Tuesday, 23 February 2010

Day 428 - Pain

'We forget very easily what gives us pain.' - Graham Greene

"Pain is a simple enough concept to grasp. You stub your toe, shout, perhaps utter a few expletives, rub it better and it eventually fades. But neuroscientists are realising that pain is much more complex than anyone thought possible, comprising not just physical sensations, but emotional ones too. Pioneering studies are providing insights into why some people experience debilitating chronic pain long after an injury has healed, as well as why some are more prone to pain than others, and why certain people never recover from bereavement.

While most pain goes away as an injury gets better, sometimes it remains for months or even years, long outlasting its original purpose. Chronic physical pain is debilitating and can cause disability, depression and post-traumatic stress disorder. It is also very common.

No one really knows why some people experience chronic pain and others do not, but imaging studies at Northwestern University, Chicago, have found a series of abnormalities in the brains of chronic pain sufferers in which the part linked to decision-making (the prefrontal cortex) is reduced, while an area of the prefrontal cortex linked to emotion is hyperactive. What is known for certain is that the brain changes in those with chronic pain so that they experience pain differently from the way they did before.

We all have a system for suppressing pain when necessary so that we can flee attackers even when injured. Those who suffer from chronic pain appear unable to access this and cannot use distraction as a means of suppressing pain; their brains seem to amplify pain signals rather than inhibit them.

Neuroscience is also revealing a host of similarities between emotional and physical pain. Professor David Alexander, the director of the Aberdeen Centre for Trauma Research, is not surprised about the link between physical and emotional pain. “If you listen to people who are damaged emotionally, they will often translate their pain into physical similes: ‘my head is bursting, my guts are aching', and so on. The parallel is very strong.”*

As I have mentioned on a number of occasions, the headache has created paradoxical feelings in me - on the one hand, I feel I want people to know about it as it could justify any incongruous behaviour, such as feeling dejected, short tempered or angry at inappropriate times; on the other hand, I don’t want people to know about it as I don’t want them to see me any differently than they would someone else.

But even those who know, after a while, stop asking you how you are, they stop asking about your headache, because they forget. But the awful thing is that I can never forget because the headache is always with me.

It’s odd, though, how easily one forgets about pain - when the headache is at its strongest you are taken aback by the amount of pain it causes because in that intermittent period of time in which the pain was bearable, you forgot how bad it really was.

And in a similar way, people forget, because most of us who have these inexplicable headaches don’t tend to have any other visible symptoms, which naturally leads people to forget about the fact that you’re in constant pain. But we ourselves are incapable of forgetting about our headache, because it never leaves us.

Many people have asked me if I can forget about the pain, but how can you? Sometimes you get distracted for a few minutes and of course you focus on something else, but the pain is always there, always reminding you of its presence. It makes you wonder if another person would be able to cope any better. Would they be able to put up with the pain too? How used to the pain have I got? According to a study mentioned above, the brain changes in those with chronic pain so that they experience pain differently from the way they did before. This makes me question how much (or how little) I feel pain in comparison to others. I sometimes wonder what would happen if someone else lived in my body - how long would they be able to put up with the pain for before handing it back to me and imploring me to take it?

I just cannot imagine what it would be like not to have a headache. I can picture an immediate feeling of lightness. Just imagine! My head always feels so heavy, so burdensome.