Physical and emotional pain are the eternal companions of a person

Painkillers, which are understandably highly regarded by people, do not really cure

They do not cure the disease or disorder, but only alleviate pain symptoms. Nothing in nature happens without consequences.

Painkillers, like most medications, have unforeseen and often unwanted side effects. Opioids are well known for their high additivity.

A high-quality medicine should strive for the predominance of benefits over harm from exposure. Overdose of narcotics, mainly prescription opioids or illicit substitutes, is the leading cause of death under the age of 50 in the United States.

The use of opioids and non-steroidal drugs is still the main recommended treatment for back pain in the US and EU countries, completely rejecting biomechanical and physiotherapeutic methods for treating diseases of the spine and joints.

Powerful corporations, especially pharmaceutical companies, understand the huge profits that can be made by drugs that fulfill the desires of consumers and put them out of their misery. It is clear that doctors also want to alleviate the suffering of their patients. In private, paid medicine, this state of affairs is profitable, and serious conflicts of interest can arise. The patient needs a powerful pain reliever.

The doctor is paid to prescribe this drug. Naturally, the doctor will prescribe it. Physicians’ lack of time, combined with patients’ desire for help, could lead to a similar outcome.

The doctor who takes the conservative approach that pain must be endured sometimes, and who warns that the remedy may hurt more of the disease over time, is swimming against the current.

Opioid addiction is terrible. But there is a much bigger medical disaster ahead of us: antibiotic resistance.

When evaluating the effectiveness of medicine, it is also useful to consider the problems that it faces every day. It must be understood that uncertainty is an inevitable feature of medicine. With the exception of doctors, few people know how unreliable medicine is, despite all the claims about its scientific nature.

Consider back pain treatment and use of MRI for back pain

Back pain is one of the leading causes of disability in the world. While an MRI is practically safe and capable of showing amazingly detailed images of the spine, MRI scans are expensive, time-consuming, and almost completely useless in many, if not most, cases. Back pain is most often non-specific, which in the language of doctors means that no one knows its causes. With such pain, tomography may be useless.

The spine is subject to natural wear and tear. With age, the spine changes, just as the skin loses its elasticity, and the hair loses color and shine. An MRI of the spine can reveal these changes, but cannot tell if they are the source of the pain. A scientific study has shown that MRI detects abnormalities in 87 out of 100 healthy people who do not have back pain.

The problem is not limited to back pain and MRI of the spine. Our body is imperfect and it changes with age. In recent years, commercial diagnostic tests for consumers have proliferated, ranging from DNA sequencing to identify risk factors to brain scans to detect precancerous structural changes. But this information is of little help in detecting clinically significant changes. Without professional medical evaluation and explanation of the results, these tests can only sow anxiety.

How can one not be intimidated by “scientific” evidence of abnormalities or clearly threatening shadows and shapes on a well-executed MRI? Such evidence leads to neurosis and spending on further costly and meaningless diagnostics, which in turn can lead to useless treatment with the risk of side effects.

Man’s innermost dream is not at all eternal life or immeasurable wealth. And not even power over the world. And even more so – not the possession of super-intelligence.

To feel this dream, one thing is enough – at least several times to experience unbearable pain. And then, in order to protect himself from new waves of terrible pain, a person will give anything, and further deliverance from pain will become his secret dream.

But pain is not just a feeling

Pain is a super-complex phenomenon that allows us, if not to understand, then at least to imagine how much more “created in the image and likeness” a person is more complicated than any “thinking machine” available to our imagination. We can easily imagine a humanly intelligent machine, similar to the one that Stanislav Lem depicted in the masterpiece story “Mask”. But even the genius of Lem failed to imagine a machine experiencing pain, like people.

And all because the phenomenon of pain is beyond the seemingly limitless imagination of man.

Pain cannot be reduced to a pure sensation – it is always affectively loaded and permeated with meanings. Furthermore. It is a ” biocultural ” phenomenon, the result of deciphering and translating bodily states into a sphere of meaning. But even if you don’t touch on this – a completely abstruse semantic property of pain – and focus exclusively on its “bodily” manifestations, you still get a riddle. For even on a purely bodily level, pain is not just a sensory phenomenon.

As developed in the 1960s neuroscientists Ronald Melzak and Patrick Wall of the theory of spinal “gate control” ( gate control theory ) it is assumed that the pain impulse is influenced not only by physiological, but also by psychological factors. Affects, motives and evaluations are involved in the very formation of pain sensation.

It turns out that one thing is the sensation of pain, and quite another is the psychological assessment of this sensation.

Answering the question posed in the title, Biro proves that psychological pain is no less real than physical. The first argument he makes is linguistic. Indeed, in many languages, physical and mental suffering are denoted by one word. At the same time, mental pain is just as difficult to express as bodily pain, people resort to metaphors, and these metaphors are very similar in both cases. The pain from the loss of a loved one also “shoots”, “stabs” and “burns”, just like the pain caused by a physical defeat.

This linguistic intuition of the most diverse cultures is also confirmed by modern neuroscience . There are two centers for registration and signal processing of the nociceptor (a neuron that is activated only by a painful stimulus), located in different areas of the brain.

The first (sensory) is responsible for the sensation of pain, the second (affective) is responsible for assessing this sensation. As a rule, they are interconnected and work simultaneously. But, as Biro shows, referring to the experiments of Naomi Eisenberg, the affective center can be activated solely by psychological trauma, without any tissue damage. Moreover, a difficult psychological experience can also trigger the center of sensations: a person experiences physical pain, although ” nociceptors are supposedly silent.” Accordingly, there is no point in dividing pain into physical and psychological.

There is a unified alarm system that responds to any type of threat. But in the case of a psychological threat, the body uses a reliable, evolutionarily proven arsenal of physical signaling.”

It is for this signaling created by millions of years of evolution that humanity pays with the ocean of its own pain. And so far, nothing could be done about it, relying only on opioid analgesics, which are increasingly contributing to the opioid epidemic.

And suddenly a breakthrough

The new study “Almond-shaped Neural Ensemble Encoding the Unpleasance of Feeling Pain” made it possible to identify and separate two subroutines of the pain algorithm:

the formation of pain as a sensation, and the formation of an emotional phenomenon – the unpleasantness of pain (the pain of a person’s experiences from the pain he experiences)

basolateral amygdala) neural ensembles play a decisive role in the formation of pathological perception of pain .

By figuring this out, the researchers were able to:

  • understand the way and technique of how BLA affects the psychological aspects of the perception of congenital acute and chronic pain;
  • determine how BLA encodes information through the coordinated dynamics of neurons in large ensembles;
  • to evaluate and measure the contribution of BLA neural ensemble activity to chronic pain; and to identify in BLA a critical target for the neural ensemble that mediates the severity of chronic pain nuisance.

This means that it is now possible to develop treatments for chronic pain that can selectively reduce the unpleasantness of assessing pain sensations of various etiologies, without affecting the positive sensory (“signaling”) function of pain, and, importantly, preserving the reflexes and sensory-discriminatory processes necessary to identify and localize pain irritants.

Just a dream!

If it is possible to bring the new method to certified mass use, then

✔ ️ sensory sensation of pain will remain with us,

✔️ but his affective score will drop a lot.

“Well, yes, it hurts,” the person will say after the procedure.

– Well, let it hurt! It doesn’t interfere with life.

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