Borrowing from Dr. Laura

So far, we have not encountered a single person with Central Pain who has not been immersed in lame advice and thinly disguised skepticism or scorn. We do not intend to side with the Job’s Comforters of this world.

Dr. Laura Schlessinger recently responded to a cancer sufferer who feared his spouse’s failure to keep a positive outlook on things might hamper his chances at recovery. The well known radio counselor and PhD in physiology indicated essentially that a very large majority of cancer sufferers willed positively “like crazy” but that there was still the possibility of an adverse outcome. We are pleased with Dr. Laura’s avoidance of the common confusion of moral/spiritual with the physiological/biochemical.

Perhaps the questioner felt his own strength needed to be kept up if his body were to respond to cancer treatment, so his concern is understandable, but Dr. Laura’s admonition was to continue to do what he could to function whether or not everyone maintained the right attitude. The heart goes out to cancer sufferers, but that disease has a long history of charlatans preying on hopes and “positive thinking”. Perhaps the main value of positive thinking is to endure the ravages of chemotherapy, but the failures in that department are well known and extensively documented, even among the strong who vowed without apparent doubt to “beat cancer”.

The remark strikes a familiar chord here at painonline. A majority of those commenting on the psychological journey that is central pain have attempted to try to use positive thinking to decrease the pain. To do so is a very common admonition from others, who sometimes go so far as to insist that the sufferer should regard severe pain as a “blessing”. Dealing with unrealistic and distant, insulated comments from those who have no idea what they are talking about is one of the most difficult parts of Central Pain.

For every person who claims a cure from such attempts, there are hundreds of failures without improvement who must cope with additional depression when observers, friends, and families accuse them of a poor, insufficiently positive outlook. According to this view, merely utilizing the freely available method of positive thinking, should make the pain become virtually nonexistent. No one needs guilt on top of severe, chronic central pain.

The problem with this theory is that clinical pain testing since as early as the 1940′s shows that people are very similar when it comes to pain response, without variation for attitudinal state. Yes, there are in fact sex differences and the like, but these studies pertain largely to an intact nervous system and normal pain, not one which is malfunctioning biochemically and drenching the synapses with known pain exciters.

We can second the NIH which strongly counsels the avoidance of stress to help deal with central pain, but simplistic axioms about a positive mental attitude ignore the maniacal production of pain exciters by the protein factories in the genes of the central pain neurons and the glial cells which surround and control them.

While everyone acknowledges the power of the brain to ignore pain for a vital moment, no one seriously believes this protective state can be maintained forever. Most “painless soldiers” develop severe pain once they reach the hospital. One of the authors at painonline endured multiple spine surgeries and required little or no pain medicine following any of these surgeries, still had severe central pain. Mind power was working for post-surgical pain, which was comparatively less severe (post-op pain does not, for example, make the touch of sheets unbearable, except in burn patients), but mental strength was insufficient to alleviate central pain. This is not to say post-surgical patients are not entitled to whatever pain relief they may require.

Despite placebo studies, which will remain fantastically popular until science actually comes up with a way to treat central pain, the reply must be made that all chronic pains CANNOT be put into one basket. Arthritis, gout, irritable bowel, etc. are NOT central pain. Severe central pain is the worst pain state known to man (source Dr. Ron Tasker, who discovered the pathway of pain in the spinal cord), and in the area of pain, degree and amount matter greatly.

Since Central Pain is known to involve the same sodium channels and receptors as the ones activated by capsaicin, that drug is often used as a model for studying nerve injury pain. Placebo or any other method of mind over matter is freely available to the capsaicin researchers. So far, no one injecting the burning chemical has shown any particular benefit from whatever mental device was being applied. Capsacin, being a chemical which opens TRPV-1 channels, causes burning pain. This is true in tall, short, fat, skinny, happy, sad, hyped, depressed, educated, ignorant, rich, and poor subjects. Chemical burn is no respecter of persons.

It is true that some with central pain have found they could endure pain better if they could exercise, if they could avoid stress, etc., but fundamentally dysesthetic pain is a durable, difficult to treat sensation of a chemical burn. Positive thinking is not going to change that. A chemical which blocks the ion channels WILL change it. Sight is also a sensation. Does positive attitude change the color red into something less vivid. Does it diminish air hunger? Does it prevent the blinding effects of bright light? Does it allow us to ignore altitude sickness? We don’t think so. If you have central pain, and you are blessed enough to have it diminish or leave, be grateful. Gratitude is a positive attribute. Attributing weakness to others for whom the pain continues is not a positive attribute. Don’t go around hectoring those who couldn’t quite pull it off. Maybe your “severe” central pain was less severe to begin with.

We have followed hundreds of subjects for many years. From the first, those with lighter burning use terms like “sunburn” to describe their skin and can don clothing, while those with severe pain nearly all compare it to the injection of “acid under the skin” and cannot tolerate the continual touch of anything on the distal areas of the body. The apparent cures nearly always come from the less severe group. Our conclusion: even minor nerve injury pain can be very distressing.

If you want to think positively, be sure to include being generous in your opinion of others, even if they cannot stop burning, no matter what they try. It isn’t as if they wouldn’t do anything in their power to escape the burn or are refusing to try anything with the slightest chance of benefit. It is simply that nothing is working. The National Institutes of Health, which includes major studies in alternative medicine, has found nothing to satisfactorily treat central pain. If something really had power for the broad central pain population, it seems likely the NIH/NIDCR would know of it.

Everyone knows of instances when people awake from comas, and instances when they do not. The cause of any awakenings has not been identified to be positive thinking by their relatives. Everyone tries to think positively. So if we are to cure central pain, we need the help of the scientists. Motivational speakers just have not gotten the job done.

In the meantime, thanks to Dr. Laura for refusing to condemn the unfortunates who fail to get well and for recognizing that the continuation or progression of a chronic illness should not automatically be relegated to a lack of positive thinking. (Nor, we might add to a lack of personal righteousness, which is not ours to judge).