Boivie’s Paradox regarding Central Pain is that “One must loose sensation in order to be a candidate for more severe pain”. As commonplace as this is in the experience of central pain, it may merely be a model for sensory impairment. Such as in hearing, for example.
Allodynia is the process whereby that which should not be painful is made painful by what is called “hyperpathia” to use Bonica’s favorite term, or “hyperalgesia”, a term used by those who associated with William Willis Jr. Neither hyperpathia nor hyperalgesia are laser accurate words, because they try to inform the minds of those who have no experience with nerve injury pain with what those who are in agony have said.
“Allodynia” refers ONLY to those stimuli which should not be painful, but are, due to nerve injury pain. Layman’s definition: Nerve injury pain is when nerves are screaming their heads off. Sound impossible? Consider the “nonpainful” stimuli. Blow them up (hyper them) about a hundred times and they do a shape shift into pain.
Touch, Vision, Sound, all these have the potential to be painful, so maybe the terms will work, if we understand and include some description of MAGNITUDE. These terms are what the scientists nowaday use, along with the ever delicate “hypersensitization”, so we will have to make do with them. Sensitization make more sense if you think of this scenario: Frat President: “If you eat the bucket of chili peppers, it will SENSITIZE your tongue” Frat during Rush Week: “That is very good, I was afraid it would make my tongue burn like fire”. Get the picture?
“Hyperalgesia” also sounds tame. Pretty mild, in fact, also incomprehensible. We will not even discuss dysesthesia, the definitionof which is incomprehensible pain. To the uneducated, “hyperalgesia” sounds like a drunk man trying to say something. “Hypersensitization” sounds like a term that might come up at a marriage counselor’s office. “Hyperpathia” sounds like something is wrong with the milk you left in the refrigerator for a month. Why do we have to be polite when we are talking about pain? If we have to use such effete words, we should at least be able to put exponents after them. It is a little like the Rapper names, “Fifty Cent” is worth maybe a hundred million dollars.
Pain to those of us with Central Pain is sort of a gangplank to hell, since Central Pain is the most severe pain state known to man. As we try to wear clothing, lay on the sheets, or endure the cold air current of a car air conditioner, we wonder why life even has purpose. We are entitled to some REAL words, but the wordsmiths do not have central pain and so they give us “nothing” words. Something is wrong here.
To those for whom the above mentioned events are not only NOT painful, but downright pleasurable, the whole idea of hypersensitization is a hard sell, because it sounds incredibly harmless. Even if it hurts us, surely it doesn’t hurt us badly.
This is the problem with a polite term like “hypersensitization”–it draws pain down to the level of a sunburn or rug rash. Prickly heat and the genetic commandeering of the pain apparatus are two entirely differnt things. CP is a torment such as one might hope they never have to endure, one that forces them to weigh life vs. the pain. It crams us into an existential crisis. That is how “HYPER” our hyperalgesia is. The problem is that “hyper” isn’t so bad, more than fifty percent of school children are supposed to be hyper, (most every kid has been accused of it many times) so how serious can it be?
Lacking models for hyperalgesia, or any similar experience, people simply do not believe, and hence, ignore or are indifferent. The puny vocabulary makes for imbecilic comments such as how lucky we are for this or that reason, usually that we are not totally paralyzed. If we ARE totally paralyzed and have central pain, but tell them that the Central Pain is much worse, they blow the comparison off, and insist we are wrong. Others often come up with some idiotic comment which declares our paralysis somehow infinitely more worse than the Central Pain. IF OUR MINDS WERE THINKING CLEARLY, we would recognize this. If their minds were afflicted with central pain, they would agree without condition.
That is how ignorant the public is of the whole phenomenon of that cute little term, “hypersensitization”, which means clinically a trainload of sensitizing chemicals pouring out of our neurons, soaking the dorsal root ganglia and the dorsal horn of the spinal cord, turning nerves from instruments of pleasure into engines of terror and suffering. Could there be anything worse? Maybe our imagination is lacking, but we really don’t think so.
Yet, the final word seems to come from those who have never experienced nerve injury pain (the majority rules, even outside their frame of reference). This is ironic since nerve injury pain is so easy to experience. Either a little capsaicin subcutaneously, or putting a blood pressure cuff on at about 250 mm Hg and squeezing a rubber ball repeatedly for a bit will fill in the picture nicely. Yes, it is true. In no time at all, they will become as wimpified as we are. Their attitude will become downright disgusting, ie “hypersensitized”. The difference is they get to stop.
According to the “My eyes see all” theory, well, the eye sees all. No need to learn biochemistry or how to patch clamp a nerve or actually measure the strength of the pain signal. Precise measurement is for the PhD’s. Paying attention (so remarkably easy) is all that is required to grasp what one is feeling with the capsaicin or the blood pressure cuff. Of course, no one would presume to take the measure of nerve injury pain WITHOUT ACTUALLY DOING the capsaicin/pressure cuff test, would they? We have heard ugly rumors of the PPP organization, the “pious pain preachers”, but do they actually exist? Of course, ALL doctors who work in pain clinics have done the little experiment on themselves, HAVEN’T THEY?
Using the word “hypersensitization” without stopping to reflect on what it actually means shows in human perception reflects a lack of curiosity. The cave man of 2006 hasn’t evolved the intelligence to develop the tools to understand pain. Still, when it comes to nerve bombardment, anything carried to the extreme can become painful. And things painful to normals can REALLY become painful in CP (hyperpathia).
Ah, the wisdom of the utter amateur, the untested and oblivious amateur, unrestricted by any evidence. Never mind that the public has been totally ignorant of the basics of medicine for 6000 years when relying on guesswork. In the year 1900 only ten percent of doctors had spent ANY time in college. Nearly all medical science is the product of the last fifty years, yet the pain wizards who walk around SEEING pain arrogate to themselves profound wisdom where pain is concerned. They graduated from the school of hard knocks. And when they had their earaches, what chemicals transmitted the message to the brain. What if the genes which produce pain chemicals went nuts? What would that feel like? Who cares. The pain Neanderthals walk through the malls, churches (especially the churches), schools, and courthouses, carrying their clubs of ignorance or other blunt instruments of inflicting injury, attempting to pound us into admitting that we are making up the whole thing. Of course, using something which inflicts pain to get us to admit we don’t have any is sort of a paradox, but there you go.
The burning is fictional, or at least fictive, even in the mind of the modern Neanderthal graduate, particularly if their discipline is behavioral science, of which they only too clearly illustrate one unfortunate characteristic of human behavior, ie. pride. “My degree converts all my opinions into fact”. Between the pain wizards of the lay public, the diploma’d “experts”, and the dainty vocabularly, even PhD’s who actually study pain don’t have a chance.
This parade of the imbeciles* moves triumphantly along; UNTIL, that magic moment of enlightenment when cord injury, stroke, or multiple sclerosis pulls open the curtains of understanding. Unfortunately, they will be in hell at that point, and more or less incapacitated to do any educating of others. Why do we have to go to hell to gain understanding? Or is it insanity that is gained? Pain is a teacher at one level, a devil at another.
Call this “educational” phenomenon “hypersensitization”. If you live a really evil life, say, become a Hitler or something, eternity will “hypersensitize” you. Nothing but chili peppers and thinking you know better for the rest of God’s children from then on out.
Those with central pain know that where their sensory impairment is most prevalent is also the area where the dysesthetic burning is most severe. Dejerine and Roussy pointed this out in 1906 in their famous work, “The Tract Optique”. Since in CP, we are talking about PAIN, we do not wish to dilute by comparisons, but the general phenomenon of Boivie’s Paradox may not be limited to pain. So we will move to sound.
Presbycussis is the loss of the ability to hear high tones which occurs as one grows older. By age 50 almost no one can hear the high tones which, for example, come from a television. I remember the trip through the college sound lab as a fifteen year old and hearing not only that frequency, but much higher ones which they tested there. I really could hear the high frequencies which their 18,000 Hz speakers put out, although they told me it was impossible.
Now, a company has created a device which emits noise at very high frequencies, which is designed to drive off annoying teenagers congregating near store fronts in a way that drives off customers. It is known as the Mosquito and its signal is also being downloaded as a ringtone, so high schoolers can call each other and get away with text messaging during class, when cellphones are forbidden. The unhip teachers supposedly cannot hear it and continue on about the “Missouri Compromise” unaware that some stealthy teenager in their class is talking about more important stuff, such as the revolving hubcaps someone has installed on their 1966 Dodge Charger. There can be nothing cooler than to outsmart your teacher with tech. (Of course, the student will miss the question on the ACT about the Missouri Compromise, which will keep them out of college, so they will wind up selling hubcaps for a living.)
The Mosquito actually works. The Transportation Safety Administration may have to put a designated teenager on flights to assure compliance until companies like JetBlue purchase allowable frequencies.
Now we come to the old lady next door, who always calls the police when your kids are playing “too loud”. Why does the noise bother her so much? Could it be she has Boivie’s Paradox of the ear? Presbycussis is the most common sensory impairment in the world. Thus, according to McHenry’s Paradox, “One must lose some hearing in order to be a candidate to be annoyed by the neighborhood kids”. Those whose hearing is down below 8000 Hz are hypersensitized to sounds. If it is down to 3000, you better tiptoe past the window. Of course, I can SEE what her brain is experiencing and I know she is making entirely too much of it.
Central Pain-like phenomena may be much more common in the world than we realize. If one part of a sensory apparatus is damaged, the brain may make the remaining parts more sensitive.
Webster’s Dictionary defines “Imbecile” as “the opposite of capsaicin injection”, or “any person who has endured a moment of low back pain or an earache, who thereby presumes to comprehend all complexities of the chemical pain cascade and to be able by LOOKING to measure the components of that system in anyone who happens to be in the imbecile’s field of vision.” Imbecility is also known as the “My eyes are a living MRI machine” delusion, which is closely related to the “My eyes are a highly accurate proteomics column” delusion, which makes them imagine they can SEE how much pain anyone ELSE is suffering.
They cannot SEE their own pain, but somehow, magically, they can SEE it in others. (I just hit my hammer with a thumb, and my eyes are killing me). If we could just find a pain that conveniently gives off light (in the visible spectrum of EM radiation), they MIGHT be ready for business. We have not found any pain like that so their perceptive abilities are not applicable. How is it that an organ designed only to see photons can also serve as a suitable device for measuring acidity, calcium, NK1, Substance P, BDNF, glutamate, and the big mother molecule NMDA, in the synapses, PLUS all the receptors and ion channels. Hmmm. I never did like to have to put in the units in high school physics. So time consuming. Photons, protons, amino acids, receptors, what difference does it make?
“I think you are exaggerating your pain” (We think you are exaggerating your intuition). Intuition is such a reliable thing. For example, at the mall, I never waste money going to those ultrasound places to see what sex the baby is, I rely entirely on intuition because it saves a lot of effort. “Your aunt Ethyl had two boys and then a girl so this one will be a girl”. Oh yeah!
Call it a hunch, but we suspect these people are also the ones who are likely to think they are qualified to speak for God, as in “Your pain is God’s will”. No, it isn’t, neither is your imbecility. God’s will, at least according to HIM, is that we get busy and relieve suffering, become Good Samaritans, and remember the afflicted. The Bible says “True religion is to visit the sick….” and it doesn’t say anything about telling them their illness is God’s will, while you are there visiting. Telling the sick how lucky they are is also just not cool, especially if pain is involved.