Pain and how to beat it

Why, with the availability of modern medicines, do so many of us put up with physical suffering? By CATE DEVINE

When Marni Jackson was stung in the mouth by a bee, it started her off on a journey of discovery. The pain she experienced was immediate - a slim, unambiguous lance, like a splinter of glass - but then it changed. Over the course of the next day, she found it was difficult to describe and there were no new words that quite expressed it. Then she was surprised by it, because it sparked off a memory of a painful emotional experience that had occurred 30 years earlier. There followed a series of sensations, from feeling dizzy and ill to weird and anxious. Finally, as her pain receded, she became bored by it. No sooner was she free of it than she had suppressed its memory, along with whatever illuminations it had brought.

Her experience gave her a glimpse of the isolation and anxiety that accompanies pain and it prompted her to wonder why, when our society is so medicalised, so many of us suffer pain. At the moment, some 70% of the UK population suffers from chronic pain - that is, pain that is persistent for at least three months.

She also realised that trying to define pain is like trying to inscribe the history of love on a grain of rice. "The more you try to pin down pain," she says, "the more it shatters into ungraspable fragments."

The result is a book which attempts to look at the nature, treatment, and definition of human pain, one of the most misunderstood, complex, and elusive subjects to challenge humankind.

So what exactly is pain? Dr Eric Brodie, reader in psychology at Glasgow Caledonian University, describes it as the unpleasant sensory and emotional experience linked to actual or potential harm to body tissue. Like Jackson, he cites the groundbreaking Gate Theory, devised in the 1950s by Patrick Wall and Ronald Melzack, which was the first to take into account our emotional response to pain by taking the focus off the pain source and putting it on the brain and the central nervous system instead.

According to their theory, pain arrives in two sorts of volleys, via two different kinds of nerve fibre. The immediate, sharp sort of pain, when you twist an ankle or burn your hand, travels along particular nerves known as A fibres, zipping up to the brain quickly and directly. But when the first acute pain fades another, slower pain - burning, aching or throbbing - sets in, travelling along slow-conducting C fibres to enter a butterfly-shaped region of the spinal cord known as the dorsal horn. It is here that the "gate controls" come in.

Triggered by cell changes launched by these C fibres, the brain sends descending messages that alter the sensory input, turning the volume of pain up or down.

Pain isn't pain until it reaches the brain. By making our feelings, attitudes, and memory part of the perception of pain, the gate-control theory also helps explain such mysterious conditions as phantom limb pain.

The painkiller industry is currently worth some £2bn. Yet is it possible actually to beat chronic pain without resorting to analgesics? Brodie points to research recently undertaken by the Scottish Network for Chronic Pain Research (SNCPR), a three-year project conducted by Stirling, Glasgow Caledonian, and Queen Margaret universities and funded by the Scottish Executive, and of which he was co-director. "There are several alternative analgesics," he says. "Music has been proven to reduce some types of pain, for example the pain of having vascular dressings changed, perhaps because it acts as a distraction and because it can evoke pleasant memories and visual images.

"There is also some evidence that smell can help some pain. The power of aromatherapy is not new, but what is new is the scientific acceptance of it."

The same applies to acupunture and Tens (transcutaneous electrical nerve stimulation).

Another complementary therapy which is causing great interest in the world of pain research is hypnotherapy. This is being pioneered by the Seattle psychologist Mark Jensen, whose presentation at a recent SNCPR seminar in Glasgow's SECC was so convincing that he has been invited back to contribute to research in Scotland.

However, complementary therapies cannot touch excruciating pain such as the pain of cancer or childbirth. Opiates like morphine are still the only way to manage this type of pain. Studies elsewhere are ongoing about their dosage and application.

Stirling Royal Infirmary is just about to start a pilot research study into behavioural therapy, or EMDR (Eye Movement Desensitisation and Reappraisal), as a way of reducing chronic pain. This has traditionally been used to treat post-traumatic stress disorder, but preliminary studies in Australia have shown that it has the potential to treat chronic pain conditions.

Total alleviation of physical pain, however, is not necessarily a good thing. It is part of life to experience the world and not to be cut off from it, says Brodie. Pain is a warning of danger and it is essential that we experience and understand it for continual survival. To be totally insensitive to pain is very rare, and makes a sufferer subject to all sorts of tissue damage. A few people do suffer from the condition, known as congenital insensitivity to pain, but a high number of people are left in this unfortunate position following a stroke.

This is a dangerous condition on which very little research has been done.

Doctors would prefer to be able to reintroduce the ability to experience pain, although they would never wish patients to suffer from it.

Surprisingly, Dr Brodie finds it reassuring to discover how little we still know about pain. "There is so much to learn and, by extension, so much to hope for," he says.

Pain: the Science and Culture of Why We Hurt, by Marni Jackson, is published by Bloomsbury on August 25, priced £7.99.

Suffering explained

Acute pain

Usually has a cause that is easily explicable and well-defined (ie, a blow to the head resulting in a headache, swelling, discolouration, or other obvious injury to the painful area). The amount of pain corresponds to the level of discomfort and it usually improves as the physical cause is identified and treated accurately. Although responses to acute pain vary from person to person, usually over time the report of pain and the person's response to it improves in relation to the improvement of the physical injury.

Chronic pain

Persists beyond the expected healing time for a particular injury and/or illness. Individuals with chronic pain typically show pain in excess of that which can be explained by physical causes alone. Not only can this pain be widespread, sometimes it may not make sense medically because it may not remain at the original site of injury nor may it stay in related areas of the body. In most cases, the pain and the disability it creates remain the same or worsens, rather than slowly and steadily improving.

SOURCE: Brain Injury Association
- Aug 14th