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Can one die from pain?

Can one die from pain?


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Is it possible that a human or any other creature can die from pain?

I googled and found different answers. Some articles say Yes while others say No.


I very much doubt it. You may however die from whatever's causing the pain. The reason you feel pain is so you stop doing whatever is causing the pain. Hence someone knows not to touch a hot fire because it is painful. But the pain itself is not actually the danger - it's the fire burning away skin. So pain is actually a good thing, a survival mechanism. So for something that is meant to prevent death it's hard to imagine it doing the opposite.

Perhaps if you were in SO much pain you may be unable to breath and paralysed - but even then I still think you'd go unconscious before that would happen, and you'd start breathing again, etc.

The only other thing I can imagine is having a cardiac event, and the heart stopping. Again, this would be because of stress. Other than that - you may commit suicide on account of insufferable pain, however it's a different situation.

However pain never comes on its own for no reason, just like smoke needs a fire. In this case it's the fire - not the smoke, that will kill you!

People who've ever been in a desperate or life threatening situation like a car accident, have often walked on a broken leg for example - feeling no pain. In this case the body was giving them a chance to escape what might have been a lion, etc.

In short, no - I don't think you can. However I cannot give a 100% correct answer. It would take just one example to prove that however!


I refer the honorable gentlemen to James Harriet. He reports discovering by accident by ending the pain he was in some cases able to reverse the pathology by ending the pain with anesthetic drugs, thus allowing the body's natural healing abilities to take over.

He first discovered it in a sheep by accident (insufficient dose to put it down) and later used it effectively on dogs.


An ALS patient's dilemma: End his own life, or die slowly of the disease?

PARKER, Colo. — In early February, as Lou Gehrig’s disease left him fighting to breathe, George Gallegos had a decision to make: Was he ready to die?

Gallegos, 68, a retired psychologist, sat in an electric wheelchair in his brightly lit home southeast of Denver. His illness, also called amyotrophic lateral sclerosis, or ALS, had left him unable to speak more than a couple of words without pausing to inhale, his chest heaving and neck cords bulging with each gulp. His hands were curled into claws. His voice had weakened to a near whisper.

"My condition has turned more serious,” he said one Monday afternoon. He was still reeling from a respiratory attack that forced him to spend much of the weekend drawing oxygen from a ventilator. “When I get to this place, I get scared. I get to feeling like I'm losing every day, and ALS is winning.”

Gallegos had two choices. He could allow the disease to take its course. Or he could pursue another option, newly legal, that would allow him to pick the time and place of his death.


Can You Die From A UTI? Pay Attention To These Symptoms.

Actor Tanya Roberts, known for her role in the James Bond film “A View to a Kill” and in “That ’70s Show,” died on Monday at age 65 after being in the hospital for a few days. Her representative told People that her cause of death “was from a urinary tract infection which spread to her kidney, gallbladder, liver and then blood stream.”

UTIs are an extremely common issue that affects about 1 in 5 women in their lifetime the infection can also occur in men. It’s estimated that 8 million to 10 million doctors’ visits each year are for UTIs, according to the Cleveland Clinic.

The news is incredibly sad, as well as alarming for many who consider UTIs as just an inevitable part of life. When does a UTI become life-threatening and what should you look out for? Here’s what you should know.

A urinary tract infection can spread to other parts of the body.

First, a little primer on how UTIs happen: Bacteria gets into the urinary system, which includes the kidneys and the bladder. This typically happens through the urethra (the duct where urine leaves the body). The bacteria then begins to multiply once in the system, according to the Mayo Clinic.

The infection is most often seen or located in the bladder, but it can happen in any part of the urinary tract.

In some cases ― particularly if left untreated ― the infection can spread to the kidneys or other parts of the body, and sometimes make its way into the bloodstream. Complications from this can include permanent kidney damage. It can also lead to sepsis, a potentially life-threatening complication. As part of the process of responding to an infection, the body releases chemicals into the blood stream to fight it off. Sepsis can occur when the body’s response to those chemicals becomes “out of balance,” according to the Mayo Clinic. This can result in damage to your organs.

There are different symptoms depending on where the infection is in the urinary tract.

Symptoms of the infection can vary, and it might not be obvious that you have a UTI (particularly if you’re not used to getting one).

If the UTI is affecting the kidneys, you may experience flank or side pain. You might also come down with a fever, nausea or vomiting. Bladder-based UTIs include pressure in the lower pelvis or abdominal discomfort. You might also notice changes to your urine, including blood in the urine and pain when peeing. Red flags that the infection is affecting the urethra are burning with urination and discharge.

Other signs of a UTI may include bladder leakage, an increased frequency in urination and cloudy or foul-smelling urine. UTIs can also cause mental confusion, fatigue and pain during sex.

See a physician if you’re experiencing any of these issues. And if you’re experiencing fever, vomiting or confusion, it might be best to seek emergency care. If you are diagnosed with a UTI, a doctor will likely prescribe antibiotics to treat the infection.

You can also reduce your risk through healthy habits and going to annual checkups.

Don’t panic. If you have a UTI, that doesn’t mean your life is immediately in danger ― people shouldn’t, and commonly do not, die from the infection ― but it does need to be addressed.

Aside from treating the acute infection, pay attention to your urinary health overall. This includes going to your annual doctor’s appointments, like the gynecologist or your primary care provider. Examinations and urine tests taken at these checkups can show if there’s something amiss.

You should also practice healthy habits at home to prevent UTIs. Experts recommend peeing after sex to flush out any potential bacteria. Make a habit of wiping from front to back after using the bathroom. It’s also smart to drink plenty of water. Drinking cranberry juice may also help (that method isn’t backed up by sufficient scientific evidence, but it also doesn’t hurt, either). If you get frequent UTIs, consider switching your birth control method or the period products you use.

Finally, talk with your doctor if anything is bothering you outside of your annual appointments. You know your body better than anyone and it’s important to take care of it.


The Science of a Broken Heart and How to Put It Back Together

Most people have experienced a broken heart, and there are multiple possible causes. But whether it comes from a breakup with a significant other or the death of a loved one, heartbreak is never easy.

Unfortunately, there’s no Band-Aid for broken hearts — but there are ways to ease the pain.

Heartbreak can be such an intense experience that some scientists suggest it feels the same as physical pain. A 2011 study found that people had similar brain activity when they viewed a photo of a former love and when they burned their arm. Kross E, et al. (2011). Social rejection shares somatosensory representations with physical pain. DOI: 10.1073/pnas.1102693108

It might even be possible to die of a broken heart. People who are in the early stages of grief are more likely to experience increased blood pressure and heart rate, which can raise their cardiovascular risk. Buckley T, et al. (2011). Haemodynamic changes during early bereavement: potential contribution to increased cardiovascular risk. DOI: 10.1016/j.hlc.2010.10.073

A 2018 study found that widows and widowers were 41 percent more likely to die within the first 6 months after losing their spouse. The researchers suspect this was a result of a 53 percent increased risk of cardiovascular disease. Fagundes C, et al. (2018). Spousal bereavement is associated with more pronounced ex vivo cytokine production and lower heart rate variability: Mechanisms underlying cardiovascular risk? DOI: 10.1016/j.psyneuen.2018.04.010 Tragically, heartbreak came at the expense of their actual hearts.

As more scientists confirm the biological basis of love, there may eventually be a treatment for heartbreak. In the meantime, psychotherapist Athena Staik shares three important tips to make it feel a little better.

Understand the past

Take an honest look at what you just went through. “Recall your emotions and thoughts during the romance — from its early stages to when things began to get rough, to when it ended,” Staik recommends. “Think of other past relationships and look for patterns.”

Prepare a self-care action plan

While it’s tempting to lie around in sweats for days on end (we’ve been there) and stock your fridge full of ice cream and pizza, taking good care of yourself now will save you from more struggle later.

“Lift yourself up emotionally, mentally, and physically,” Staik says. “Exercise. Eat super healthfully. Cut out sweets and alcohol as much as possible.”

Connect

When we’re used to being around someone 24/7, it can be quite a shock to our system when they’re no longer around. “Practice deep breathing, yoga, and meditation,” says Staik. “Connect with people you trust.”

Losing a loved one is one of the most excruciating ways to obliterate a heart. While there’s no way to bring the person back, there are ways to mend the broken hearts left behind. Psychologist Julie S. Lerner explains exactly how to grieve.

Allow yourself to cry

“‘Be strong,’ a phrase often heard during the grieving process, doesn’t have to mean keeping your feelings bottled up inside,” Lerner says. “It can also mean expressing them in whatever way feels best for you. Remember that no one ever died from crying.”

Make space for the loss

It can be tempting to just try to forget about your loss and move on with the endless distractions available to us these days (alcohol, projects, dating apps, you name it), but you can’t outrun grief for long.

“Don’t fully immerse yourself in work or other activities. Loss is a part of life, so make room and time to grieve,” Lerner says.

Self-soothe

“Don’t feel guilty about enjoying life even during the grieving process. Make time to do things that you love and that help you feel good,” Lerner says. “Keep your house organized, buy yourself flowers, take a bath, connect with pets — whatever works for you!”


What is pain, and how do you treat it?

Pain is an unpleasant sensation and emotional experience that links to tissue damage. It allows the body to react and prevent further tissue damage.

People feel pain when a signal travels through nerve fibers to the brain for interpretation. The experience of pain is different for every person, and there are various ways to feel and describe pain. This variation can, in some cases, make it challenging to define and treat pain.

Pain can be short- or long-term and stay in one place or spread around the body.

In this article, we look at the different causes and types of pain, different ways to diagnose it, and how to manage the sensation.

Share on Pinterest Pain can be chronic or acute, and it takes a variety of forms.

People feel pain when specific nerves called nociceptors detect tissue damage and transmit information about the damage along the spinal cord to the brain.

For example, touching a hot surface will send a message through a reflex arc in the spinal cord and cause an immediate contraction of the muscles. This contraction will pull the hand away from the hot surface, limiting further damage.

This reflex occurs so fast that the message has not even reached the brain. However, the pain message does continue to the brain. Once it arrives, it will cause an individual to feel an unpleasant sensation — pain.

The brain’s interpretation of these signals and the efficiency of the communication channel between the nociceptors and the brain dictate how an individual experiences pain.

The brain may also release feel-good chemicals, such as dopamine, to try to counter the unpleasant effects of pain.

In 2011, researchers estimated that pain costs the United States between $560 billion and $635 billion each year in treatment costs, lost wages, and missed days of work.

Acute pain

This type of pain is generally intense and short-lived. It is how the body alerts a person to an injury or localized tissue damage. Treating the underlying injury usually resolves acute pain.

Acute pain triggers the body’s fight-or-flight mechanism, often resulting in faster heartbeats and breathing rates.

There are different types of acute pain:

  • Somatic pain: A person feels this superficial pain on the skin or the soft tissues just below the skin.
  • Visceral pain: This pain originates in the internal organs and the linings of cavities in the body.
  • Referred pain: A person feels referred pain at a location other than the source of tissue damage. For example, people often experience shoulder pain during a heart attack.

Chronic pain

This type of pain lasts far longer than acute pain, and there is often no cure. Chronic pain can be mild or severe. It can also be either continuous, such as in arthritis, or intermittent, as with migraines. Intermittent pain occurs on repeated occasions but stops in between flares.

The fight-or-flight reactions eventually stop in people with chronic pain as the sympathetic nervous system that triggers these reactions adapts to the pain stimulus.

If enough cases of acute pain occur, they can create a buildup of electrical signals in the central nervous system (CNS) that overstimulate the nerve fibers.

This effect is known as “windup,” with this term comparing the buildup of electrical signals to a windup toy. Winding a toy with more intensity leads to the toy running faster for longer. Chronic pain works in the same way, which is why a person may feel pain long after the event that first caused it.

Describing pain

There are other, more specialized ways of describing pain.

  • Neuropathic pain: This pain occurs following injury to the peripheral nerves that connect the brain and spinal cord to the rest of the body. It can feel like electric shocks or cause tenderness, numbness, tingling, or discomfort.
  • Phantom pain: Phantom pain occurs after the amputation of a limb and refers to painful sensations that feel as though they are coming from the missing limb.
  • Central pain: This type of pain often occurs due to infarction, abscesses, tumors, degeneration, or bleeding in the brain and spinal cord. Central pain is ongoing, and it can range from mild to extremely painful. People with central pain report burning, aching, and pressing sensations.

Knowing how to describe pain can help a doctor provide a more specific diagnosis.

An individual’s subjective description of the pain will help the doctor make a diagnosis. There is no objective scale for identifying the type of pain, so the doctor will take a pain history.

They will ask the individual to describe:

  • the character of all pains, such as burning, stinging, or stabbing
  • the site, quality, and radiation of pain, meaning where a person feels the pain, what it feels like, and how far it seems to have spread
  • which factors aggravate and relieve the pain
  • the times at which pain occurs throughout the day
  • its effect on the person’s daily function and mood
  • the person’s understanding of their pain

Several systems can identify and grade pain. However, the most important factor in getting an accurate diagnosis is for the individual and the doctor to communicate as clearly as possible.

Measuring pain

Some of the pain measures that doctors use are:

  • Numerical rating scales: These measure pain on a scale of 0–10, where 0 means no pain at all, and 10 represents the worst pain imaginable. It is useful for gauging how pain levels change in response to treatment or a deteriorating condition.
  • Verbal descriptor scale: This scale may help a doctor measure pain levels in children with cognitive impairments, older adults, autistic people, and those with dyslexia. Instead of using numbers, the doctor asks different descriptive questions to narrow down the type of pain.
  • Faces scale: The doctor shows the person in pain a range of expressive faces, ranging from distressed to happy. Doctors mainly use this scale with children. The method has also shown effective responses in autistic people.
  • Brief pain inventory: This more detailed written questionnaire can help doctors gauge the effect of a person’s pain on their mood, activity, sleep patterns, and interpersonal relationships. It also charts the timeline of the pain to detect any patterns.
  • McGill Pain Questionnaire (MPQ): The MPQ encourages people to choose words from 20 word groups to get an in-depth understanding of how the pain feels. Group 6, for example, is “tugging, pulling, wrenching,” while group 9 is “dull, sore, hurting, aching, heavy.”

Other indicators of pain

When people with cognitive impairments cannot accurately describe their pain, there can still be clear indicators. These include:

  • restlessness
  • crying
  • moaning and groaning
  • grimacing
  • resistance to care
  • reduced social interactions
  • increased wandering
  • not eating
  • sleeping problems

The doctor will either treat the underlying problem, if it is treatable, or prescribe pain-relieving treatment to manage the pain.

There is a prevalent myth that Black people feel pain differently from white people. Because of this, Black Americans often receive insufficient treatment for pain, compared with their white counterparts.

Racial bias in pain assessment and management is well-documented.

For instance, a 2016 study revealed that half of white medical students and residents believed that Black people have thicker skin or less sensitive nerve endings than white people.

The research also showed that these misconceptions affected the medical personnel’s pain assessments and treatment recommendations. This indicates that healthcare professionals with these beliefs may not treat Black people’s pain appropriately.

Eradicating racist stereotypes and biases are crucial steps toward addressing systemic inequities in healthcare.

Doctors will treat different types of pain in different ways. A treatment that is effective against one type of pain may not relieve another.

Acute pain treatment

Treating acute pain often involves taking medication.

Often, this type of pain results from an underlying health issue, and treating it may relieve the pain without the need for pain management. For example, if a bacterial infection is causing a sore throat, antibiotics can treat the infection, easing the soreness as a result.

Acetaminophen

Acetaminophen is a type of analgesic, or pain reliever. It is an active ingredient in hundreds of medications, including over-the-counter and prescription drugs.

Often known by the brand name Tylenol, acetaminophen can relieve pain and a fever. Combined with other ingredients, it can help treat allergy symptoms, coughs, flu symptoms, and colds.

Doctors often prescribe drugs that contain acetaminophen and other ingredients to treat moderate to severe pain.

When taken in higher doses, however, acetaminophen can cause serious liver damage. People should never exceed the recommended dosage.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are another type of analgesic. They can reduce pain and help a person regain daily function. They are available over the counter or on prescription at a range of strengths. NSAIDs are suitable for minor acute pains, such as headaches, light sprains, and backaches.

NSAIDs can relieve localized inflammation and pain that is due to swelling. These drugs may have side effects relating to the digestive system, including bleeding. Therefore, a doctor will monitor a person taking a high dosage.

It is always important to read the packaging to find out what is in an analgesic before using it and to check the maximum dosage. People should never exceed the recommended dosage.

Opioids

Doctors prescribe these drugs for the most extreme acute pains, such as those that result from surgery, burns, cancer, and bone fractures. Opioids are highly addictive, cause withdrawal symptoms, and lose effectiveness over time. They require a prescription.

In situations involving severe trauma and pain, the doctor will carefully manage and administer the dosage, gradually reducing the amount to minimize withdrawal symptoms.

People should discuss all medication options carefully with a doctor and disclose any health conditions and current medications. Opioids may significantly affect the progression of several chronic diseases, including:

  • chronic obstructive pulmonary disease (COPD)
  • kidney disease
  • liver problems
  • previous drug use disorder

Opioids can cause dangerous side effects in people with certain chronic diseases. For instance, they can cause respiratory depression, which can exacerbate the symptoms of COPD.

Chronic pain treatment

A range of nondrug therapies can help relieve pain. These alternatives to medication may be more suitable for people experiencing chronic pain.

  • Acupuncture: Inserting very fine needles at specific pressure points may reduce pain.
  • Nerve blocks: These injections can numb a group of nerves that act as a source of pain for a specific limb or body part.
  • Psychotherapy: This can help with the emotional side of ongoing pain. Chronic pain often reduces the enjoyment of everyday activities and makes working difficult. Also, studies have found that chronic pain can lead to depression and that depression intensifies chronic pain. A psychotherapist can help a person implement changes to minimize the intensity of pain and build coping skills.
  • Transcutaneous electrical nerve stimulation (TENS): TENS aims to stimulate the brain’s opioid and pain gate systems and thus provide relief.
  • Surgery: Various surgeries on the nerves, brain, and spine are possible for treating chronic pain. These include rhizotomy, decompression, and electrical deep brain and spinal cord stimulation procedures.
  • Biofeedback: Through this mind-body technique, a person can learn to control their organs and automatic processes, such as their heart rate, with their thoughts more effectively. Virtual reality may now play a role in the use of biofeedback in pain management, according to 2019 research .
  • Relaxation therapies: These include a wide range of controlled relaxation techniques and exercises , mostly in the realm of alternative and complementary medicine. A person can try hypnosis, yoga, meditation, massage therapy, distraction techniques, tai chi, or a combination of these practices.
  • Physical manipulation: A physiotherapist or chiropractor can sometimes help relieve pain by manipulating the tension from a person’s back.
  • Heat and cold: Using hot and cold packs can help. People can alternate these or select them according to the type of injury or pain. Some topical medications have a warming effect when a person applies them to the affected area.
  • Rest: If pain occurs due to an injury or overworking a part of the body, rest may be the best option.

With adequate pain management, it is possible to maintain daily activities, social engagement, and an active quality of life.


If pain has not really been an issue for a person earlier, it is unusual for it to become a problem during the dying process

There is no evidence suggesting that painkillers such as morphine would prevent endorphins from being produced, however. Pain isn’t always an issue when people die. My own observations and discussions with colleagues suggest that if pain has not really been an issue for a person earlier, it is unusual for it to become a problem during the dying process. We don’t know why that is – it could be related to endorphins. Again, no research has yet been done on this.

Our brains could help to protect us from severe pain at the end of life (Credit: Javier Hirschfeld/ Getty Images)

There are a number of processes in the brain that can help us overcome severe pain. This is why soldiers on the battlefield often don’t feel pain when their attention is diverted. Work by Irene Tracy at the University of Oxford demonstrates the fascinating power of placebo, suggestion and religious beliefs in overcoming pain. Meditation can also help.

Euphoric experiences

But what could cause a euphoric experience during death, other than endorphins? As the body shuts down, the brain is affected. It is possible that the way in which this happens somehow influences the experiences we have at the moment of death. The American neuroanatomist Jill Bolte-Taylor has described in a TED talk how she experienced euphoria and even “nirvana” during a near-death experience in which her left brain hemisphere, which is the centre of logic and rational thought, shut down following a stroke.

I think there is a chance that your relative had a deep spiritual experience or realisation. I know that when my grandfather died he raised his hand and finger as if he was pointing at someone. My father, a devout catholic, believes that my grandfather saw his mother and my grandmother. He died with a smile on his face, which brought profound reassurance to my father.

The dying process is sacred to Buddhists, who believe that the moment of death provides great potential for the mind. They see the transition from living to dying as the most important event of your life – that point when you carry Karma from this life into other lives.

That doesn’t mean that religious people generally have more joyful death experiences. I have witnessed priests and nuns become extremely anxious as they approach death, perhaps consumed by concerns about their moral record and the fear of judgement.

Ultimately, every death is different – and you can’t predict who is going to have a peaceful death. I think some of those I have seen die didn’t benefit from a rush of endorphins. I can think of a number of younger people in my care, for example, who found it difficult to accept that they were dying. They had young families and never settled during the dying process.

Those I have seen who may have had an ecstatic experience towards the end of their lives were generally those who somehow embraced death and were at peace with the inevitability of it. Care may be important here – a study of lung cancer patients who received early palliative care were found to be happier and lived longer.


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Comments

My name is Ann Lee, i was doing very great until one morning i woke up with painful joints all over couldn’t even move an inch, my mum called our family doctor for check-up and i was took to the hospital later did i found out that i was diagnosed with Rheumatoid Arthritis, i bought lots of medicine as told but nothing worked out a friend of mine told me to contact Standard Herbs Home for herbal remedy which a friend of his also contacted when he was diagnosed of Rheumatoid Arthritis and they really helped him, so i contacted Standard Herbs Home and i purchased the herbal remedy and after 4 months i went for check-up and i was cured from Rheumatoid Arthritis, God bless you Standard Herbs Home.

I have been dealing with rheumatoid arthritis for my whole life, it started about in my early 30s back in the 90s. I would have my hand swell up to big red balloons around my knuckles and I wouldn’t be able to move the hands at all. What I did notice that helped relieve the pain, but not the swelling was Absorbine Jr. The arthritis cream made it easier with the stiffness and the pain when I had the worst conditions. The swelling and the movement were still bad though and sometimes that made it hard to do the easiest of tasks around the house. The thing I noticed at first and the early signs were pain and the swelling. The swelling where my knuckles would get red where the first indications that I had rheumatoid arthritis I searched for alternative treatments and started on rheumatoid arthritis herbal formula i ordered from Health Herbal Clinic, my symptoms totally declined over a 5 weeks use of the rheumatoid arthritis disease natural herbal formula.i read reviews from other previous patients who used the herbal formula,i am now active, i can now go about daily exercise!! Visit there website herbs are truly gift from God.

Recent surveys have concluded that female doctors are more attentive, compassionate, and thorough than male doctors. I have been very fortunate to have such an outstanding female doctor who tends to me like she would her father. And yes, I have experienced the non- chalant and brusque attitude of a number of male doctors. I would suggest these women in pain seek the care and compassion of their own gender whenever possible.

Women have known about this dismissal for many generations!
Most women will not even bring up “womanly” symptoms or pain because they don’t want the psychological diagnosis. If they do bring up their symptoms they are dismissed anyway so what good is it?
Now that we are getting female doctors in the business we are starting to get more action.
Wake up, Men! You are loosing business!

Many women with chronic pain do not have “clearly definable conditions” yet still suffer immeasurably. Lest not ignore them in favor of only women who are “lucky” enough to have diagnoses.

My pain was excruciating. 9 on the scale of 0 to 10. I went to a major teaching university & hospital in Boston only to be told that the pain was caused by depression. About 3 years later I was finally diagnosed with primary progressive multiple sclerosis. A year later, nerve pain meds finally reduced my pain to about a 6 on the pain scale. Male doctors the whole way. Here to tell ya… !

Well said. I had a pain specialist that was assigned to me with bad bedside manners. Very dismissive with superiority attitude. I guess because of what I am, Asian female. I complained about his behavior and was assigned to a whole different team of doctors. I couldn’t ask for better treatment had I not complaint about this person.

I can understand the real value of this blog because i often suffers with pain. Last year i start some workout to lose weight and then some muscle issues occurred. I am suffering with backbone pain since that time. I am totally agree here pain in women is common as compared to men.


Scientists are unraveling the mysteries of pain

With the opioid crisis, the quest to understand the biology of pain and explore new ways to treat it has taken on fresh urgency.

More than three decades ago, when Tom Norris was fighting cancer, he underwent radiation therapy on his groin and his left hip. His cancer disappeared and hasn’t come back. But Norris was left with a piercing ache that burned from his hip up his spine to his neck.

Since then, Norris, now 70, has never had a single day free from pain. It cut short his career as an aircraft maintenance officer in the U.S. Air Force. It’s been his constant companion, like the cane he uses to walk. On bad days, the pain is so excruciating, he’s bedridden. Even on the best days, it severely limits his ability to move about, preventing him from doing the simplest chores, like taking out the garbage. Sometimes the pain is so overpowering, Norris says, that his breathing becomes labored. “It’s like I’m drowning.”

Norris, who lives in a Los Angeles suburb, spoke to me from a long, cushioned bench, which allowed him to go from sitting to lying flat on his back. A tall and genial man, he’s become adept at wearing a mask of serenity to hide his pain. I never saw him wince. When his agony is especially intense, his wife of 31 years, Marianne, says she can tell by a certain stillness she sees in his eyes.

To ease his pain during surgery to remove a pin from his pelvis, Brent Bauer focuses on a virtual reality game called SnowWorld, which involves throwing snowballs at snowmen and penguins. Orthopedic trauma surgeon Reza Firoozabadi at UW Medicine’s Harborview Medical Center in Seattle was testing the effectiveness of the game, developed by the University of Washington’s Hunter Hoffman, a pioneer in VR for pain relief. Bauer broke numerous bones, including his pelvis, when he fell three stories.

When the pain began to take over his life, Norris sought solace in speaking out. He became an advocate for chronic pain sufferers and started a support group. And for 30 years he has searched for relief. For many of those years he was on fentanyl, a powerful opioid that he says covered his pain “like a thick blanket” but kept him “basically horizontal and zoned out.” He has tried acupuncture, which was somewhat helpful, as well as bee stings, magnet therapy, and faith healing, which weren’t. Norris now manages his pain with physical therapy, which improves his mobility, and steroids injected into his spine, which quiet his inflamed nerves.

Like Norris, nearly 50 million people in the United States and millions more around the world live with chronic pain. The causes are diverse, from cancer to diabetes to neurological illnesses and other ailments. But they share a common source of suffering: physical agony that disrupts their lives, intermittently or all the time. It’s not uncommon for cancer patients experiencing severe, unrelenting pain after chemotherapy to opt out of treatment in favor of the ultimate salve of dying.

The toll exacted by chronic pain has become increasingly visible in recent years. After doctors in the late 1990s began prescribing opioid medications such as oxycodone to alleviate persistent pain, hundreds of thousands of Americans developed an addiction to these drugs, which sometimes produce feelings of pleasure in addition to easing pain. Even after the risks became evident, the reliance on opioids continued, in part because there were few alternatives. No novel blockbuster painkillers have been developed in the past couple of decades. (Read how science is unlocking the secrets of addiction.)

The misuse of opioid pain relievers—which are ideally suited for short-term management of acute pain—has become rampant across the United States. In 2017, an estimated 1.7 million Americans had a substance abuse disorder stemming from having been prescribed opioids, according to the National Survey on Drug Use and Health. Every day in the U.S., about 130 people die from opioid overdoses—a grim statistic that includes deaths from prescription painkillers as well as narcotics like heroin. (See the toll of the opioid crisis on one Philadelphia street.)

The quest to understand the biology of pain and find more effective ways to manage chronic pain has taken on fresh urgency. Researchers are making significant strides in detailing how pain signals are communicated from sensory nerves to the brain and how the brain perceives the sensation of pain. Scientists also are uncovering the roles that specific genes play in regulating pain, which is helping to explain why the perception and tolerance of pain vary so widely.

These advances are radically altering how clinicians and scientists view pain—specifically chronic pain, defined as pain that lasts more than three months. Medical science traditionally regarded pain as a consequence of injury or disease, secondary to its root cause. In many patients, it turns out, pain originating from an injury or ailment persists long after the underlying cause has been resolved. Pain—in such cases—becomes the disease.

The hope is that this insight, coupled with the steadily advancing understanding of pain, will lead to new therapies for chronic pain, including nonaddictive alternatives to opioids. Norris and other patients are keen to see those breakthroughs happen. Researchers, meanwhile, are testing promising alternative strategies, such as stimulating the brain with mild electric shocks to alter its pain perception and harnessing the body’s intrinsic capacity to soothe its own pain.

Clifford Woolf, a neurobiologist at Children’s Hospital in Boston who’s studied pain for more than four decades, says it’s tragic it has taken a “societal catastrophe” for pain to get the attention it deserves from scientists and physicians, but the impetus this has given to pain research is a silver lining. “I think we have the potential in the next few years of really making an enormous impact in our understanding of pain,” he says, “and that will definitely contribute to new treatment options.”

The capacity to feel pain is one of nature’s gifts to humankind and the rest of the animal kingdom. Without it, we wouldn’t reflexively recoil our hand upon touching a hot stove or know to avoid walking barefoot over broken glass. Those actions, motivated by an immediate or remembered experience of pain, help us minimize the risk of bodily injury. We evolved to feel pain because the sensation serves as an alarm system that is key to self-preservation.

Zoltan Takacs, a biomedical scientist and National Geographic explorer, and Nguyen Thien Tao, a herpetologist with the Vietnam National Museum of Nature, searched for toxic creatures in Chu Yang Sin National Park in Vietnam’s Central Highlands. Hoping to identify compounds that could lead to new pain medications, the two scientists captured scorpions, snakes, snails, frogs, centipedes, and spiders.

The sentries in this system are a special class of sensory neurons called nociceptors, which sit close to the spine, with their fibers extending into the skin, the lungs, the gut, and other parts of the body. They’re equipped to sense different kinds of harmful stimuli: a knife’s cut, the heat of molten wax, the burn of acid. When nociceptors detect any of these threats, they send electrical signals to the spinal cord, which transmits them via other neurons to the brain. Higher order neurons in the cortex—the final destination of this ascending pain pathway—translate this input into the perception of pain.

Upon registering the pain, the brain attempts to counteract it. Neural networks in the brain send electrical signals down the spinal cord along what’s known as the descending pain pathway, triggering the release of endorphins and other natural opioids. These biochemicals inhibit ascending pain signals, effectively reducing the amount of pain perceived.

Scientists had sketched out this basic schematic of ascending and descending pain pathways when Woolf began working in the field in the 1980s. A soft-spoken man with eyes that seem to brim with kindness, Woolf was struck by the plight of patients he saw in the surgery ward when he was pursuing his medical degree.

“It was clear that all were suffering from severe pain,” he says. Woolf felt the senior resident surgeon seemed almost resentful that they were complaining. “I said to the surgeon, ‘Why aren’t you doing anything?’ ” Woolf recalls. “And the surgeon said, ‘Well, what do you expect? They just had an operation. They’ll get better.’ ”

“Pain was a problem the medical profession downplayed—to a substantial extent because there were no safe and effective interventions,” Woolf says. This realization kindled his desire to understand the nature of pain.

Using rats as a model, he set out to learn more about how pain is transmitted. In his experiments, Woolf recorded the activity of neurons in the animals’ spinal cords in response to a brief application of heat to their skin. As he expected, he observed these neurons firing excitedly when signals arrived from the nociceptive neurons. But Woolf made an unexpected finding. After a patch of skin subjected to heat a few times became inflamed, the neurons in the spinal cord attained a heightened state of sensitivity. Merely stroking the area surrounding the previously injured patch caused them to fire.

This showed that the injury to the skin had sensitized the central nervous system, causing neurons in the spinal cord to transmit pain signals to the brain even when the input from peripheral nerves was innocuous. Other researchers have since demonstrated this phenomenon—called central sensitization—in humans and shown that it drives various types of pain, such as when the area around a cut or a burn hurts at the slightest touch.

A startling conclusion from Woolf’s work and subsequent research was that pain could be generated in the absence of a triggering injury. This challenged the view held by some doctors that patients who complained of pain that couldn’t be explained by any obvious pathology were likely lying for one reason or another—to get painkillers they didn’t need, perhaps, or to gain sympathy. The pain transmission system can become hypersensitive in the wake of an injury—which is what happened in the rats—but it also can go haywire on its own or stay in a sensitized state well after an injury has healed. This is what happens in patients with neuropathic pain, fibromyalgia, irritable bowel syndrome, and certain other conditions. Their pain is not a symptom it’s a disease—one caused by a malfunctioning nervous system.

With advances in growing human stem cells in the lab, Woolf and his colleagues are now creating different types of human neurons, including nociceptors. This breakthrough is allowing them to study neurons in greater detail than was previously possible to determine the circumstances where they become “pathologically excitable,” Woolf says, and fire spontaneously.

Woolf and his colleagues have used lab-grown nociceptors to investigate why chemotherapy drugs cause neuropathic pain. When the nociceptors are exposed to these drugs, they become more easily triggered and begin to degenerate. This likely contributes to the neuropathies that 40 percent of chemotherapy patients endure.

While scientists like Woolf are advancing the understanding of how pain is transmitted, other scientists have discovered that these signals are just one factor in how the brain perceives pain. Pain, it turns out, is a complex, subjective phenomenon that is shaped by the particular brain that’s experiencing it. How pain signals are ultimately translated into painful sensations can be influenced by a person’s emotional state. The context in which the pain is being perceived also can alter how it feels, as evidenced by the pleasantness of the aches that follow a strenuous workout or the desire for a second helping of a spicy dish despite the punishing sting it delivers to the tongue.

“You’ve got this incredible capability of altering how those signals are processed when they do arrive,” says Irene Tracey, a neuroscientist at the University of Oxford.

A skilled communicator who speaks in rapid-fire sentences, Tracey has spent much of her career trying to bridge the mysterious link between injury and pain. “This is a highly nonlinear relationship, and many things can make it worse or can make it better or could make it very different,” she says.

In experiments, Tracey and her colleagues have imaged the brains of human volunteers while subjecting their skin to pinpricks or bursts of heat or smears of cream laced with capsaicin, the chemical compound that makes chili peppers spicy. What the researchers have found has led them to discover a much more complex picture of pain perception than had been previously envisioned. There’s no single pain center in the brain. Instead, multiple regions are activated in response to painful stimuli, including networks that also are involved in emotion, cognition, memory, and decision-making.

They also learned that the same stimulus doesn’t produce the same activation pattern every time, indicating that a person’s experience of pain can vary even when the injuries are similar. This flexibility serves us well, raising our pain tolerance in situations that demand it—for instance, when carrying a scorching bowl of soup from the microwave to the kitchen counter. The mind knows that dropping the bowl midway would result in greater misery than the brief anguish caused by holding the bowl, so it tolerates the momentary suffering.

Tracey and her colleagues have shown that fear, anxiety, and sadness can make pain feel worse. In one of their experiments, healthy student volunteers listened to Prokofiev’s deeply melancholic “Russia Under the Mongolian Yoke,” slowed to half speed, and read negative statements such as “My life is a failure.” At the same time, they received a burst of heat on a patch on their left forearm, which had been rubbed with capsaicin. Later the students received the same stimulus as they listened to happier music and read neutral statements such as “Cherries are fruits.” In the sad condition, they reported finding the pain “more unpleasant.”

Comparing scans of the students’ brains in the two moods, the researchers found that sadness influenced more than just the emotion-regulation circuitry. It led to increased activation in other brain regions, indicating that sadness was physiologically dialing up the pain. “We’ve made people anxious and threatened and fearful,” Tracey says, “and we’ve shown that that makes the actual processing of those signals amplified.”

Strong medication would be needed to dull the pain after surgery for arthritis in her hand, Jo Cameron was informed by her anesthesiologist. But the 66-year-old Scottish woman doubted it. “I bet you any money I will not take any painkillers,” she told him.

The anesthesiologist looked at her as if she were not fully sane. He knew from experience that the postoperative pain was excruciating. When he came by to check on her after surgery, he was astonished to find that she hadn’t requested so much as the mild analgesic he’d prescribed. “You haven’t even taken paracetamol, have you?” he asked.

“No,” Cameron recalls having replied cheerfully. “I told you I wouldn’t.”

Growing up, Cameron says, she was frequently surprised to discover bruises whose origins were a mystery. When she was nine, she broke her arm in a roller-skating accident, but three days passed before her mother noticed that it was swollen and discolored. Years later, Cameron gave birth to her two children without any pain during delivery.

“I don’t really know what pain is,” she says. “I see people in pain, and I see the grimace, the strain on their faces, and the stress, and I have none of that.”

Cameron’s inability to sense physical hurt may be unremarkable to her, but it places her in a rarefied group of individuals who are helping scientists unravel the genetics underlying our ability to feel pain. Her amazed anesthesiologist put her in touch with James Cox, a geneticist at University College London. Cox and his colleagues studied her DNA and found she had two mutations in two neighboring genes, called FAAH and FAAH-OUT. They determined that the mutations reduce the breakdown of a neurotransmitter called anandamide, which helps provide pain relief. Cameron has an excess of the biochemical, insulating her against pain.

Cox has been studying people like Cameron since he was a postdoc at Cambridge in the mid-2000s, when his supervisor, Geoffrey Woods, learned about a 10-year-old street performer in Pakistan who could walk barefoot over hot coals and stick daggers into his arms without so much as a whimper. The boy would earn money from these stunts and then go to the hospital to be treated for his wounds. He was never the subject of a study—he died from head injuries after falling off a roof while playing with friends—but Cox and his colleagues were able to analyze the DNA of six children from the same clan, who showed similar insensitivity to pain. The children each had a mutation in a gene called SCN9A, known to be involved in pain signaling.

The gene makes a protein that is instrumental in the transmission of pain messages from nociceptive neurons to the spinal cord. The protein, christened Nav1.7, sits on the surface of the neuron and serves as a channel for sodium ions to pass into the cell, which enables electrical impulses constituting the pain signal to propagate along the threadlike axon that connects to another neuron in the spinal cord.

The mutations the researchers discovered in the SCN9A gene yield malformed versions of the Nav1.7 protein that don’t allow sodium ions to pass into nociceptive neurons. With their nociceptors incapable of conducting pain signals, the children were oblivious when they chewed their tongues or scalded themselves. “The beauty of working with these extremely rare families is that you can identify single genes which have the mutation and essentially are human-validated analgesic drug targets,” Cox says.


Spiritual Needs at the End of Life

People nearing the end of life may have spiritual needs as important as their physical concerns. Spiritual needs include finding meaning in one's life and ending disagreements with others, if possible. The dying person might find peace by resolving unsettled issues with friends or family. Visits from a social worker or a counselor may also help.

Many people find solace in their faith. Others may struggle with their faith or spiritual beliefs. Praying, talking with someone from one's religious community (such as a minister, priest, rabbi, or imam), reading religious texts, or listening to religious music may bring comfort.

Family and friends can talk to the dying person about the importance of their relationship. For example, adult children can share how their father has influenced the course of their lives. Grandchildren can let their grandfather know how much he has meant to them. Friends can relate how they value years of support and companionship. Family and friends who can't be present could send a recording of what they would like to say or a letter to be read out loud.

Sharing memories of good times is another way some people find peace near death. This can be comforting for everyone. Some doctors think it is possible that even if a patient is unconscious, he or she might still be able to hear. It is probably never too late to say how you feel or to talk about fond memories.

Always talk to, not about, the person who is dying. When you come into the room, it is a good idea to identify yourself, saying something like, "Hi, Juan. It's Mary, and I've come to see you." Another good idea is to have someone write down some of the things said at this time—both by and to the person who is dying. In time, these words might serve as a source of comfort to family and friends. People who are looking for ways to help may welcome the chance to aid the family by writing down what is said.

There may come a time when a dying person who has been confused suddenly seems clear-thinking. Take advantage of these moments, but understand that they might be only temporary, not necessarily a sign he or she is getting better. Sometimes, a dying person may appear to see or talk to someone who is not there. Try to resist the temptation to interrupt or say they are imagining things. Give the dying person the space to experience their own reality.


Pain as an Art Form

Selections from the Pain Exhibit. To see a slide show, click here.

Pain doesn’t show up on a body scan and can’t be measured in a test. As a result, many chronic pain sufferers turn to art, opting to paint, draw or sculpt images in an effort to depict their pain.

“It’s often much more difficult to put pain into words, which is one of the big problems with pain,” said Allan I. Basbaum, editor-in-chief of Pain, the medical journal of The International Association for the Study of Pain. “You can’t articulate it, and you can’t see it. There is no question people often try to illustrate their pain.”

“The Broken Column,” by Frida Kahlo (Banco de México Diego Rivera and Frida Kahlo Museums Trust)

One of the most famous pain artists is Mexican painter Frida Kahlo, whose work, now on exhibit at the Philadelphia Museum of Art, is imbued with the lifelong suffering she experienced after being impaled during a trolley accident as a teenager. Her injuries left her spine and pelvis shattered, resulting in multiple operations and miscarriages, and she often depicted her suffering on canvas in stark, disturbing and even bloody images.

Sacramento resident Mark Collen, 47, is a former insurance salesman who suffers from chronic back pain. After his regular doctor retired due to illness, Mr. Collen was struggling to find a way to communicate his pain to a new doctor. Although he has no artistic training, he decided to create a piece of artwork to express his pain to the physician.

“It was only when I started doing art about pain, and physicians saw the art, that they understood what I was going through,” Mr. Collen said. “Words are limiting, but art elicits an emotional response.”

Mr. Collen wrote to pain doctors around the world to solicit examples of art from pain patients. Working with San Francisco college student James Gregory, 21, who suffers from chronic pain as the result of a car accident, the two created the Pain Exhibit, an online gallery of art from pain sufferers. The images are evocative and troubling.

“Some of them are painful even to look at,” Dr. Basbaum said. In November, he included an image from the site on the cover of Pain it can be seen here.

Finding ways to communicate pain is essential to patients who are suffering, many of whom don’t receive adequate treatment from doctors. In January, Virtual Mentor, the American Medical Association Journal of Ethics, reported that certain groups are less likely to receive adequate pain care. Hispanics are half as likely as whites to receive pain medications in emergency rooms for the same injuries older women of color have the highest likelihood of being undertreated for cancer pain and being uneducated is a risk factor for poor pain care in AIDS patients, the journal reported.

Some of the images from the Pain Exhibit, like 𠇋roken People” by Robert S. Beal of Tulsa, Okla., depict the physical side of pain. Others, such as 𠇊gainst the Barrier to Life,” convey the emotional challenges of chronic pain. “I feel like I am constantly fighting against a tidal wave of pain in order to achieve some quality of life,” wrote the work’s creator, Judith Ann Seabrook of Happy Valley in South Australia. “I am in danger of losing the fight and giving up.”

Mr. Collen said the main goal of the exhibit is to raise awareness about the problem of chronic pain. However, he said he hopes one day to find a sponsor to take the exhibit on tour.

“People don’t believe what they can’t see,” Mr. Collen said. 𠇋ut they see a piece of art an individual created about their pain and everything changes.”

To see a slide show of selections from the Pain Exhibit, click here, or visit the Web site to see the full gallery of photos. Another slide show from The Times in February features art created by migraine sufferers.


Watch the video: ΜΑΝΩΛΗΣ ΑΓΓΕΛΟΠΟΥΛΟΣ - Όταν κοιμάται ο δυστυχής (May 2022).