
The Neuroscience of Pain - devy
https://www.newyorker.com/magazine/2018/07/02/the-neuroscience-of-pain
======
Spearchucker
Not sure what this article is trying to say, other than a 7 Tesla MRI is
godawful powerful.

Yes, we all experience pain differently. I've had more than a standard share
myself (ripped arm from shoulder, in the region of ~20 dislocations followed
before it got fixed). And I've never heard of chronic pain (hypersinsitivity
to pain). And yes, pleasure is pain's opposite, but an even more evil beast.
Because true, unadulterated pleasure is an ephemeral beast - it doesn't come
often, and it never stays. Pain can stay. For a long, long time.

And that brings me to what the article doesn't discuss - how we (and how
different people) deal with pain. I can take a lot - apparently more than
most, because of that shoulder. Had to go under full anaesthetic every time to
get it set. And until then I had to just... take the pain.

And after a few dislocations taking the pain got to be surprisingly easy. I
somehow disassociated myself from it. I could feel the pain, but somehow it
registered a bit like a pilot light, and a lot less that what I feel when I
stub my toe or bash my shin. It was as if I was telling myself that hey
there's the pain, it hurts, but it's not that agony that it is. Or was. I
don't know how to describe it.

So I read that article, and I said all of this stuff, and I'm still not sure
what the point of it all was, other than inform me that someone's hoping to
provide a definitive measure of the severity of pain using MRI.

~~~
codingdave
It is a New Yorker article - it isn't trying to make a singular point and
convince you of it... it is storytelling about some interesting work being
done.

As far as you not having heard of hypersensitivity, that isn't a shock. I
first heard of it as a diagnosis from the Mayo clinic, after my local docs
weren't able to find anything wrong with me. And they said that many doctors
aren't yet familiar with it yet. It is a fairly new area of research.

But again, that circles back to the article -- it talked of how their findings
support the effectiveness of cognitive behavioral therapy for chronic pain.
(Also what the Mayo clinic recommended, BTW.) I found much of the article
resonated well with my experiences of chronic pain, and I am hopeful that
someday research such as this will be able to find reasonable treatments that
dial the sensitivity back down to normal for people with abnormal pain
responses.

Another term you can research if you really want to dig into this is "central
sensitization".

------
tasty_freeze
> One of her most striking experiments tested the common observation that
> religious faith helps people cope with pain.

I know there is always the problem that popular reports have to so simplify
research results that they veer into misrepresentation. But as described, the
stated conclusion is impossible to support. Devout Catholics and atheists,
collectively, had similar responses to pain stimuli. But if you shows both a
picture of the Virgin Mary before the pain, Catholics reported one point lower
pain scores.

How could the conclude that? What if instead they segregated the groups into
(US) football fans and non-fans, and showed both pictures of, say, Mike Ditka,
a famous tough, non-whiny guy? If the football fans reported lower pain
scores, would that mean sports helped them cope? Or are they simply primed to
act more manly?

Or rap fans/non-fans were primed with pictures of 50-cent? Or history buffs
pictures of Earnest Shackleton?

------
RcouF1uZ4gsC
> In 2000, Congress declared the next ten years the “Decade of Pain Control
> and Research,” after the Supreme Court, rejecting the idea of physician-
> assisted suicide as a constitutional right, recommended improvements in
> palliative care. Pain was declared “the fifth vital sign” (alongside blood
> pressure, pulse rate, respiratory rate, and temperature), and the numerical
> scoring of pain became a standard feature of U.S. medical records, billing
> codes, and best-practice guides.

This is one of the reasons that I find the push to solely blame physicians and
pharma for the opioid epidemic misleading. In the early 2000's treatment of
pain was being pushed, and it was deemed the "fifth vital sign", even though
it is subjective unlike the other four vital signs. Physicians were being
evaluated on how their patients said they treated pain. Given this
environment, it is no surprise that pharma developed powerful drugs to target
pain, and physicians prescribed these drugs in large amounts. We are today
dealing with the fallout of this push.

~~~
Canadauni
The makers of OxyContin have been losing lawsuits [0, 1] for aggressively and
misleadingly marketing (saying that it wasn't addictive) the drug for pain
management leading to the levels of opioid addiction that we see in cities
around North America. I think pharma, particularly Purdue, deserves the lion's
share of the blame in this.

[0][https://www.cbc.ca/news/health/oxycontin-class-
action-1.4093...](https://www.cbc.ca/news/health/oxycontin-class-
action-1.4093781) [1][http://fortune.com/2018/05/16/oxycontin-purdue-pharma-
lawsui...](http://fortune.com/2018/05/16/oxycontin-purdue-pharma-lawsuit-
tennessee-florida-opioid-epidemic/)

------
superkuh
After I read this I went off to learn more about the dorsal posterior insula
and pain. It's role in being a necessary but not sufficient or just something
correlated is still being debated with many experiments for and against.

[https://www.nature.com/articles/nn.3969](https://www.nature.com/articles/nn.3969)
and
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706052/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706052/)

then
[http://journals.plos.org/plosbiology/article?id=10.1371/jour...](http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1002345)

As far as I can tell on my very quick literature survey lately it's against,
and because of invasive studies done with actual electrodes covering the
relevant areas of the insula. And the activity there (which would be later
picked up as blood flow inferred by MRI) doesn't seem to necessarily "track"
pain like the foundation paper(s) on the theory suggested.

------
forapurpose
What are the evolutionary advantages of extreme or chronic pain? Some pain is
a message and an incentive to do something about it, but extreme pain and
chronic, high levels of pain paralyze people without any apparent benefits.

Perhaps I assume too much, that humans are such evolutionarily fined tuned
machines that every 'bug' must be a feature.

~~~
tasty_freeze
> What are the evolutionary advantages of extreme or chronic pain?

That is a funny question. It is like asking: what is the evolutionary
advantage of a broken leg? Sometimes things go wrong and the result is pain.
There is no purpose to it; it just happened. Not everything has an
evolutionary purpose.

My wife has Ehlers Danlos Syndrome, resulting in malformed collagen throughout
her body. As a result, her tendons are too stretchy and don't work well, and
so her bones don't align as they should, leading to wear and tear on joints
and now incessant pain.

Also, many kinds of failures show up after the typical reproductive window.
There is little evolutionary pressure to prevent such failure mechanisms.

~~~
abiox
> That is a funny question. It is like asking: what is the evolutionary
> advantage of a broken leg?

i'm unconvinced... a broken leg isn't a normal biological function, while
(afaik) pain is an entirely internal process that is a 'response' mechanism.

> Sometimes things go wrong and the result is pain. There is no purpose to it;
> it just happened. Not everything has an evolutionary purpose.

the ostensible purpose of 'some' pain is to cause you to stop or avoid doing
something damaging, or being aware of a need to seek remedy. for those few
people who don't feel any physical pain (congenital analgesia)... life is
actually more dangerous.

when it comes to incapacitating levels of pain, things seem to get murky.
there is some arguable benefit to adopting a protective posture (covering a
wound, adopting a fetal position, etc) to mitigate further harm... but it
seems these same behaviors can also increase risk of harm as well, especially
when it comes to pain causing reduced situational awareness and other
reasoning impairments.

------
ben509
>For this reason, the International Association for the Study of Pain
(I.A.S.P.) has a code of ethics, and its members are pledged not to inflict or
increase pain except in an experimental setting.

What would we do without ethical codes?

~~~
taneq
Just like any "obvious" rule, these rules are there because something stupid
and terrible happened and people said "we need a rule against this."

