Monday, 31 October 2016

About Mystery Pain

Sometimes people say they feel a lot of physical pain.

Then someone says to them, "It's all in your head. Get over it!"

Then they feel belittled, misunderstood, frustrated - maybe even angry. Because they feel the pain is real. So this only adds to their pain.

Actually, all pain is in our heads. No matter where in our body the cause of the pain is, it's our brain that makes it possible for us to feel that pain.

Some medications work by dealing with the cause of pain in whatever part of the body - but other painkillers work by affecting the brain's ability to communicate pain, without even dealing with the cause of the pain where it's located. And yet the person stops feeling pain. Even if the pain was in our toe. That's because all pain is "in our head" in a sense.

There's also such a thing as phantom pain. Some people who have had a limb amputated, sometimes feel pain as if they still have the limb. Some days they feel it worse than other days - even though they don't actually have the limb! This sort of pain is often treated with anti-depressants. Not because the person is depressed - but because pain is felt in the brain whether or not there's a physical cause in some other part of the body.

There's a video of a cat which had a paw amputated, and you can see the cat still trying to move kitty-litter using the paw which it no longer has. That tells you that the cat's brain was acting like it still had the paw, to some extent. And the cat didn't need to just "get over it". It's how the brain works!

Maybe human brains are the same. Maybe a person's brain can communicate pain, even when there is no physical cause of pain elsewhere in the body. But it's still felt as pain! That pain someone feels can be as real as phantom pain in an amputee, or as real as that cat trying to move the paw it didn't have.

In such cases when someone's pain is caused mainly by their brain, without a known physical cause elsewhere in the body, the symptoms of pain might be able to be relieved by using painkillers or anti-depressants which work on the brain. But that still doesn't cure the cause: it only masks or prevents the symptoms.

So the question is, if someone's pain is caused mainly by their brain, with no obvious physical cause elsewhere in their body, what is the cure. Is it simply "get over it"?

Well I think the first question would be to ascertain whether the person has a disorder of the brain, or whether the person's brain is actually acting precisely how the brain can be expected to act given that person's circumstances either known or unknown.

If it's a brain disorder, and you know it - then treat it as such. But if the person has had things happen to them, then maybe the brain is acting in a way that's only to be expected, even if that means pain.

In the case of amputation, maybe the brain can't be expected to act in a new way, without time and re-training.

If a person needs to "get over it", they probably have a complex combination of things going on in their lives, which might all be accumulating, which could be physical, emotional, dietary, spiritual, viral, bacterial, relational, any number of things, which might be working together to cause the brain to feel pain - which might prove they have a good and normal brain. So "getting over it" mightn't be as easy as a single decision.

It might require a combination of new responses or behaviours covering multiple issues in their life. Unless we can help them identify and respond to the complex combination of factors which might be affecting them, resulting in their brain communicating pain, then telling them to "just get over it" might just add another issue which might affect them even more.

The body and brain is complex, and so is the mind and spirit of man - and all parts of our body and our lives and our being affects the other.

When a person presents with physical pain, unless the pain is self-inflicted, or the person is lying, not necessarily in this order:

1. Seek to identify any mental, emotional, spiritual and relational issues the person might be facing and seek to diagnose what affect those issues might be combining to have on the person's physical body and brain.

2. Seek to help the person deal with those issues directly, in their own right. This could be complex, and could involve a variety of approaches.

3. In the meantime, optionally medication or other forms of social assistance could be administered or offered, which might alleviate the affects of those issues on the person's body or brain.

4. Seek to diagnose direct physical causes of pain in the body.

5. Identify locations of referred pain, from any primary sources of pain in the body.

6. Treat the cause of the pain at both its source and in referred locations.

7. Meanwhile, optionally also treat the symptoms of pain at whatever locations its felt, and also in the brain.

8. If a cause of pain cannot be found either in the person's body or psyche/pneuma/relationships, then consider the person's brain.

9. If the feeling of pain is a natural response of the brain to known circumstances outside the brain which are not directly treatable (such as a previous amputation; or other causes which have since been cured already) then perhaps the brain needs time and re-training. This doesn't mean the person is ill mentally or physically - it's the brain acting exactly how you'd expect a healthy brain to act given the previous circumstances.

10. Otherwise, having eliminated all those possible causes of pain, consider whether the brain itself has a disorder, caused only by the brain itself. Seek to diagnose the cause in the brain. Seek to treat the cause. Meanwhile optionally administer medication or other forms of assistance which can alleviate the symptoms.

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