NOTE: I am not writing this series of posts about Melanie Thernstrom's The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering (Farrar, Straus and Giroux, 2010) as a book review. I do highly recommend this book for anyone who is suffering chronic pain or is close to someone who is, but I am not trying to make the case for that. It's really a matter of inspiration: a book written by a chronic pain sufferer would naturally hold interest for me, giving me much to ponder in relation to this blog.
"...[C]hronic pain is, by definition, a pain that the brain fails to moldulate." (page 47)
This is the final sentence of the chapter named, "Acute and Chronic Pain", in which Thernstrom does a marvelous and succinct job of explaining the differences between the two kinds of pain. She also writes about the beneficial effect of distraction, which helps me understand why meditation and prayer serve to lessen the pain for a while.
Acute pain elicits a very different neurological response than does chronic pain. It's a survival mechanism, as Thernstrom explains it: "After an injury, the brain can sometimes stave off pain by temporarily switching on powerful pain-inhibiting mechanisms and releasing its own painkillers, such as endorphins, into the spinal cord, in a process known as descending analgesia." (page 46) Thus, cave dwellers were enabled to run away from the tiger that had just bit them, feeling no pain until safely returned to the cave. Thernstrom cites the example of the young surfer, Bethany Hamilton, who said, "'I didn't feel any pain [after the shark bit off my arm] -- I'm really lucky because if I felt pain, things might not have gone as well.'" (page 47)
But chronic pain has an entirely different neurological mechanism. I can't describe it any better than does Thernstrom : "Chronic pain is not protective [as is acute pain]; its intensity bears no relation to the amount of tissue damage and may, in fact, arise without any apparent damage at all. It is like a broken alarm that rings continuously, signaling only its own brokenness." (page 43)
I have said many times (trying to avoid sounding pathetic), "I don't think my brain knows how not to have a migraine." Inadvertently and intuitively, I was stating in a layperson's terms the conundrum of chronic pain. The system is broken and it is persistently, insistently telling me so, thereby creating more pain.
I am reminded of Edgar Allen Poe's poem, The Bells.
I cannot tell you the relief I felt as I pored over this chapter, reading and re-reading in order to ensure my understanding. And this even though I had listened to my neurologist explain that the brain becomes accustomed to pain and develops habitual pathways for it. Why had this lesson not sunk in before? I think that, for most of us chronic pain sufferers, there is an unkind and persistent voice in our ear saying, "You wimp!" Knowing that there is an actual neurological reason for the constant pain in my head takes it from the depths of wimphood (wimpostiy? wimpitude?) and into the realm of simple physical reality. I guess I just had to hear that message several times for it to really make its way past all those neurons firing off in automatic and helpless alarm.
Thank you, Melanie.
Then there is the issue of distraction. As discussed before in this blog, my meditation and prayer practices are most helpful during a migraine. It's not so much that I perceive the pain as being lessened, it's more that meditation and deep relaxation bring the whole of my attention to a broader, deeper and more peaceful place. This seems to relegate the pain to a less significant chunk of my awareness. One of the ways I perceive this is in the difference between saying, "I am in pain," and "There is pain here."
Since I cannot mediate for the entire six to thirty-six hours of a migraine, there is always Seinfeld on DVD, music, National Public Radio (who'd have thought that Car Talk can be a distraction for pain?), books on CD and public television.
When I was a kid and had stubbed my toe or bruised my shin, my Mom would tell me, "Say Jack Robinson!" Where that came from and what it meant, I do not know, but in light of what Thernstrom reveals, it surely was meant as a distracting measure, both for my Mom, who didn't necessarily need a wailing child on her hands, and for me, as a way to distract me from the pain. These days, I take three slow, deep breaths to distract myself and the pain seems to recede more quickly than if I dwell on it.
Finally, here is a case in point: I have spent an hour writing this post despite the fact that I was lying down with a blindfold over my eyes until 8:45am today. As I concentrate on writing, the pain recedes into the background. When I turn off the computer, the pain will - I know this from experience - force its way back into my awareness. Time for some meditation.
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