Wednesday, November 10, 2021

Glial Cells, Chronic Pain, and the Weird Obsession with Physical Causes

According to the people who count up stuff like this, more than a billion people around the world suffer chronic pain. "Chronic pain" here means pain that is either unrelated to obvious physical injury or lasts long after the obvious damage has healed, and that lasts at least two months. Chronic pain is a slow-moving medical catastrophe and also big business, which explains why there have been a ton of studies about what causes it.

Today's NY Times has a story about the role of glial cells in pain. One the one hand it is interesting biomedically, as we figure out that the cells we used to think just served as scaffolding for neurons actually do a lot of other stuff. One the other it suffers from the weird obsession with proving that chronic pain has some identifiable physical cause and is not just "in your head." Like this:

For pain sufferers, this is a welcome validation of their reality. “Learning this,” said Cindy Steinberg, the national director of policy and advocacy at the U.S. Pain Foundation, and a chronic pain patient herself, “is enormously helpful to those of us who suffer chronic pain.” In a chronic-pain support group Ms. Steinberg runs, she said that people find it a huge affirmation to learn there’s a distinct biology underlying their pain. It confirms what they’ve long known but often see doubted by doctors and friends: That their pain is as real as any other.

To which I say, there is no such thing as "unreal" pain. Every thought you have, every feeling no matter how fleeting, is something physical happening in your brain. What else could it be? If your pain were caused by obsessing about how cruelly your mother treated you, that would still be a physical thing, and if glial cells are involved in processing pain, then they would be involved in that pain, too.

On the other hand, even pain with overtly physical causes like stab wounds is also a psychological phenomenon, and some people can control it by modulating their thoughts. Remember that some studies have found petting a dog or cat reduces the sensation of pain more than powerful opiates do. Just as there is no pain that is not physical, there is no pain that is not psychological, because you experience it in your mind.

Very good studies have shown that chronic pain is more likely to strike people who have other stressors in their lives, like a divorce or losing a job. This includes both pain that seems to have an overt physical cause like a ruptured spinal disc and pain that does not. The notion that chronic pain could be entirely caused by some problem with glial cells strikes me as absurd; it is easy to show that for many people it is a symptom of a life out of whack. Which, again, does mean that it is not physical, because everything in your mind is physical, or that it could simply be wished away.

At a theoretical level we have understood the complex connections between mind and body at least since Hippocrates. But people keep acting like they are completely separate things, and newspapers where people ought to know better keep publishing stories about entirely imaginary distinctions between things in your mind and things going on with your nerve cells.


David said...

Is the obsession with proving pain is real so weird given the amount of "everyone suffers, you're not special, get over it" and "spare me your upper-middle-class-liberal self-obsession" messages one sees? Why, on this very blog . . .

David said...

I don't much like my own "gotcha" tone, but truly, what do you expect people to do? There are a lot of Freddie De Boers out there. And, IMHO, De Boer's response to Douthat was quite deprecatory, his protests to the contrary notwithstanding.

John said...

De Boer doesn't deny that Douthat is suffering, or that he was dismissed by doctors. He disagrees with the diagnosis of chronic Lyme disease. I don't think people with chronic pain are not suffering; I know they are. Both De Boer and I are bothered by the notion that if you don't accept people's self-diagnosis of their suffering's cause you are somehow demeaning them or dismissing their suffering. But the fact of the suffering the the theory of its origin are two utterly distinct matters. Confusing the two is bad science and, I think, dubious morality. I do not think it is dismissive or cruel to ask the hardest possible questions about causes, because that is how we learn to fix things.

David said...

Come on, De Boer's response to Douthat is not nearly so disinterested. Nowhere does he talk about rigorous science. De Boer himself states plainly that what bothers him about Douthat is what De Boer sees as upper-middle-class whining. And surely there's a Laschian element in your own stance?

G. Verloren said...

I think the simplest, clearest, most incontrovertible demonstration that pain is both physical and mental is the situation of phantom pain "in" missing limbs, and the discovery of mirror box therapy.

You can cure someone of crippling, agonizing phantom limb pain simply by creating a modestly convincing optical illusion. The brain is stuck in a pain signal loop, and they are absolutely feeling genuine pain, but all you have to do to end that loop is go through certain mental motions that help "reset" the signal transmitters and receptors.

We are computers - complex bioelectrical programs running on equally complex organic hardware. Just as sometimes your desktop computer can get stuck in a signal loop, so too can our brains. The trick is finding how to break the loop and reset settings.