becoming pain literate

although my daughter’s pain has dominated our lives for more than three months, the whys or wherefores of it have not been discussed in detail. the pain has been described as being like the volume control on a radio being stuck on high, or a pain gate left open that won’t shut.

i try my best to be reassured – that’s a big ask when i don’t really understand what this pain actually is.

i’m pain illiterate, but i’m trying my best to understand.

pain can be visceral, parietal or referred. it can be somatic or neuropathic.

in an interesting podcast for the Medical Journal of Australia, Professor Jürgen Sandkühler, Head of the Centre for Brain Research at the University of Vienna, discusses the neurophysiological differences between acute and chronic pain. he describes chronic pain as a ‘disordered system of pain perception, where the pain has no functional meaning’ and goes on to discuss neuronal responses in spinal cord pathways associated with chronic pain. he describes how chronic pain causes changes that become a ‘memory trace of painful stimulus’. over time, chronic pain results in maladaptive behaviour of the nervous system. in the long-term, physiological changes mean that a relatively low stimulus will trigger a strong pain response, otherwise known as hyperalgesia.

okay. got that. i think.

but, just as i think i’ve got my head around hyperalgesia, i find its siamese twin: allodynia. i’ll leave you to ponder the differences.

it seems clear that chronic pain begets pain, and that is a bleak prognosis. yet, in an accompanying article to Sandkühler’s MJA podcast, Neuroplasticity and pain: what does it all mean? Philip Sidall suggests there is cause for hope:

The first reason is that, although it may sound strange, neuroplasticity is by nature plastic. This means that although nervous system changes can occur, they are not necessarily irreversible…The other reason for hope is that the findings provide us with a much better understanding of the role of psychological factors in pain and the potential for treatment. There is no room for the old dualist view of pain being either real or psychological. Cognitive and emotional processes strongly engage brain and spinal cord pathways that are directly involved in altering the responsiveness of pain pathways. By doing so, psychological factors influence neuroplastic processes and thus directly modify the pain experience.

that’s timely. tomorrow we have a third meeting with the psychotherapist supporting my daughter.

The British Pain Society has published a useful guide on Understanding and Managing Pain (pdf). Pain Concern provides information on a number of painful conditions, and advice and guidance on living with pain.

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