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Post No.: 0868chronic


Fluffystealthkitten says:


The brain itself doesn’t have any pain receptors, yet the experience of pain all happens in the mind. This doesn’t make the experience not real though, as anyone who has ever felt pain (or love, or horror, or relief…) can certify!


Chronic pain isn’t just a continuance of acute pain. Acute pain is adaptive because it warns us to look after an injured body part and encourages us to not repeat whatever caused the injury again. But chronic pain doesn’t seem to be adaptive at all because it still exists long after any apparent tissue damage has apparently repaired, thus chronic pain seems to be a problem at the neuropathological or neurological level – it’s not a warning of an injury or disease but appears to be a debilitating disease in itself. It’s perhaps something to do with the pain signal somehow being stuck and replayed in the brain – analogous to a broken car engine warning light still blinking even though the car engine has been successfully fixed? This means that treating chronic pain can be totally different to treating acute pain, and the drugs mightn’t work. Whatever the solution, chronic pain is neither pleasant nor healthy.


If it’s true that chronic pain has nothing to do with lasting tissue damage and it’s only because the pain signal has somehow gotten stuck and is maladaptively replaying in the brain, then it would again prove that the brain doesn’t reproduce a 1:1 representation of the wider world – even of one’s own physical body beyond the brain. (It would also support the idea that living as ‘brains in vats’ is possible because all perception and sensation is down to what happens in the brain, and simulated signals could theoretically be fed into an isolated brain to simulate that it’s experiencing a wider world!)


The experience of pain occurs in the brain, and so is every other kind of experience for us. All of our perceptions and experiences of reality happen inside our heads. Being ‘all in our heads’ again doesn’t mean that our experiences aren’t real or we can easily switch on/off whatever we feel at will though. Hallucinations happen inside our heads, but it’s not easy to genuinely convince yourself that you are eating a fiery chilli when you’re not, for instance; hence it’s not easy to convince yourself that you are not feeling pain, although there are ways to somewhat distract the mind or to cope, like taking some deep calming breaths, or alternatively ****ing cussing!


We adapt to pleasures e.g. the tenth slice of cake isn’t as appetising as the first or second. But we don’t adapt to pains so much e.g. the tenth electric shock doesn’t get any less obnoxious. Pain and loud or persistent noises are warning signs, and warning signs become ineffective in helping our self-preservation or future genetic progeny if they can gradually become ignored, like that gangrenous wound or one’s crying baby (the cries of babies have a quality called ‘roughness’ or fluctuation strength, and sounds and alarms that have or exploit ‘roughness’ are the hardest to ignore – they can literally be used for torture). Distressing thoughts have evolved to be signals or alarms that seize our attention too.


Some distinctions between pain and pleasure are hardwired from birth. But others depend on the current reference point, which is in flux – like the temporary respite after finding a bit of shelter from the freezing rain, or the huge relief after having a pee after gasping for one!


Now being numb to pain isn’t the same thing as being mentally resilient to it i.e. sensation tolerance isn’t the same as pain tolerance. To demonstrate true pain tolerance, one must experience excruciating pain yet still carry on – thus anyone who’s on the ground, bent over in agony, screaming or crying, yet isn’t asking for the pain to stop, is pretty tough (or masochistic!) – not someone who doesn’t feel anything or much to concern them in the first place. It’s like the difference between someone being blind and not noticing the wraith in front of them, compared to someone noticing the wraith in front of them yet still not running away. The latter person is demonstrating bravery whilst the former is just unaware of any anomaly whatsoever.


Not being able to feel pain at all is not an advantage. Those who have congenital insensitivity to pain (CIP) end up injuring themselves without noticing, like touching searing hot surfaces without immediately moving away, or they might sustain a deadly infection for not instinctively protecting their open wounds. Both fear and pain help keep us alive. So if you want a robot to act in self-preservation then it’ll need to be programmed to experience a version of fear and pain or something aversive towards threats that could exterminate it.


Likewise, it’s potentially detrimental to not flinch to surprise stimuli because the reflex reaction is a survival mechanism too. It might at times result in an over-reaction but at least your reflexes are working. Our unconscious reflexes are faster at detecting the trajectories of rapid objects than our conscious minds are able to ever achieve, hence are vital for our reaction times and ultimately survival. Corpses don’t flinch, and you don’t want to be a corpse(!)


A high pain tolerance isn’t always advantageous either. Similarly, there’s often a fine line between bravery and stupidity! If you’re not going to get injured then perhaps you should push yourself further because your body has a lot more to give – but even if, say, one could keep one’s arm in a bucket of ice for hours, it’d be foolish to because one will get frostbite. So just because you may believe you’re tough, you can still be idiotic e.g. proving how tough you are by deliberately burning your hand! Feeling pain evolved for a useful survival reason. And even though pain is ultimately in the mind – as in if you poke a dead body then it might bleed but it won’t feel anything – harmful injuries like burns, cuts, sprains and bruises certainly aren’t just in the mind!


A pain signal transmits from a live body part, such as from a trapped tail, via nociceptors, then it’s felt once the brain and mind receives it. Emotional pains, such as from heartbreak, show us that pain doesn’t have to originate from a bodily injury though. And these emotional pains activate the same areas of the brain as somatically-sourced pains.


We will instinctively grab and maybe rub our leg or head, for example, immediately after we bump it, yet will likely recoil if someone else tries to touch the tender part – this is perhaps to generate warmth and blood flow to the area to aid healing and/or to enhance the brain’s map of the body, in a way that a touch from another person cannot reliably emulate? Adding more sensory input can help relieve phantom limb pain too, when a strategically-placed mirror can trick the brain into believing that the body is whole again.


Anyhow, we should understand that even if someone is considered ‘sensitive’ and with a low pain threshold – it won’t be their fault because it’s in large part down to their genetics, which they logically never chose, earned or therefore morally deserved.


Some people may naïvely remark that something like, say, urticaria or eczema isn’t life-threatening – but it can indirectly be if chronic, difficult to avoid or treat, and severely limits a person’s quality of life, which in turn affects their mental health and desire to continue living. Death isn’t always the worst outcome; hence some people with terminal illnesses and chronic pain wish to undergo voluntary euthanasia. And when people lack understanding and stigmatise those who experience, usually invisible, chronic pains of any sort – such insensitive remarks can directly add to the depressive symptoms of those who already suffer. Stress is known to exacerbate the subjective experiences of almost any kind of ailment, and sometimes even the objective symptoms too e.g. high cortisol, due to stress, can worsen one’s insulin resistance or osteoporosis. Understanding and compassion is thus nearly always the considerate approach. Meow.


Malingering or faking symptoms was the topic of Post No.: 0834.


Knowing that the experience of pain ultimately happens in the mind – the placebo effect can, however, be useful to exploit. Placebos can work, modestly, for some things – if you believe something will work then it will up to as far as it can psychologically, and even sometimes physiologically. You will think and also act in a way that’s consistent to your beliefs, and thus your actions will potentially lead to or enhance the results. Even the efficacy of genuine medications can be boosted slightly if you just believe in them more.


The placebo effect largely works through confirmation bias. Placebos and hypnosis are about beliefs and expectations, and our beliefs and expectations can work powerfully. Chronic primary pain – or pain as a condition itself rather than as a symptom of another diagnosed condition such as a back injury – won’t benefit from long-term opioid use (not least because it’s highly addictive too). We perhaps should be searching for psychological solutions for psychological problems? Our psychology can directly affect some physiological functions too, like how just thinking of anxious thoughts will increase our blood pressure slightly, and vice-versa.


The placebo effect from a placebo drug for treating depression might be due to the psychological effect of belief alone? Or it might be due to the fact that participants in such experiments are being studied by people who care, and it’s this social aspect that improves one’s symptoms? Or it might be because one feels a greater purrpose for participating in an experiment that could find a solution to a major health problem?


This once more isn’t to say that psychological problems aren’t real or serious, or that applying psychological solutions is easy! Well like the rest of the body, the brain is ultimately a physical machine made up of physical matter that operates on physical principles – moreover it’s a highly complex one that’s (far) more difficult to mend than a heart. What’s psychological is ultimately physical – of neurons, hormones, electrochemical signals, etc. concerning the central and peripheral nervous system. Whatever procedure or intervention that’s carried out is thus going to be a physical one too, including if they’re talking therapies – words or the chimes of bells are physical sound waves, the smell of incense involves particles, and drugs involve molecules and compounds, for instance.


Notwithstanding, the domain for finding a solution to a psychological problem should be one that focuses on the effects on the mind more than on the effects on any external proxy. One should focus on solutions that address the brain for problems that, at their root, arise from the brain e.g. solving chronic feelings of insecurity not via ‘retail therapy’ or cosmetic surgery but via methods like gratitude exercises or hanging around a better social crowd.


Beliefs and expectations can work for our benefit, like when they give us a sense of hope, reappraise our pains or struggles as worth it because we’re working towards unlocking an achievement or some worthwhile future goal we desire, or mentally unshackle us to let us realise our full performance and potential. However, they can sometimes work against us too, like when we believe that someone is out to get us, that we’re not worthy of love, or we suspect that a safe food will harm us.


Mindfulness exercises might help us to realise when a chronic pain isn’t – at a particular time and place – much of a problem, which could allow us to figure out how to recreate these conditions when the pain is relatively bearable.


There’s still a psychological component to many debilitating conditions that can be managed by changing the stories we tell ourselves about our problems, like believing that we will come back, and will come back stronger.




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