Psych Central


The other day I learned that I’ve been walking around for the better part of a decade with a dislocated toe.

I knew something was wrong. I’d had it X-rayed and the doctor said it looked like I’d jammed my toe somehow (true) and had developed some form of arthritis. I can’t remember the name. He gave me a prescription I never filled. I was not ready for a lifelong commitment, and figured such is age. You get arthritis, you learn to live with it.

I don’t know how painful arthritis is, but this was extremely painful. I got rid of shoes that hurt too much, and was more than once brought to tears in the aisle of DSW just from trying on a shoe that hit my toe wrong. I often had near-blinding stabs of pain randomly, when I was lying in bed. The weight of the bedclothes could be painful. I’ve recently developed plantar fasciitis from walking wrong.

Then, the other night, I turned in the kitchen and had a sudden stab of pain in my toe. But  even as I was still staggering dizzily while it throbbed, my first thought was: It’s fixed.

And it is. There’s remaining tenderness that I hope will pass, but the pain is gone. I can bend my big toe for the first time in years. My foot is changing shape. That wasn’t an increasingly painful bunion after all. My toe was out of place. Now it’s back in place and everything is different.

But what’s most interesting to me is how different I feel even beyond my foot. The best way I can describe the sensation is of lightness in my brain. And I realize how much of my brain was busy with this pain, every minute of every day. My brain knew my toe was fixed before I’d even had time to think about it. And without that pain taking up bandwidth, it’s like new spaces have opened up in my head. Neurons have been freed up for other things. (What shall I do with them?)

In this book chapter, I learned that parts of the brain involved in pain include the thalamus; the primary, secondary, and posterior insular cortexes; the cingulate cortex; the anterior insular cortex; the prefrontal cortex; the cerebellum; the basal ganglia; and the supplementary motor cortex. That’s a lot of brain, though scientists don’t yet understand everything that happens in these regions.

The cingulate cortex is the most consistently activated region; this is probably the emotional processing of pain. Among many other feelings I had about my foot, it served as a constant reminder of my mortality. Arthritis=old=closer to death. I feel ten years younger since my foot stopped hurting.

The motor cortex came into play when I moved my foot to relieve the pain. The prefrontal cortex appears to help us modulate the pain. Research shows a lot of subjectivity in how each of us experiences pain. I have a fairly high threshold. I barely noticed the 24/7 low-level ache and was mostly troubled by the frequent moments of acute pain.

Interestingly, some regions of the brain deactivate in moments of pain, including the posterior cingulated cortex, the precuneus, and the ventromedial prefrontal cortex. According to this chapter:

…emerging evidence suggests that these areas are highly active during the rest condition when conscious subjects are frequently allowed to think in an unconstrained fashion. Then, when subjects are engaged in a task, these random thoughts are terminated and produce an apparent deactivation.

This suggests that the brain perceives pain as a task, something it must attend to. So if pain is suppressing these regions of free-flowing thought, this might particularly relate to the curious sensation of my brain being free.

I’ve never given much intentional thought to pain. I have thought about how horrible it must be to live with chronic pain, without actually putting my pain in that category until it went away. Suddenly, though, in the absence of pain, I realize what a complicated, nuanced sensation it is. And I am very, very grateful to have full use of my brain again.

P.S. A few months ago, one of my yoga teachers suggested I stop favoring my foot so much in class because yoga has proven therapeutic for people with arthritis. Since then, I have stretched that foot as much as I could bear every time I practiced. I believe that finally loosened the muscles enough to let everything snap back into place. Starting a yoga practice is one of the best things I’ve ever done for myself, in sometimes surprising ways.

 


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Sophia Dembling (December 12, 2011)

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PsychCentral (December 13, 2011)

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    Last reviewed: 14 Dec 2011

APA Reference
Dembling, S. (2011). How Pain Ate My Brain. Psych Central. Retrieved on April 23, 2014, from http://blogs.psychcentral.com/research/2011/how-pain-ate-my-brain/

 

 

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