Pain 1. Why does pain matter?

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Pain and how the brain perceives it involves more than just saying ‘ouch’ if we cut off a finger with a pair of scissors. Understanding how the brain interacts with pain helps us deal with pain constructively rather than just smothering it in pain killers.  This blog looks at 3 reasons why pain matters: as a learning process; how it protects us and why ignoring it leads to future troubles.  So if a child clamps his nose in a pair of hot hair straighteners, his brain perceives the excessive heating of the skin and the tongs are rapidly withdrawn.  The memory of this is stored in the brain, so he has learnt not to put his nose too near a source of heat.  An important basic lesson learnt during childhood.

To understand how pain protects us, I want to look at the rare condition called congenital insensitivity to pain or CIPA, where the person cannot feel pain.  Anybody suffering from long term pain may feel envious of this, however, people with this disorder rarely live for very long because they are unaware of when they damage themselves, for instance if they damage their ankle by falling off a kerb.  For most of us this will be excrutiatingly painful and the brain will do everything it can to help us avoid weight bearing on the injured ankle- unless we are in a life or death situation, but that will be covered another time.  But for people with CIPA, they will continue walking as before, making the situation much worse.  Of course, this type of thing can happen to a diabetic as well – they slowly lose the nerves to their feet, so can damage a foot or ankle, not realise it and eventually gangrene can set in and they lose the foot and so on.  So pain is extremely useful and we certainly need it to protect us and prevent us from damaging ourselves further.

Minor pain can easily be ignored.  Go out for a run, return home and the knee hurts a bit – but it soon wears off, so we feel we can ignore it.  Or we fall over, the hip hurts as a result, but we are sure it will get better in due course since these things normally do.  Now there is an extremely funny book written by Dr Lorimer Moseley called Painful Yarns – I heartily recommend it.  Dr Moseley has a doctorate in Pain Science from Sydney University1 and wrote this book to help people understand their pain by using metaphors and tales of adventure.  The book has a couple of cautionary tales about ignoring pain.  The second of these deals with when he hitched a lift in a pick up truck with ‘Crazy Kevin’ .  As they drove along (Lorimer was driving the truck at this point), a warning light came on.  The young Lorimer repeatedly pointed this out to Kevin

Crazy Kevin: “All right yer bug worry wart.  You keep drivung and I wull fux utt up.”

With that, Crazy got something from under his seat and then leaned over towards me.  He stuck his head up under the dash.  He was fiddling around there for a while (this made me a little uncomfortable), and then with a final click, something happened and the light went off.  He came out with a little globe in his hand.

Needless to say, things got worse (and funnier) as more lights came on and Kevin reached in and pulled the light bulbs out.  After he’d dropped Lorimer off, Lorimer watched him drive away, then suddenly the pick up truck accelerated wildly and instead of turning a corner, shot straight forwards, banged into the kerb, burst into flames and accelerated hard into a wall where it stopped, still on fire, with the rear wheels still spinning madly.  Kevin did escape with various cuts and bruises.  The take home message: “Pain is a critical protective device – ignore it at your peril”.  If we ignore pain or dose up with painkillers or use a TENS machine to dull the pain, whilst carrying on activities as before, it is only a matter of time before something goes Twannnggg or we end up under the surgeon’s knife having our bone spurs removed, or the knee ‘resurfaced’ and so on.  Usually we have to cease the activity that caused the pain;  I become wordless when people inform me that they have given up running because ‘it is bad for the knees’.  Had they not ignored the warning signs, but found out what was causing the pain, struggling with conventional and unconventional approaches, then they could still be running – or playing tennis, or shoving heavy weights about in the gym and so on and so forth.

So pain teaches us what causes us danger and it protects us if we damage ourselves.  Ignoring or masking a pain that is ongoing will result in injury and cessation of activity.  Without pain, we are in real danger.

 

 

  1. Dr Moseley is now Nuffield Research Fellow in Medical Sciences at Oxford University, UK []

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