Tuesday, 5 July 2016

Archives of pain.

Ouch! Ooh! Aarrgghh! Mercy mercy me! You hurt me!

How do you respond to pain? Are you a stoic or are you some kind of pussy? Do you ride it out or do you hop on the spot? I waver depending on the nature and the circumstances of the pain being inflicted. To a degree we all do. That's what Dr Tim Salomons was at Skeptics in the Pub to talk about.

He's a lecturer and Marie Curie International Incoming Fellow (whatever that is) in the School of Psychology at the University of Reading. He's also a techno baldie dude from Toronto who spoke for a little longer than was comfortable under the Skeptics protocol. Not that it wasn't interesting. He clearly knew his stuff and was unafraid to admit when he didn't, openly confessing to knowing next to nothing about acupuncture, which is an admirable trait in anyone.

His talk wasn't constructed into a particularly overarching narrative so this hapless, yet hard-working, blogger will try to pull it into some shape. Left to do the heavy lifting as usual, eh!

He started off by showing us some examples of people in pain. Nothing too serious. Mild heat application to upper arm areas, pin pricks, that kind of stuff. He had a neat traffic jam analogy as to how we deal with pain. The stoics sit there and cope with it. Others panic and jump about. Where that analogy falls down is that someone beeping their horn and shouting out their window in a traffic jam is clearly a dick. Someone doing the same because they're in pain not so.

From there he went on to explain why pain is useful. He'd met a chap who'd not been able to go into a swimming pool until he was sixteen years old because one part or another of his body had always been in plaster. This fellow couldn't feel pain. It sounds great in theory but in reality he was unable to moderate his behaviour when danger beckoned and instead carried on until something was broken or cut.

If you put your fingers on a hot iron those fingers send a message to the brain and the brain tells you to remove them. If you can't feel pain you keep them there and get more seriously burnt. It's not all one way traffic though as your brain employs a form of executive function to make a decision whether or not to act to avoid the pain.

You may think you'd always want to avoid the pain and in the case of burnt fingers or walking on broken glass you'd be correct. There are, however, scenarios when your brain tells you to endure the pain. An example would be administering an insulin injection to oneself. On a different level experiencing childbirth. In a very extreme example if a soldier was injured on a battlefield and broke his ankle the brain may tell that soldier to walk on that ankle for as long as was necessary to avoid suffering further, and potentially lethal, injuries.

So our brains can already control pain when they want to. But can we teach our brains to control it when WE want to. It'd help with running, hangovers, and some considreably more serious things too.

Some people manage pain better than others. Tim and his team had carried out some tests on willing volunteers. They're not as morally dubious as they first sound. The volunteers were given a joystick and when pain was administered were told if they moved the joystick right the pain would be lessened. 50% of the volunteers had their pain reduced from 10 seconds to 5. Another 50% got 5 seconds of pain either way.

The latter half soon reported their pain being more intense than the former half despite them both, essentially, receiving the same amount of pain. It became apparent that a feeling of helplessness was instrumental in their struggling to cope with the pain. It's easy to see how this happens in people's emotional lives too. People who feel helpless start to feel despair and, as most of us have witnessed, eventually enter into a downward spiral of behaviour. On the other hand those who felt in control of their situation felt better about it and were able to manage what they now began to see as a minor inconvenience.

There was some complicated brain science stuff that I didn't really understand but Tim found tests that had 'proved' that emotional pain, social rejection, relationship break ups etc; had the exact same effect on the brain as genuine physical pain.

This was interesting but our host for the evening also proffered a counter argument. The brain science, so far, is inconclusive. The same receptors that light up in your brain when you're in the company of someone you love also, it seems, beam when you're shown an advert for a new iPhone. Maybe we do just love our phones.

Our brains are very complicated things (revelation of the day!) but one of the guys Tim had been working with had had a serious accident and developed lesions that had closed down approximately 25% of his brain. He was far from brain dead though. In fact despite a memory about as short as a Boris Johnson promise he functioned pretty well.

Memory itself is not particularly useful when identifying or dealing with pain. Very young children are able to recognise pain even if, as those of you who've seen a toddler on a buggy smash into a wall repeatedly know, they might not be able to work out what's causing it. Even creatures as seemingly simple as fish and ants know to avoid dangerous situations if possible. They may not have a conscience as such but it could be said they're aware of pain on a very basic level and try to avoid it where they can.

Conversely phantom limbs suggest memory can sometimes cause pain. Tim had a patient who'd lost an arm. She'd come in complaining of pain in three places. On the stump of the removed arm, on the limb that was no longer there, and the deferred pain in the opposite arm. He did some fancy brain manipulation stuff and she went away happier. The phantom limb pain and the deferred pain had gone. The stump pain was still there but she felt she could deal with that.

During the Q&A session he was asked if the current mindfulness fad could help us to deal with, or overcome, pain. He had a fairly dim view of it. Mostly negative. He agreed if it worked for you, much like the placebo effect, then at a push it was useful. But if you got your hand caught in a shredder or you're being crushed it's better to get out of that situation rather than think 'this is a thing I'm experiencing now'. It's not like pondering a bloody raisin.

It was an interesting talk and though I can't say I learnt anything huge from it I did consider how we could hone various pain management techniques to deal with such things as stubbed toes, anxiety, or our bosses being total bellends. All of which have been genuine concerns of mine.

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