The Duration Factor in the Central Pain equation. What does it all add up to?

For everything there is a season, and a time for every purpose under heaven. What does time mean about central pain?

It is impossible to go out into the world, particularly that portion which considers itself educated, and avoid confrontational debates about central pain. One can hardly explain what it is, without being immediately challenged as to its’ severity. This is generally based on the fact that the listener has never heard of it before; and, if central pain were really that severe, surely it would be public knowledge. Yeah, right! Sort of like tensor analysis is public knowledge.

After one of these demoralizing and discouraging incidents, the author was pondering WHY people are so downright insulting and vicious when chronic pain is claimed, particularly if the pain is represented as more severe than other pains. It is immediately obvious that “implied” comparison with those pains experienced by the listener is the most sensitive area. Pain hurts. No one wants theirs minimized, even if it means minimizing yours.

The thought occurred that people usually have pain in one small area of the body. We typically step on one nail, have one tooth drilled, burn one hand, etc.

The other dimension of pain which is even easier to overlook is TIME. When the statement is made that central pain is the “worst pain known to man”, the listener seems to bristle with skepticism or even personal resentment. Perhaps we need another phrase which does not engage the egos of the “brave” souls who listen, however briefly, about the plight of central pain sufferers. Maybe something that includes the time element would improve communication.

The actual pains of central pain are no more severe, but sometimes no less severe than any other bad pain. Not all central pain is severe. Still, CP groups have more severely pained people per capita than any other subset of the population. A good jolt of lancinating pain will match up to just about anything nature and an intact nervous system can dish out. Lancinating pain is, we imagine, sort of like what Darth Vader used to try to get Han Solo to talk, up in Lando Calrisian’s gas mine. Darth even had tough guy Harrison Ford screaming.

Without the visual symbols of pain, the reality of physical agony is probably not going to sink in. The lightning flashes on Darth’s interrogation machine and the long needle on the mind probe all evoked painful experiences common to humans. Central Pain, being mysterious, causes no such automatic response. We digress. Lancinating pain, being intermittent, is NOT the pain which is most devastating to central pain sufferers. That honor, first place in the torture category, belongs to the burning dysesthesia, an evil tool against mankind if there ever was one.

Central pain dysesthesia resembles a chemical burn. Most of us know what to do with a chemical burn. We wash it off immediately with water, apply some benzocaine and give our bodies time to heal. If the burn is really severe, then some silver sulfadiazine will do the trick.

Even those who are literally set on fire, who endure long suffering in the burn wards, do not have severe pain lasting more than two months. But what if, once they were burned, the burning lasted FOREVER. How would that be? Would there be any problem with their claiming the worst pain known to man, even if the burning were no worse than what others touched by flame briefly perceive? Would the claim be acceptable if the burning continued but never grew worse than what was initially experienced? What if the burning continued, but subsided slightly in intensity until it was somewhat less than what one feels while resting a hand on a hot stove? TIME is a big deal, and grows bigger with time.

TIME cannot be ignored. Like pressure from Lake Ponchartain on the levees, TIME can wear down a strong person to nothing. It can break them, easily and predictably. Come to think of it, the levees gave way after one night of flood pressure after Katrina. Now, what if the water never let up for a lifetime? Same rainfall, but without letup. How much would be left of a city then? Maybe it would become a tourist attraction for dive groups. In contrast, Central Pain evokes no such curiosity. Even a quick driveby is annoying. Just too ugly. There is no such thing as pain tourism. “Yes, Martha, this is all that is left of that person’s personality.”

And so, armed with the realization that the durability and inhumanly long time extension of central pain is really its most vicious and dehumanizing aspect, the author decided it was time for a little one-on-one research.

Not far from a favorite bookstore is a gym, where college students let off some steam, housewives try to stay slim, and a few athletes in training perform awesome lifts of very heavy weights. After forming an acquaintance with one of the trainers who works at the gym, the author decided to perform a little experiment. This individual warms up with 80 lb. dumbbells, one in each hand. The muscles bulge almost beyond belief, and even if this author still had an intact spinal cord, it seems doubtful such a powerful physique would ever be in reach. The cooperative trainer agreed to participate in a little endurance study.

The agreement was that he would carry a weight and not change hands, so the effects of TIME could be evaluated. He picked up ONE 35 lb. dumbbell and off we went along the sidewalk outside the gym. Although 35 pounds was nothing to this person in the gym, he discovered that it grew rather heavy after about three blocks. After another three blocks he began to experience pain in his arm. The pain was not in his muscles, but in his tendons at the elbow, where the weight was beginning to punish him. After several more blocks, he asked if he could end the experiment since his back was also beginning to hurt.

The author agreed to the disconinuation since it was John Bonica, the inventor of the epidural block and one of the early contributors to the painonline research (and certainly a continuing inspiration) himself developed the incurable pain that would send him into medical school and pain research, by using dumbbells.

Dr. Bonica had been a professional wrestler and in his enthusiasm he decided to train by running in Central Park in New York with a 50 lb. dumbbell. This training sideswiped him. It ended his career. He developed very severe pain in his back. According to what Dr. Bonica concluded, and what he told this author, the pain was due to bone spurs which formed on his lumbar vertebrae in response to the loading over time. Dr. Bonica said:

“In those days, we thought the most determined person would win. I had no idea that weight I could handle easily in the gym, would ultimately destroy my health when I hefted it for repeated jogs in the park. When my back began to hurt, I saw Doctor after Doctor and no one could tell me why I had pain. So I went to medical school, studied anesthesia, and in the 1930′s invented the epidural block. No one wanted to hear about it at first and so I determined to be an advocate for pain patients.”

Dr. Bonica went through sixteen surgeries in his lifetime to try to get rid of his back pain, but nothing ever removed it and he had to walk with a special shoulder to floor brace (crutch) in his later years.

The time test at the gym explains why central pain is in fact the worst pain known to man. It is not that the essential, momentary pain is worse than every other pain. Central Pain’s terror comes from the fact that it NEVER ceases. Spontaneous dysesthetic burning becomes true torture after a few weeks, and after that the body can only digest itself psychologically until few or no characteristic human goals remain, other than to escape the pain. This is a disgusting state to be in, but it is unavoidable. We are not aware of any other pain states which match this. Cancer pain can be treated with morphine. RSD or complex regional pain syndrome is terrible and heartbreaking, but it only occurs on the hands, or perhaps the lower legs. Central Pain is, or can be, ALL PLACES, ALL THE TIME.

And so, there is no reason to challenge Dr. Ron Tasker’s declaration on the matter. Severe central pain is the worst pain known to man. (Dr. Tasker, perhaps the greatest pain clinician who has ever lived, called it “deafferented pain” in the text, but in his office, he used the term “central pain” with me–author’s note).

It is TIME which makes central pain the worst pain known to man. If there are any doubters, may we suggest a journey across town with a 35 lb. dumbbell. Are there any heavier weights in the gym? Yes, and your body can endure them briefly, but if you are in it for a lifetime, maybe one of the two pound jobs in pastel colors would work out better. We have it on good authority that even one of those becomes heavy if one attempts to carry it around all day. As a matter of fact, we know of one lady who had to have cortisone injections and a bucket of ibuprofen for doing too many aerobics with one pound weights.

Central Pain sufferers are not only fragile, but they are broken. TIME is not on their side. When YOU imagine pain, are you thinking of an instant or a lifetime?