Thursday, July 14, 2011

Pain, Captain, is a thing of the mind

In America we spend a staggering amount of money trying to control pain -- $90 billion a year on back pain alone, according to some estimates. Drugs help some people, but opioids like OxyContin are subject to abuse and have serious side effects. Plus, they don't work for everyone, and some people report debilitating pain no matter how many painkillers we give them. Others are sickened by the drugs, so they have a choice between pain and nausea. Is there a better way?

Everybody understands, in a rough way, that while pain may be a physical thing how we respond to it depends on our state of mind. In certain circumstances we can easily endure levels of pain that would make us curl up on the floor in others. The oldest and most trite response to pain, "think about something else," really can work wonders. Lately doctors have been trying to teach better psychological pain management as a supplement or even a substitute for drugs:
Consider a study by scientists at Wake Forest University. After only a few days of meditation training—teaching people to better focus their attention, concentrating less on the discomfort and more on a soothing stimulus—subjects reported a 57% reduction in the “unpleasantness” of their pain. Such improvements are roughly equivalent to the benefits of morphine.
There is nothing magical about meditation, and other psychological approaches have also gotten good results. Exercise, for example, helps many people with chronic pain, possibly just because the flood of other sensations coming from hard-worked body parts crowds out the pain message. Ice and heat help many people, although nobody knows how they work. Ditto for acupuncture. One of the weirder findings of pain research is that playing with a dog or cat helps some people more than the most powerful narcotics. They key is to keep the pain from monopolizing our brains, push it off to the side, relax our bodies, and get on with life.

Getting into the woo-ish side of things, I have the strong sense that chronic pain can be a symptom of a life out of whack. Psychological stress can certainly lead to physical pain -- this was understood by the Greek doctors who wrote the Hippocratic treatises and modern research confirms it. Not getting enough sleep makes pain worse. Depression can cause or worsen body aches. When people feel good about themselves and their lives, they find pain much more manageable, and it often turns out that people debilitated by pain are experiencing psychological crises or disaster like divorce. People who hate their jobs have much more trouble with pain than people who like them.

So when I read that more than 100 million Americans suffer from chronic pain -- which is surely one of those exaggerated statistics produced by using the widest possible definition, but, anyway, that's what the NIH says -- I don't see a medical crisis. I see a nation of people who don't feel good about their lives, their world, and themselves. Yes, I know many people suffer pain because they have been injured or have arthritis. But pain is not just a physical sensation. It is a state of mind, even a state of the spirit, and a nation in pain may be suffering as much spiritually as physically.

2 comments:

Thomas said...

Have you read this article in the New Yorker? It starts about itching, but then gets into the subject of pain, and discusses how lots of back pain really is "in the head," in some sense, but not due to psychological problems - its a bit like phantom limb sensation. There is also a section on how they are successfully treating some phantom limb pain by using mirrors to trick the brain into sewing the limb as there but unharmed...

Thomas said...

http://www.newyorker.com/reporting/2008/06/30/080630fa_fact_gawande

Forgot the link.