Later On

A blog written for those whose interests more or less match mine.

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Pain as emotion

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Interesting:

I’ve got a new article on the psychology of back pain in the February issue of Best Life (the one with Jeff Gordon on the cover):

From the perspective of the brain, there are two distinct types of pain. The first type of pain is sensory. When we stub our toe, pain receptors in the foot instantly react to the injury, and send an angry message to the somatosensory cortex, the part of the brain that deals with the body. This is the type of acute pain that doctors are trained to treat. The hurt has a clear bodily cause: if you inject an anesthetic (like novocaine) into the stubbed toe, the pain will quickly disappear.The second pain pathway is a much more recent scientific discovery. It runs parallel to the sensory pathway, but isn’t necessarily rooted in signals from the body. The breakthrough came when neurologists discovered a group of people who, after a brain injury, were no longer bothered by pain. They still felt the pain, and could accurately describe its location and intensity, but didn’t seem to mind it at all. The agony wasn’t agonizing.

This strange condition – it’s known as pain asymbolia – results from damage to a specific subset of brain areas, like the amygdala, insula and anterior cingulate cortex, that are involved in the processing of emotions. As a result, these people are missing the negative feelings that normally accompany our painful sensations. Their muted response to bodily injury demonstrates that it is our feelings about pain – and not the pain sensation itself – that make the experience of pain so awful. Take away the emotion and a stubbed toe isn’t so bad.

Chronic pain is the opposite of pain asymbolia. It’s what happens when our brain can’t stop generating the negative emotions associated with painful sensations. These emotions can persist even in the absence of a painful stimulus, so that we feel an injury that isn’t there. It’s like having a permanently stubbed toe.

Doctors have traditionally focused on the bodily aspects of chronic pain. They assume that a healed body is a painless body. If a patient has chronic back pain, for example, then he is typically prescribed painkillers and surgery, so that the pain signals coming from his spinal nerves are stopped. But the dual pathways of pain mean that this approach only treats half of the pain equation. Unless you find a way to treat the emotional pathway, then the chronic pain will continue.

Alas, the article isn’t online. But researching the piece definitely changed the way I think about my own back. For instance, it’s made me much less concerned with my potential structural flaws – like herniated discs – and much more concerned with my emotional state of mind.

Written by Leisureguy

30 January 2008 at 12:00 pm

Posted in Daily life, Medical, Science

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Acupuncture, even fake, works for back pain

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From the Associated Press:

Fake acupuncture works nearly as well as the real thing for low back pain, and either kind performs much better than usual care, German researchers have found. Almost half the patients treated with acupuncture needles felt relief that lasted months. In contrast, only about a quarter of the patients receiving medications and other Western medical treatments felt better.

Even fake acupuncture worked better than conventional care, leading researchers to wonder whether pain relief came from the body’s reactions to any thin needle pricks or, possibly, the placebo effect.

“Acupuncture represents a highly promising and effective treatment option for chronic back pain,” study co-author Dr. Heinz Endres of Ruhr University Bochum in Bochum, Germany, said in an e-mail. “Patients experienced not only reduced pain intensity, but also reported improvements in the disability that often results from back pain and therefore in their quality of life.”

Although the study was not designed to determine how acupuncture works, Endres said, its findings are in line with a theory that pain messages to the brain can be blocked by competing stimuli.

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Written by Leisureguy

6 October 2007 at 11:28 am

Posted in Daily life, Medical, Science

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