The Window Pain
Yes. That is what I said.
No, it is not a typo.
Ok, maybe a bad pun. But you did read it correctly.
During the Christmas holidays, I had spent some time with my extended family. During dinner one evening I was asked about “chronic pain”. The concern was more about how to relieve chronic pain of peripheral neuropathology, a debilitating disorder with sensation of pins and needles affecting upper and lower limbs. I shared how Gabapentin has been effective for such symptoms. However, this medicine made her feel foggy and without much relief.
The thin frame of this very kind woman, in her late sixties begged the question of likely complications from osteoporosis; a problem which she acknowledged having. After we ruled out the possibility of anemia in her history, I shared how it is likely her symptoms were related to her bone loss, especially if other labs for metabolic issues of medication side effects were non-contributory.
Chronic pain is a burden that is unrelenting. It seems to never to cease its invasion of comforts. It tends to be a constant disruption during valued time with family and friends. Even the efforts to hide the pain can become stressful alone. The attempts to quiet its torment often feeds upon the the very energy needed to prevent it; burdening the sufferer with more tension, fatigue, headaches and emotional drain. It can cause depression and anxiety.
Over the years I have worked with many patients burdened by chronic pain. Medications seem to help many people initially, but limitations from tolerance, dosage safety and side effects seem to restrict effective long-term coverage.
Today, I came across an article which seems to explain many unanswered questions surrounding chronic pain. It seems to suggest how medication to treat pain becomes less effective over time due to incorrect targeting of pain. Further, we are not taking into account how our bodies have a different kind of brain, separate from the one on our shoulders. Sure, they have shared pathways in communication. But there seems to exists a “pre-approved sharing of pain” that is learned locally in areas around the source site which is not targeted by our medicines. The very fibres of dorsal root networks at the spinal cord level learn from its neighbours what to watch for after there is injury next door. Pain therefore propagates over a greater surface area from the pain origin.
At first blush, this seems to resemble an exaggeration of the one suffering pain. Yet, as the article discloses, there exists a growing level of sensitization and a lowering of the threshold from the pain origin in neighbouring nerve fibres.
But what is most peculiar is how this threshold and spread of pain is permitted. You may tend to think that these changes take place at a very local dermatone region alone. Yet this article points out that a “long distance call” is placed by the site injured as a collect call to the brain.
The call is made through the network of the thalmus (operator) which interacts with a “body home address (sensory cortex)” and transfers priority messages to key players in another map of local neighbours (Cingulate cortex).
Here, phone numbers are pulled before sending them a “Neighbourhood Alert Watch”, through direct calls to their phone poles at the spinal column level.
It is only at that phone pole level where a particular home is set on either a warning mode or normal mode. It seems like a lot of work to place long distance calls when crossing a neighbours yard for help would seem more practical.
So, in order to really treat body pain effectively, new strategies will be considered for silencing the address lookup table in cingulate, as well as calming a neighbour who is easily panicked at the dorsal column level. Current strategies only address site specific pain. It does not target the “local pain sharing network “, nor does it calm an easily startled operator in the brain that is eager to rally your neighbours when local pain erupts. Function specific neuroreceptors and application alternatives are considered.
Enjoy the article here.
Tsagareli, M. (2013) Pain and memory: Do they share similar mechanisms?. World Journal of Neuroscience, 3, 39-48. doi: 10.4236/wjns.2013.31005.