Friday, July 18, 2008

The pain is all in your head

Firstly, this excellent essay by Atul Gawande is a reminder of how cruel life can be.

Scratching through one's skull is an undeniable sign of way too much suffering.

Secondly, it's a story of how the understanding of perception is evolving ...
Annals of Medicine: The Itch by Atul Gawande for The New Yorker

...This may help explain, for example, the success of the advice that back specialists now commonly give. Work through the pain, they tell many of their patients, and, surprisingly often, the pain goes away. It had been a mystifying phenomenon. But the picture now seems clearer. Most chronic back pain starts as an acute back pain—say, after a fall. Usually, the pain subsides as the injury heals. But in some cases the pain sensors continue to light up long after the tissue damage is gone. In such instances, working through the pain may offer the brain contradictory feedback—a signal that ordinary activity does not, in fact, cause physical harm. And so the sensor resets....
The ideas aren't quite as novel as Gawande suggests. I recall fifteen years ago veteran physicians, with lots of experience with intractable pain and chronic fatigue, had begun to think the problems were "all in the patient's head". By which we meant, with intentional irony, that the problem was "malwiring" of the brain.

The good news is, the brain is plastic. We can't easily alter it directly, but we can slowly reprogram it through the mind. That's how the mirror-box therapies Gawande describes work, and presumably that's how exercise therapy works for chronic fatigue syndrome (albeit both imperfectly).

We'll get better at this 'rewiring by programmed experience' techniques, but we're also going to have to sometimes rewire directly -- with microfilament implants and with the grosser neurosurgical techniques sometimes used for intractable seizure disorders.

(original link via FMH)

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