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Michael McMahon

Chronic Pain

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Hi, my name is Michael McMahon. I'm inquiring about the function of chronic pain. It can be a very strange illness in that it cannot be observed by someone else or any medical device. But the pain can still be severe for the patients. I was reading about the different theories into its nature. The slight problem I have with the overactive immune response hypothesis or the central sensitisation theory is that pain seems to be an evolved and adaptive response. Could chronic pain be a type of biological stress test? A stress test is where a device is tested to its breaking point to see where it fails and what needs to be done to fix it. Maybe chronic pain could be where the brain deliberately simulates organ failure to see what has to change in order to modify the body part. Science is reductionistic which has obviously been a very successful outlook in many areas. But in some respects the human body is almost infinitely complicated with lots of interdependent systems. This means that in order to change one system the body must make alterations to many others in order to compensate. One brutal but efficient way to do this would be to test the organ to failure so that the body and the genes could check all the different systems to be modified and hence design a blueprint for organ repair or strengthening. This would explain why chronic pain is invisible; because all the physical changes are happening deep in the genes. It would also account for why the pain could be so excruciating. Organs can never rest (if your heart for instance stops beating momentarily you die), so the only way to simulate their failure is to induce extreme long lasting pain to compensate for it. Another point is that it could explain why it happens in seemingly healthy and fit individuals. This is as the pain could be preemptive in nature if the body senses that an organ is not strong enough to withstand anticipated stress and heavy loads or demands. However, I'm not a biologist. It is only a hypothesis.

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15 hours ago, Michael McMahon said:

This would explain why chronic pain is invisible; because all the physical changes are happening deep in the genes.

 

There wouldn't be any changes to the genes themselves. It's possible there are changes in certain gene expressions in response to the environment, but that's slightly different. If you want to look at modulation the nervous system, including the brain, seems the best place to start. The stuff about the body deliberately simulating organ failure doesn't make sense. Ultimately though it's not a very well researched area so you are likely to find more questions than answers. Good luck.

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Thanks for your reply. I will look into the modulation of the nervous system thanks. Well whatever about my theory chronic pain must serve some function. It's hardly the case that evolution messed up so badly that some people suffer seemingly endless pain for no reason whatsoever. All emotions including pain are adaptive. It couldn't be that their subconscious mind becomes sadistic and subjects them to pointless torture.

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Just now, Michael McMahon said:

It's hardly the case that evolution messed up so badly that some people suffer seemingly endless pain for no reason whatsoever.

Evolution can be thought of a series of trials and errors. Acute pain was obviously a successful trial: people unable to feel pain usually die young. But chronic pain may be an 'unsuccessful' trial in that it confers no reproductive or survivability advantage, while not being erroneous enough to stop people from reproducing. I don't know, i'm just speculating. I think it more likely that chronic pain is some kind of biochemical and/or psychosocial modulation upon acute pain and hence the former is an inevitable consequence of the latter for some people. When i was a nurse i was thinking of becoming a pain specialist but life took me in other directions. I haven't looked into it for a very long time but the books i studied when i did though might still be pertinent:

This one is a medical textbook, very detailed and expensive, but worth it if you want to delve deeply into the subject:

https://www.elsevier.ca/ca/product.jsp?isbn=9780702040597

This one is more accessible both in terms of price/availability and requisite knowledge:

https://www.amazon.co.uk/dp/B009UV5ZG4/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1

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46 minutes ago, Michael McMahon said:

Very unfortunately many chronic pain patients die by suicide so it actually is erroneous enough to stop people reproducing.

Likely true, but did it inhibit their ability to reproduce? Experiencers of chronic pain are usually older, having had a chance to reproduce. Anyway, it would be irrelevant if chronic pain is some modulation of acute pain: you couldn't have the former without the latter.

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I see pain as a method of persuading (or forcing) you to favour a damaged part of the body, until it has repaired itself. If the brain keeps getting the damage signals, then it will continue giving the pain sensation. 

Some things can't be repaired, so the signals don't go away. Or maybe something does get repaired, but the damage signal keeps getting sent in error. Or maybe even the damage signal gets sent in complete error for no good reason. 

I don't see any evolutionary benefit in the body "stress testing" body parts. I'm not aware that repair is stimulated by the pain sensation in the brain. I don't find it likely, although can't say that I know anything to the contrary. 

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I think pain probably serves multiple roles. I agree with you that one function is to report body damage, identify threats in the fight-or-flight response and to just act as a general deterrent to getting injured. However if this was the only purpose of pain it would definitely be overkill. If you've got a sick stomach for instance you cannot fix it with your bare hands. Therefore it would be futile to keep getting alerted to it by pain signals if this was its only function. It must have healing properties too. The exact mechanism of consciousness and hence pain is obviously still a mystery. But we can still make inferences. I think some mental illnesses may be your subconscious mind taking a huge risk. Let's take a depression. The most efficient way to determine if your life has meaning is for the person to find a solution to overcoming despair. The solution they find could vary from anything like hedonism to helping others. It's still a sort of stress test I suppose.

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4 hours ago, Michael McMahon said:

If you've got a sick stomach for instance you cannot fix it with your bare hands. Therefore it would be futile to keep getting alerted to it by pain signals if this was its only function.

Not necessarily. Stomach pains can indicate food poisoning, and probably did during our evolutionary past. Toxins can circulate in the blood, and damage muscle and organs, so cutting down on energetic activity might protect the body until the infection is cleared. Something similar might well apply to viral infections. Athletes can do real harm to their fitness, by overdoing it while they are suffering from an infection.

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I don't think the only function of pain is to make you rest and cut down energetic activity. You're body could force you to rest by deliberately weakening the body part or temporarily paralysing it. It could do so without the sensation of pain if this was the sole objective. Modern health services have obviously improved a lot in how it treats mental illness. But in evolutionary history chronic pain patients could not have taken sick days off to rest. Pre-historic societies would of lacked the resources to facilitate it.

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It is a fact though, that sick animals tend to retreat to a quiet corner, and curl up and wait out the infection. And of course, doctors prescribe bed rest for the sick.

I'm not sure if it's true, but it seems that healing seems to happen a lot quicker overnight when you're asleep. 

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I appreciate your replies. Yes rest is of course very important to recovery. I just don't think that it's the primary function of pain. We'll have to agree to disagree.

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48 minutes ago, Michael McMahon said:

I appreciate your replies. Yes rest is of course very important to recovery. I just don't think that it's the primary function of pain. We'll have to agree to disagree.

I'm only guessing anyway, just hazarding an opinion. I think though, that if pain via the brain is involved in healing, it's likely to already have been investigated. The brain does influence growth, via the pituitary so it's not impossible. Maybe stem cells could be activated by a hormone via the brain.

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While I think pain has healing properties it is clearly limited in what it can achieve. Some organs like the heart never rest. Therefore the amount of pain necessary to repair it would be insurmountable. Some body parts are possible to live without such as an arm or a leg. This I imagine places a limit on how much pain the mind can use to repair them. Too much severe intense pain and there's a risk of amputation. Too much long lasting mild pain would be disabling. And then with chronic pain there's a risk of suicide. I think for these reasons we don't fully see the healing powers of pain. But like I said before I'm not a biologist or evolutionary scientist.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459752/ 

Hi I found an article about epigenetic mechanisms in chronic pain syndromes. I think chronic pain is a simulated stress test for recovery purposes. I mentioned how chronic pain might cause changes deep in the genes. But maybe it's the epigenome that's involved instead. Perhaps recovery takes place on the cellular level. I understand that epigenetics is about gene expression and not the actual genetic code. 

 

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Hi again. How pain works is not fully understood. But I was thinking what if by  severely overloading a certain pain response in the short term, that painful sensation might then be hampered and restricted in the long term. There are many different aspects of health such as stamina, tone and strength. Maybe reducing one might help increase another one. There's a lot of information about psychological sensitisation and habituation. So while chronic pain hurts in the short term maybe in the long term one might get habituated to it and have it may have a partially analgesic effect.

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Treatments working on similar principles already exist. Capsaicin, which puts the kick in chilis,  is effectective with certain types of peripheral pain. Some chronic pain is due to pathological modulation of the central nervous system.

It's been 6 months - did you get a chance to read those books i recommended? You obviously have an enduring interest in the subject - why not harness that and learn the science behind pain in detail?

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Here's how it actually works:

First, there's a difference between pain (simple spinal reflex arc) vs suffering (conscious/subconscious (?) acknowledgement and reaction to a painful stimulus).

A pain reflex (stimulus-->reaction) has survival value. Step on a sharp object and quickly be able to withdraw may lead to improved chances of survival. Pretty obvious. The stimulus excites a receptor, which sends a message to the spinal cord, where a synapse relays the message to the appropriate nerve to elicit the appropriate response. Afferent/efferent pathways, if you wanna get technical....Touch a hot stove and you withdraw your hand so fast you may hit yourself in the chest, for example. That's the pain response....A second later, you start hopping around and screaming. That's the suffering response, after the pain stimulus message was sent not only to the spinal cord, but forwarded to the brain...That's for acute pain-- single stimulus/single response.

Chronic pain involves the ongoing stimulation of nerves-- chronic arthritis or  a broken bone, for example. There's the immediate reflex and then there's the cerebral message/response arc. This elicits the phenomenon of "extinction." The brain sends a message back down to the original receptors "We got the message, You can take a break now." Negative feedback. Compare it to the experience of walking into a musty basement and immediately being hit by the smell of mold. It doesn't take long for you to forget all about it as you continue your work there

Just as, say, the immune system works well to help us survive, sometimes the balance between the destructive & constructive forces of the immune response is not perfectly tuned and we get auto-immune diseases, some people have an apparently genetic insufficiency of the extinction portion of the pain system. People with fibromyalgia have unusually sever and prolonged problems with pain. This is somehow related to their metabolism of neurotransmitters such as serotonin. endorphins &/or adrenergics. They often also suffer sleep problems, anxiety &/or depression-- other situations of disordered neurotransmitter levels. Positive feedback at work.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821819/

 

 

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guidoLamoto: “Chronic pain involves the ongoing stimulation of nerves-- chronic arthritis or  a broken bone, for example.“

There are indeed physical correlations to certain painful sensations. But sometimes unfortunately chronic pain can be invisible; it can only be observed through a person’s behaviour. Consciousness isn’t entirely reductionistic. Chronic pain is of course a very real illness as it would be incredibly difficult to consistently feign anxiety.

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