserves the doctor’s very best effort, even if he is failing miserably to cure it. When the doctor’s knowledge hits the wall, he should not heap accusations of mental weakness upon the patient as a cushion against his own failure. The struggle against pain is not the same as curing it, but the struggle is the highest honor a physician can receive, as Albert Schweitzer stated. Because of the doctors who believe our words, less is CP man/woman being viewed as a weakling and more is nerve injury pain being viewed as something very powerful, the proper response to which is elimination of pain, not denial that pain is a real entity. If you cannot relate to this principle, you are very fortunate in the physicians you have encountered in the course of your central pain.
In other words, pain is finally being taken seriously. The PhD candidates have discovered an unknown frontier that was sitting right in front of them. No need to study the mating habits of some bug to get that degree, because unstudied and nasty pain chemicals are sitting all over the surface of the dorsal root ganglion.
Animal suffering is easy to measure, now that chemical assays for the pain proteins are freely available. There is no reason to assume humans are different, since our pain chemical are the same. The pain exciting molecules synergistically lead to acids, and it is not too much of a stretch to conclude that sensitive nerves do not like acid. Chronic pain is just too easy to create and observe in animals to deny the molecular process any longer. If pain is chemistry, then those who know no chemistry should disqualify themselves on the topic.
Pain denial does not work and never has. Those with CP may make it through the ordeal with some shred of self respect if we can shut up the weirdo theologians telling us to thank God for our Central Pain and the crackpot, old-time doctors (regardless of their graduation date) who tell us it does not exist, or is merely an aspect of psychology (which they cannot adequately define either). Used this way, psychology is just a term for an area they do not yet understand, but may submit sage guesses concerning it. Heaven help them when they realize psychology is just another branch of chemistry and physics.
Many of these people went into psychology because they hated chemistry and physics; and here it is back, threatening to expose them as unlearned. No wonder they are alarmed at the claims of pain sufferers to be in terrible shape, far worse, for example, than those whose mothers didn’t toilet train them properly. To their credit, some of the psychologists who were trained to recognize the art of kidding oneself have recognized the chemical underlyings of pain and have gone back and educated themselves in biochemistry. Among such people are the most effective and dedicated pain scientists. To say they are joined by the majority of their colleagues, however, would be an extreme overstatement. Such psychologists hole up in their forts at McGill, UFla, and other such bastions of pain truth, in danger of being ejected by the “mainstream” professional bodies, who could not be more put out by the chemistry talk if they had to actually understand what “serotonin” and “dopamine” really are.
The anesthesiologists have always had an open mind about pain, but who until recently thought mainly in terms of awake and asleep are nevertheless not ones to question pain. Too often lagging are the neurologists who deal with such a wide reach of symptoms in every condition that they tend to become great “lumpers”, bringing together a diverse range of disease expressions but appearing to bring order by verbally grouping diverse things together and calling it a “syndrome”. This creates a false sense of order in the most chaotic branch of medicine. Saying the words “Central Pain” is sometimes good enough for them, and they cannot be bothered with von Frey hairs and cold tolerance testing.
Neurologists frequently mean different things by the same term (example: when they say spinothalamic tract pain, do they mean pain in the anterior or lateral, or both ST tracts, and just as a curiosity, or do they even have anatomy in mind or just functional symptoms and when will they get around to proving that either the anterior or lateral tracts or both exist in HUMANS). A neurologist not trained in nerve injury pain often cannot see the forest for the trees; or is it the other way around. Either way, even if atopoesthesia is the most strange phenomena for you, it will hardly impress the neurologist, who takes “strange” as the default condition of the nervous system.
Neurosurgeons sometimes prefer to be on the “cutting pinnacle” of medicine, rather than the cutting edge, and will deal with pain when someone figures out a way to “surgerize” or “ecotimize” it. In the meantime, it is largely an annoyance. Neuroradiologists range from the Good, to the Bad, to the Ugly. They all charge the same, a lot, but a few of them actually know what they are doing, and these people are worth every penny.
Central pain is like a light shining into the fallible parts of medicine, but sometimes we show up the genuine hero, the real doctor, the angel in a white lab coat, who cares, listens, sorts, and trusts us that we are not attempting to mislead him. Who can really thank the concerned doctor who gives us the dignity of being a real patient.
Pain plays a most peculiar, but fortunately, a MINOR role in the lives of most people. It is not spontaneous, but is part of an organization of the body, meant to play a role, but capable of going haywire. It is true that some people love certain music and others hate it, but it is remarkable how universal the response to pain is. Inject a little capsaicin under the skin to sensitize C fibers and theories about religious origins or psychological constructs go out the window. People get pretty far afield rather quickly. For example, the painless soldier myth. If being shot is actually not painful, as evidence by the exceptional anecdotes of those in battle who do not realize they have been wounded, what do we do with the data which make this the extreme exception, and the extreme awareness of pain which 99.999% of wounded soldiers feel all too well. This would make NONpain psychological and pain the ordinary situation.
Pain is predictable. Hardy found that humans find a certain level of temperature to be painful with a deviation of less than one percent among all those studied. There is a system to this. Pain is not meant to be random. There is a very clear sequence of chemical events which are necessary to create pain. This sequence involves proteins which are produced by the genes in our body and animal studies across the world duplicate the same chemicals and the same relationships no matter when or where these matters are studied. Variations, if any, are no more common than say, blue eyes and brown eyes, color of the iris being largely irrelevant to whether the person has vision. Be you an expert in the martial arts or the most nervous high strung sissy, the calcium channels which open the flow to pain signal will behave in identical fashion.
Study reveals rules, principles, and order. Nerve function is very much an energy requiring process with our brains consuming perhaps twenty percent of the total energy used by the body. The chemistry of pain “energy consumption” or diversion of activity to acid forming activity does not appear to vary according to race, although it does seem to vary slightly according to gender, because of the effects of estrogen on the brain.
In a sense, life is a highly organized burning of fuel. This is not to say there is nothing spiritual behind it, but we know little or nothing of the nature of “spiritual matter”, presuming that even the spirit must be made of something. Speculation on what might constitute spiritual matter is just not helpful to understanding the “off the shelf” set of pain chemicals which sit well supplied in the dorsal root ganglion, thalamus, and insular cortex. In Central Pain these chemicals are stacked from floor to ceiling in these areas, and there is no room for anything else. Someone ordered too much acid and the synaptic storage rooms are getting downright acidic. Yet still the genes send over the boxes of acid and pretty soon things get out of hand and the workers responsible to keep things under control decide to abandon their duties and get out while there is still time. Touch is painful now, and even if there is no touch, the pain chemicals are at a steady boil. Chemical damnation has been achieved. Off come the clothes, off come the shoes, and on comes the skepticism and disdain of surrounding “pain experts”. The impotent medical profession tends to join in with the pain skeptics, but deep down they strongly suspect it is all too real and a dark blot on medicine’s ability to cure.
This can all be a bit embarassing to the doctor with a “god syndrome” even if he hides out in what he prefers to call a “multidisciplinary” group. It is not helpful to have a radiologist, a psychiatrist, a neurologist, a neurosurgeon, a neurophysiatrist, and a bevy of nurses who know zero on how to cure the dysesthesia of central pain. All those zeros will still sum up to zero (except on the medical billing side of things). Too often we resent them and they are wary of us, but we keep them in Gucci loafers and they give us hope. We are sick together. This actually helps, surprisingly. It is not a cure, however.
Pain frustrates the believer, especially when they realize it is hurting their desire to accomplish good. Why should anything go amiss in a perfect (God created) universe. Theologians have reasoned that a perfect universe would have to eliminate free agency, and that such a universe would not allow for chance, choice, or for real people. Hence, earth as we know it. Just as on earth we create a heaven only to the extent we have gained knowledge and choose to use it, exaltation may be something like a bestowal of sufficient knowledge to eliminate pain and wrongdoing, or as it has been said, “Man will be saved no faster than he gains knowledge”. Religion reasonably laughs at the notion man would ever be able to do this on his own, seeing the absolute requirement for a Divine Being to accomplish eternal happiness.
But we become robots if absolutely no effort is required for salvation. Why go through the bother of earth life. Just make us perfect right off the bat. Maybe we could never appreciate the gift of salvation properly if we had not had to struggle so desperately for a little happiness here on earth. Hence, the commandments, and the rather thoroughgoing and persistent need for repentance.
One of the commandments being to “subdue the earth”, why not begin the subdual at pain? Pain people, like all preoccupied people, want to repent, but are, well… preoccupied. So pain cannot be all good. In fact, it can be really, really bad. Sorry, you theologians will just have to take our word for it. Inject yourselves with capsaicin if you dare (let us suggest the tongue, lips, or urethra as a test site), just for a small taste of nerve injury pain, and you will in the end conclude that a sane mind is a much better one with which to repent than an agonized one. Given the rather universal need for repentance, we can enhance the process if we can get pain down to the level where it does not ruin our lives. We would like the privilege of repenting, but right now, we are trying to get around the terrible burning dysesthesia.
But we digress and have no wish to see discussions of pain deteriorate into theological debates. Pain is as we find it, and soon enough, the multifaceted workings of the chemical pain cascade will be threaded out. It will be no more of a mystery than gall bladder dysfunction.
Pain is not inherently any more complicated than other important bodily processes, but it is surprisingly resilient and durable since we seem to achieve survival best when aversive learning is present. Pain has been overlooked scientifically until recently, being mistaken for one of the fundamental processes of the universe, and delving into it being considered a foolhardy attempt to change the way the universe operates. This view was sometimes taken by both the atheist and the believer, neither of whom recognized the contradiction in reasoning.
Random life can have no right nor wrong since molecules are not accountable for their characteristic behavior; and, scripture is packed with the idea that God’s work was usually aimed at relieving illness and pain. The book of Job seemed to be a contradiction to this, but it only seems to be. On careful reading, we see that pain is clearly from an evil source. There is as much to be learned about faulty “comforting” of pain in the book of Job, as there is about enduring it well. The person who imagines that pain is all in the mind or is the result of something bad we have done may find Job backfiring on them when they themselves consider in more depth about Job’s “comforters”, to which they are often philosophically related.
We are coming out of the dark ages on this, but attempts reoccur to revert to pain superstition, the mixing of pain with religion being a common mode of thought, even in the minds of atheistic scientists, who really should know better. We must research pain, and not merely call it an “act of God”. To say pain should be endured well is no different than to say earth life has a purpose. The remark does not explain pain, nor place it in any particular position in which it may be understood. Unnecessary pain is a mystery to be solved, and one which we have a duty to solve. There will be other trials sufficient to teach us obedience and gratitude, including gratitude to the scientists who will soon defeat pain. It will be a very late gift to mankind, long overdue, but better late than never.
NMDA, located near the surface of nerve synapses is apparently the central chemical in chronic pain. Its downstream effects on the NR2B subunit of its receptor are becoming more apparent all the time, thanks to the tireless efforts of the pain researchers. Their intellectual pursuits are as close to God’s work as anything we can identify here on earth.
Passing on the proposition of a Creator, what is God for if not to relieve pain? What is the Devil for if not to inflict it? There is a pain of the soul, an area in which religion operates, and there is a pain of the body, in which science operates. We should not confuse the function of the operators. Pain of the conscience is NOT the same thing as pain from nerve injury. Suffering some of the latter may remind a person of his weaknesses and serve as a reminder of his need for God, but too much pain may impair attention to avoidance of the pain of the soul. The scientist will not bring us to heaven, but he can help avoid unwarranted visions of hell. Central Pain is a very fearsome matter, and like any burning, demands the mind’s attention. To focus on the good or the bad, as the exercise of our choice allows, we must first STOP the burning.
In deep pain, is it sacrilegious to look to scientists? Do we pray God to relieve us or to help them? We do not feel obligated to yield to those who derive their theology from personal wresting of the scriptures, who consider the words endless pain to be religious and untouchable. We feel it permissible to contemplate the relation of pain to theology with as much validity as the next person, being perhaps more qualified than we desire to be. Our take on it is, that Job or no Job, God will help the scientists if we put in the effort.
Thus, as the pain subject ponders on the call to righteousness, there is awareness that he is not likely to break any records in that area or even make a start, unless the scientists do their job of easing meaningless pain. By analogy, we do not want to starve, so we thank the earth as it were, and then, realizing that perhaps the earth is God’s provenance, we thank Him. We do not want to be in severe pain either, so we thank the scientists as well as the source of all inspiration and truth. There is no conflict between science and religion in the search for a cure for pain.