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Wednesday, July 15, 2009

Pain in the Brain

Posted by Anke on 07/15 at 12:13 PM “Take it for Pain. Take it for Life. Aspirin.” This certainly sounds reassuring, and has worked for headaches, colds, and other acute pains for 70 years now. (The history of aspirin is a feature in the latest edition of Chemical Heritage magazine:  http://www.chemheritage.org/pubs/magazine/feature_aspirin_p1.html). But pain is a many-headed beast, and comes in other shapes and sizes which cannot be controlled by over-the-counter drugs. Wait, wait! Before you turn away with an image of Auntie Margie’s rheumatism (which always flares up when you ask her to do the dishes) in mind, follow me on a quick and dirty trip into the brain.

Ideally, pain is an awareness of ‘something wrong’, our brain’s way of telling us that some damage has occurred. If you cut your finger while making a sandwich, for instance, you will quickly stop the cheese slicing, investigate the aching area and then clean the wound (tap water or, an unsavory yet popular alternative, saliva), thus avoiding further damage and preparing the skin for healing. Soon, the pain vanishes. If there was no pain in the first place, you would not be aware of the cutting accident and could seriously, permanently or even fatally damage yourself. And who’s going to eat that sandwich then? In a way, pain is ‘good’ for you. (That being said, a headache might be a sign to get a massage, or to work less, not a sign to pop a pill – but that may be the German in me speaking…).

Sometimes the pain does not stop when the injury is over, however. The brain develops a life of its own and continues to send pain signals without a physiological cause. Also, some bodies have permanent conditions (say, asymmetries or off-kilter muscle structures) which produce pain. And sometimes, pain just pops up like a recurring nightmare, for no obvious reason. As soon as such pain continues over a long period of time or appears again and again, it becomes chronic pain. And this pain that lives in the brain continues to baffle doctors and patients alike. Some drugs may help to shut off the pain signal, but at the cost of rather awful side effects, and no guarantee given. Some alternative therapies (acupuncture, chiropractic techniques, meditation, what-have-you) may help, but it is hard to understand why they would relieve some people’s pain and not others’. It is a long, frustrating and costly search for an alternative cure which structures the life of many a chronic pain patient.

In the end, chronic pain remains a mystery. It is as real as acute pain, and certainly as painful. Therapy is not a slam-dunk but a dribble-lose-the-ball-hit-your-own-head-sort of affair. And it is necessarily incomprehensible to families and friends of patients, the co-sufferers. Here’s hoping that some school of medicine, whether Western or not, comes up with something to take for chronic pain, and hopefully for a shorter period than a full life. Meanwhile, note that one in five Americans experiences chronic pain. That rude person in the grocery store may not be grumpy, but in pain, day after day. And as for Auntie Margie – she will thank you for doing the dishes and may just take you out for ice cream after.

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