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The conventional wisdom is that pain is caused by damage, but it's more subtle than that. Pain is a signal that can be triggered by damage, but can also be caused in response to less physical causes such as fear and a memory of past damage – and can be suppressed by activity or positive thinking, at least to a degree. This is awkward ground, as Lyman recognises: it's close to saying that "it's all in the mind", which is both literally true and deeply offensive to those suffering persistent pain. But it also offers hope that enormously dangerous pharmaceuticals can – sometimes – be replaced or complemented with cognitive therapies that might be effective. There appears to be a difference between people seeking pleasure and avoiding pain but actually the true analogy is people seeking rewards and avoiding punishment. Some of us find pain to be pleasurable, think of people who do marathon runs, or like me, love hot chilli peppers. And somebody who might think a mouldy piece of bread is disgusting when they are fully fed might consider it a pleasure or a reward to those who have been starving for two days. A reason we should try to maintain a healthy weight isn't just because increased weight adds to stress on our bones and muscles but also because it increases diseases within our fat cells. The Painful Truth explores cutting-edge research, encompassing phantom aches to persistent pain, and including interviews with survivors of torture as well as those who have never felt pain. It not only provides hope for reducing and managing pain, but takes us to a deeper understanding of what it means to be human.
In SnowWorld - a virtual world, burns sufferers hurl snowballs while undergoing their notoriously painful wound care - diversion is a potent pain reliever. The belief in something working and its expectations can have an incredible effect on healing and pain. Even the colour of a sugar pill can have an impact on how we perceive and heal - blue pills might work better with depression and red pills for anxiety. Even fake surgery (where patients think surgery has occurred but a doctor has merely cut the skin) have worked as well as actual surgery. Studies on acupuncture done correctly and sham acupuncture where a practitioner just takes a needle, placing it in all the wrong places works just as effectively if the person believes that this treatment would work and when compared to the proper acupuncture treatment occurring.Another approach is to accept the pain we feel by becoming a non-judgmental observer - instead of trying to control or defeat it. This can be done through mindfulness. This might sound like madness but I have tried it and have felt it works. The author also describes the social pain which many have felt, whether it be rejection or hearing cruel words from another person. And now that we live in the age of social media we are all just one heartbeat away from an angry word, isolation and rejection and all of these things can cause hurt and pain. This is another example where pain is a protective measure that helps us to avoid isolation or rejection and deal with emotional issues.
The brain contains 86 - 100 billion nerves and possibly as many as 10,000 billion connections but we can rewire our brains. The more we use certain brain receptors and how they communicate with one another through neurotransmitters then the body begins to remember the feeling of new pain rather than actual physical pain. Depression, anxiety, and loneliness can also worsen the pain felt by someone and increase the chance of short-term pain becoming persistent. Lyman proposes that as humans are social, being socially excluded can increase the feelings of danger at an unconscious level. Synchronous activities can be helpful, such as choirs, team sports, and shared craft activities. These can all lead to a sense of purpose and hope that can reduce the severity of persistent pain.
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In most cases of persistent pain, the brain has become overprotective and is no longer detecting tissue damage. What is phantom limb pain? Can words actually hurt? Why do we experience pain, even after we've healed? A remarkable book that explores the boundaries and the meaning of pain - and how conventional understanding and treatment are failing us. ― Sunday Times It's also interesting how some people can really feel pain when we might see someone else in pain. Think how we might wince when somebody falls over and hurts themselves. However in psychopathy these people when shown using brain imaging will not really feel another person's pain although they can empathise with their own. However empathy and mirror neurons can often indicate how much we are going to feel another person's pain but it might be just part of our brain chemistry and make up.
The author then talked about the value of simple, repetitive movements that can release serotonin through such simple approaches carrying out art and craft activities or knitting in particular which can help people reduce the feeling of pain. Through small repetitive movements, pain can become much more manageable in how we deal with percieve pain.In 1995, a twenty-nine-year-old British builder was clambering down a building’s scaffolding and, when he was near enough to the ground, decided to jump down onto a plank of wood. What he didn’t realize was that there was a fifteen-centimetre nail protruding up from the plank, which went straight through his left boot. The builder and his nail were brought into hospital; the man was in so much agony that he had to be given the powerful pain reliever fentanyl as well as a sedative. The builder’s boot was carefully cut away by the medical team, revealing the nail to have penetrated between his toes, causing no injury whatsoever. M onty Lyman is a British doctor and The Painful Truth is his second book, released in 2021. It provides excellent explanations of persistent pain and the research around it. It has already changed how I consult patients presenting with pain in general practice. Everyone has had the experience of being deeply engaged in some activity, incurring damage, and not noticing until afterwards. Soldiers frequently report it: they also sometimes feel significantly less pain from their injuries than civilians, because an injury that takes you off the battlefield makes you safer than you were. The signals get mixed, and the pain felt changes accordingly.
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