Was reading a fascinating article in NYT Magazine about Ashlyn Blocker’s challenging (painful?) life without pain. The most striking point from the article is the idea that pain is a gift. Of course, it is. Pain is a gift, a gift of information (that is necessary for survival). We usually don’t think of pain in this way, but perhaps we should. Perhaps, we should be… thankful for our ability to feel pain. “The Hazards of Growing Up Painlessly” is a great read.
[This was the "pain-as-a-gift" part of this blog. The rest is some NT perspective thoughts on the issue of congenital pain insensitivity.]
So, how would the NT perspective make sense of congenital pain insensitivity?
Congenital pain insensitivity is an information processing problem, i.e. a problem of communication between peripheral neurons and central neurons. Unlike in the case of induced pain insensitivity (by way of anesthesia), in the case of congenital pain insensitivity the information-exchange between the peripheral neurons and the central neurons is not muted (blocked) per se but is not undertaken in the first place. Peripheral neurons of the congenitally pain-insensitive person (neural colony) are either electro-chemically mute or speak a foreign electro-chemical dialect that is not recognized by the rest of the neural colony.
The classic neural view is that a “person” with congenital insensitivity to pain does not feel pain. The NT perspective has a slightly different spin on this: the peripheral neurons of such a “person” do feel pain but are not able to pass on the information up the neural chain of command. Put differently, the adaptive nocioceptive information-processing is taking place but only on the periphery of the body. In other words, the afferent (bottom-up) signal is received but because it is not passed on up the neural command chain it is never amplified enough to warrant an efferent (top-down) response.
This tells us something interesting about what pain is. Pain isn’t pain. Pain is information and information in and of itself is not painful, it just is. Information does not hurt, information informs, that is, compels a neural response. So, then what is pain and why does it feel painful? As I see it, pain is signal-amplification, signal-strength, signal-intensity, signal-urgency. In a properly communicating neural colony, pain is urgency of efferent (top-down) response.
Pain – as information – is just information about regular stimuli – such as pressure but what makes pain painful, what makes this regular information feel so phenomenologically irregular – is the amplification of efferent (top-down) response. So the pain of pain is informational overflow, informational overwhelm, and the resulting sense of efferent urgency (which we experience as “I have to do something about this.”). And it is this “I have to do something about this” (it is this efferent urgency) that is interpreted as “therefore whatever it is that I am feeling so urgently about is unacceptable or dangerous or painful.”
Pain becomes pain on the way down, once the signal has been interpreted as having informational priority and deserving of an urgent response. But on the way up, pain isn’t pain yet. On the way up, pain is sensory-specific information. On the way down, once amplified, pain is efferent urgency, the “I have to stop this!.” And it is this “I have to stop this” urgency that becomes a neural post-factum interpretation that a signal that was just received (and resulted in an urgent/amplified efferent (top-down) adaptively-evasive response) must be encoded as “bad” for the organism (bad for the neural colony, bad for the “body”), i.e. as pain.
[This kind of information-processing view of pain isn't meant to invalidate suffering, it's meant to understand how it comes about and what can be done about it.]
[The idea that "pain itself is not painful" is hard to communicate and I am just writing of the cuff, musing on the topic. It's been a long-standing interest of mine since the days when I did a practicum at the Roswell Park Cancer Institute Pain Clinic with Dr. Zevon. In those days I was interested in the interplay between time perception and pain perception - testing an information-processing hypothesis and defended a dissertation on that topic.]
The seemingly impossible (so far) trick is to get the peripheral neurons to talk to the rest of the neural colony (to the rest of the nervous system). As a scientific culture we have learned to mute and un-mute (e.g. via Naloxone) neural information-processing but we have not exactly learned how to make mute peripheral neurons speak in the first place.
What haven’t we tried as a science in this regard?
We haven’t tried “brain-machine interfaces.” Because the technology is not there yet. I envision that in future we might be able to hook up peripheral neurons to the rest of the nervous system through some kind of electro-chemical nano-translators. It would be too impractical to implant them for every peripheral neuron but a certain ratio of dispersal could be experimented with to assure that – functionally speaking – enough of the peripheral neurons are not asleep on their border guard watch to assure a good enough defense perimeter. To clarify, nothing of this sort yet exists and I am just musing out loud.
What else haven’t we tried? To my knowledge, we haven’t tried to teach congenitally pain insensitive people to experience pain. Perhaps, a combination of mindfulness-based attention deployment and/or sensitization training can facilitate some kind of peripheral neurogenesis that would enable peripheral neurons to pass on the distress info up the neural command chain.
Finally, the most direct NT hypothesis that I can think of is to investigate any genetic commonalities between the so-called extremophiles (recently discovered species that live in painfully hot or cold conditions) and humans with pain insensitivity.
While most extremophiles are unicellular, some are multicellular, such as Pompeii worm and Tardigrades. This matters because the NT perspective (the Neural Tribe perspective) extends only so far as there are neurons (thus the motto: “Wherever you find a neuron, there – as a species – you are.”) To clarify, worms and insects have nervous systems (i.e. are home to neural colonies, to use the NT lingo).
The NT thinking here is straightforward: a neuron is a neuron is a neuron, regardless of the animal species that it inhabits. Peripheral neurons in pain-insensitive humans might be somehow similar to neurons of extremophiles. Perhaps, what we view as a congenital abnormality is an evolutionary anachronism of adaptation, a kind of mismatch between the specific electro-chemical neural language of a given neural colony and the eco-habitat its body-form lives in.
Just thoughts from the NT perspective. I hope these musings gave you something to think aboout and something to feel thankful for.
Be well, in pain or pleasure.
Young woman in pain photo available from Shutterstock
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Last reviewed: 19 Nov 2012