November 17, 2020 • 51 mins
In recent decades we’ve come to understand that there’s a lot more to pain than: touch hot stove/feel burning hand. Pain is a far more sophisticated experience and, unfortunately, a system that can often go haywire, with terrible effects.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You Should Know, a production of five
Heart Radios How Stuff Works. Hey, and welcome to the podcast.
I'm Josh Clark. There's Charles W. Chuck Bryan over there,
and Jerry's out there running around somewhere. We just gave
her a hot foot. It's hilarious. Uh, and this is
(00:22):
stuff you should not tried. Are continuing exploration of pain? Mhm.
What else have we talked about with paint? We did
one on the pain scales, okay a couple of years ago,
and uh, then we did one on something about perceiving pain. Well,
this one, this one, this is just totally stuff you
(00:43):
should know them because we did a bunch of like
more niche stuff and now we're going back and doing
like the umbrella topic and we're talking about pain, which, Um,
is there a super ancient old evolutionary Um, right, I
guess that's shared basically throughout all living things. I would
(01:05):
say it's a pretty fair guess. I think so, Yeah,
because um, there's something that pain pain specifically, which is this.
We'll get into defining it and how hard that is
in a second, but um, it seems to be a
a fairly universal, almost universal process where our body says, hey,
there's something really bad going on, say on your hand,
(01:28):
So move your hand away from wherever it is in
space right now, and hopefully that will help keep it
from getting further damage. Like pain is a signal saying, um,
do something, dummy, move and it's it. I mean, that's
that's you know, you see it in and basically any
animal we've ever encountered, including the beaver and the porcupine.
(01:49):
That's right. And by the way, we did other people
who can't feel pain ten years ago. Yeah, it actually
seems longer ago than that. That's funny because I thought
pain Scales was forever ago and it was so Yeah,
I have no sense of time anymore. So, so we
are talking about pain, Chuck, you feel pain right or
do you have a high pain threshold? Are you sensitive? Uh? Well,
(02:11):
you know it's funny because I went back and listen
to the Pain Scales and I kind of chatted about
that for a bit. But I have a pretty high
pain threshold. Yeah, okay, I would say mine's average. Let's
just go with that. I wonder what I said in
the Pain Scales app because there's no way I didn't
respond to your your thing you know it will be
(02:33):
a mystery. So um. Apparently pain is the most common
reason that people, um go seek medical attention. But when
they go seek medical attention, as we talked about in
the pain Scales episode, the whole reason there is such
a thing as a pain scale is because it's a
fully subjective experience and it's really difficult to describe. And
(02:55):
it's taken medicine, like many, many years to get to
a point where they tell the people their training, doctors
and nurse practitioners and medical staff, like, if somebody tells
you they're in pain, they're experiencing pain, you have to
take them at their word. Um. And that's actually kind
of a new development because there are plenty of times
(03:15):
when it appears that there's absolutely nothing wrong and that
the person shouldn't be in pain. And for years doctors
just kind of treated people like like that like kooks
and didn't believe them, which was very sad. And now
we're finally figuring out there's situations where you can be
experiencing pain even though there's no reason for you to
be experiencing pain, which really underscores just how subjective it is.
(03:38):
That's right. Uh. In three, there was an actual definition
for pain that was introduced that has a couple of
really important caveats that will kind of play out through
this episode. Pain is an unpleasant, sensory and emotional experience.
There's the first caveat associated with actual or potential tissue
damage or described in terms of such damage, which is
(04:03):
a big caveat there, because you can walk into a
doctor's office and say, I've got some big time tissue damage. Doc,
I'm experiencing big time pain, and they can look you
over and be like, this guy didn't have any tissue
damage at all. So that's in the actual definition of
pain of pain. So I think that the reason they
caveatted that was for the very simple reason that pain
(04:28):
can be emotional. And I don't mean like real emotional pain.
I mean a physical pain that is may be made
worse by emotion or brought on by emotion, or that
you're you know, you really don't have a pain, like
you've got a chronic pain, let's say, but nothing's going
on under the hood to cause it. Yeah, And like
(04:48):
we've learned so much about pain since nineteen seventy three
that I saw that just this past July, um the
International Association for the Study of Pain updated and revised
their their definition. It's still basically the same, but they've
included a lot of stuff that we talk we're going
to talk about in this episode. Does it say pain
whatever you say, dude, right yea, they said pain is uh, yeah,
(05:14):
it is so far at least. Um. There's a bunch
of different types of pain, though actually not that many,
but there's a few. Acute pain, which is very short lasting.
If you if you put your finger on the burner
of the stove or something like that, or um, slam
it in a window, that's going to be an acute
pain where you know it's really helpful, so you know
(05:38):
your body is gonna say, wait a minute, that's super hot.
Or by the way, dummy, you just put your finger
in a window and you immediately have a reaction to
stop that immediate acute thing from happening, even though the
pain is gonna still be there. It's not like you
slam your finger in the window, yank your thing away
and shake it a little bit and it's gone. Right. Well,
it can be depending on the level of pain, but
(05:59):
it makes sense that it would still linger even in
acute paint, which from what I can tell, is like
the ideal version of pain. It's, like you said, it
makes you stop doing whatever you're doing, but the fact
that it still hangs around for another minute, it's almost
like it's teaching you a lesson, like not only stop
doing that, don't do that again. Yeah, and there's some
overlap in these, by the way, So when we talk
(06:20):
about the next one, no susceptive pain, this comes about
from tissue damage, like real tissue damaged by like physical
or a chemical agent. We're talking a chemical burn, or
a trauma or a surgery. This can also include slamming
that finger in the window. It can also include you
worked out really hard the day before and you're really
(06:40):
sore the next day. Yeah, as long as there's some
sort of like mechanical reason or some sort of damage
to tissue, or even temporary damage like a sore sore muscle.
Um And it also includes malignant pain, which is cancer pain,
which is where tumor starts growing in your tissue, impresses
on nerves and blood vessels and create pain like that.
(07:01):
And no, no susceptive pain is what most people think
of when they think about pain. Um And it can
be both acute and chronic. But I guess the best
way to kind of differentiate no susceptive pain from the
rest of it, there's actually something going on that is
causing the pain signal to be created. Um And it,
like I said, it can be short lasting or long lasting. Um.
(07:24):
And it's different from a different type of pain, appropriately
enough called neuropathic pain. Whereas no susceptive arise from arises
from tissue damage, neuropathic arises from damage to the actual
nerves themselves. Yeah. Like, uh, I don't know if you
remember this story from almost a year ago. It was
last October when I hit my shin on my bed
(07:48):
so hard that water started leaking out of my eyes.
I wasn't crying, it was just literally water coming out
of my eyes. And I've never felt pain like that before.
And it was clearly some kind of literal nerve damage
because for three or four months, I had like a
three uh three inch by three inch square on my
(08:10):
shin that was completely numb. And uh, it's it's the
worst pain, like physical pain I've ever felt in my life.
They I mean, that would definitely qualifies neuropathic pain. You
clearly messed up the nerves in that little area. UM,
and you're lucky that it only lasted three months, because
apparently neuropathic pain, which can include everything from hitting your
shin to banging your funny bone, your elbow UM two
(08:33):
things like sciatica or even multiple sclerosis. Anytime the neurons
in your nerve fibers are are damaged. UM, that's neuropathic pain,
and it can last. It can very easily translate from
acute pain over to chronic pain, which is pain that
last six months or longer um, which can itself be
no susceptive or neuropathic. Uh. It can also, unfortunately be psychogenic.
(08:57):
Chronic pain can be, which is where you have lasting, uh,
sustained pain over six months or longer um for no
good reason whatsoever. Yeah, and this is you know, it
gets really sort of murky and confusing. Here. We are
not saying that chronic pain is all in your head,
but we're saying that in some cases that there there
(09:20):
is no reason behind you continuing to feel chronic pain.
But so many people suffer from chronic pain. I think
roughly it kind of varies, you know, depending on the year.
But somewhere in the neighborhood of twenty adult Americans suffer
chronic pain every single year. Um, And it's when you
(09:41):
hear people talk about that, like, uh, I just feel
bad for him. I can't imagine what it's like to
walk around in constant pain, and it's probably even more
frustrating when a doctor can't trace it to a thing like, hey,
we fixed that. It shouldn't be hurting anymore, right, especially
if they're being patronizing and treating you like your cook, Well,
that's a bad doctor. You should not go. Sure, But again,
(10:04):
I mean, like I feel like people with fibromyalgia or
chronic fatigue. I don't know if you experience pain with
chronic fatigue, but have long been treated like their nuts,
like it's all in their heads, just because you know,
science has not been able to identify exactly what the
deal is. Yeah, I would say, if your doctor is
like that, go to a doctor with a little better
bedside manner. At least they might be saying the same thing.
(10:26):
But they would should treat you with respect. And if
if they're wearing oversized clown shoes, so much the better.
That's usually it did give way for a great doctor,
that's right. Um, I don't think we said that, uh,
we we talked about no susceptive pain, but no susception
is taken from the Latin word for hurt, and um
(10:48):
pain is its own thing like pain perception. We're talking
about what's going on with the central nervous system, uh
the peripheral central nervous system as well, and how it
processes this information is really uh interesting and still cloudy
because the brain is involved. And we've done dozens and
(11:09):
dozens of podcasts that involved the brain, and at some
point during all of them we usually say something like,
this is kind of their best guess right now, because
the brain is still such a mystery. Yeah, we have
made like advances by leaps and bounds since the sixties
when we kind of started to change our understanding of
pain and definitely refining it. But one of the things
we figured out is that no susception itself is separate
(11:33):
from the experience of pain. It's like the body giving
the brain information about something that's going on with your
body right now, but it's not pain itself. Pain is
the brain responding to that information, and so no susception,
as we'll see, is kind of this process where your
(11:53):
body um detects some sort of noxious stimuli UH, and
the no susceptors your specific kind of UM little sense
receptors that are tuned to pain. As we'll talk about UM.
They send a signal to your brain saying, hey, there's
something going on here, and then in your brain, your
your brain starts sort through the whole thing and decides
how to respond. So no susception and pain they're very
(12:15):
much intertwined, but they're definitely different things, and we've actually
seen that one can exist without the other. Yeah, I
mean they've done studies that UM and I. I mean
we had to have talked about this and other people
that can't feel pain UM congenital analgesia. I don't remember
ever saying those words before. I think we had to
have There's no way, although knowing us, it's possible we
(12:40):
walked around that one. Well maybe so. But there are studies,
including ones on that people who can't feel pain, that
have shown that no susception can occur without the experience
of pain, and UM pain can be experienced with the
absence of no susception. So it's sort of a two
way street. Yeah, that's like that psychogenic pain where you
there's no reason for you to be feeling that pain
(13:02):
right then, right, yeah, And because it's the brain, it's
um and you put in here it's like it sounds funny,
but your brain is what's feeling the pain. Like when
you smash that hand in a window. Um, you might
think that your hand feeling the pain, but technically it's
your brain, if that makes sense. Yeah, or even that
like you're you're that hand that window smashing your hand
(13:26):
set off a specific unique kind of um uh signal
that that transmits a pain signal directly your brain. Your
brain experiences the pain. That's just not quite right. That's
actually Renee des cartes interpretation of it, and can so well.
Considering he was working in the first half of the
sixteen hundreds, he wasn't that far off the mark, especially
(13:49):
considering that before him the Greeks had thought up basically
up to day car, everyone had thought, starting with the Greeks,
that pain was like a spirit intrusion, it was like
something external at all. And in fact, our word pain
comes from uh pena like subpoena, which means penalty. So
this like pain was considered a punishment from the gods
(14:11):
um And Dave Carr was like, no, I think this
is an internal process, and he had like the broad
strokes of it. It's just that he didn't have the
details that we have now today. Yeah, he kind of
got well he got one half of it pretty right. Um,
but I mentioned it was a two way street. It's
a two way street in a lot of ways. Because
what we've learned since decart is that we do have
(14:33):
pain signals that go up from nerves in the body
to the brain to say hey, I'm hurt. Those are
called ascending signals. But then we also have another signal
going I'm just gonna call it downstream for lack of
a better term, descending signals that come from the brain
that can kind of mute the pain or turn off
the pain signals. And that's you know, as we'll see
(14:56):
later when it comes to medication and stuff. It's sort
of managing that way, like whatever traffic light is on
that two way street. Yeah, well that was like a
huge thing, Chuck, like to figure out that. Wait a minute, Like,
first of all, the experience of pain is totally in
the in the brain. Right, your hand itself isn't actually hurting.
Your brain is hurt is what hurts. It just feels
(15:17):
like it's coming from your hand. And then secondly, the
idea that your brain can influence this the experience of pain,
that was just revolutionary. And so as a result, we've
come to kind of see pain as the brain. There's
a neuroscentist name vs. Rama Shan Droton who's just brilliant
and he um, he said that pain. This is paraphrasing him.
(15:40):
He said that pain is the brain's opinion of the
current state of your health. You got no pain, It's
all good. You've got pain. Your brain is interpreting there's
something wrong with like your hand or your leg, or
your guts or something like that. And it's just an opinion.
And the opinion can be gotten wrong too. Well, you
know what they say about opinions. Yeah, everybody's got an
(16:02):
elbow of them. All right, I think we should take
a break and we're gonna come back and dive into
some hard science right after this. Alrighty, so your brain
(16:38):
has an opinion about the current state of your health. Um,
we're still at the stage where we're sort of testing
out how pain is generated and how we experience it.
But what we kind of think right now is what
we mentioned a little bit earlier is that some of
the sense receptors located on the nerve endings are really
(16:58):
finely tuned two different kinds of UM, different kinds of pain,
but really tuned to different kinds of thing that might
cause pain, like a hot stove or a needle going
to your arm. Yeah. And you can pretty much divide
them into three categories. Mechanical which is pulling, stretching, tearing, cutting, chemical,
which say like exposure to acid or something, and then
(17:21):
thermal like like heat or cold. Um. And the idea
that these no susceptors are capable of being triggered by
exposure to those kind of stimuli from the external world,
that that is what kicks off the no susception process. Yeah.
And they, uh, they're all very different and they have
(17:42):
different ways of communicating with the brain. Um. There are
some that do things really really fast. Uh. These U
there are some called a fibers. They have a little
it's kind of like a little express train instead of
having to make stops along the way, has a fatty
mile in sheath that's going to insulate the electro conduction
(18:04):
basically on the wire and it really just zaps it.
They're really really fast not a lot of information losses
going on. And that's like that first really intense pain
you feel when you burn your hand or when you
slam it into the window. Is that's kind of what's
going on with the A fibers, right, And then you've
got sea fibers, which aren't insulated and they are slower conducting,
(18:28):
but they also have a bunch of they recruit a
bunch of them to conduct signals from different parts of
different areas um to the brain to say, hey, this
is this is actually pretty pretty problematic. We got a
real thing going on here. And they account for the
follow up like usually burning, throbbing kind of sensation that
(18:48):
can be followed by that first like bolt of pain
that the A fibers deliver, and then that's from the
actual like like uh no susceptors. There's other stuff that
spens to like if you cut open your hand, those
damage cells you know, spill their guts and so like
potassium and glutamate and substance peace starch start like change
(19:10):
start firing off, like other neurons in the area um
you might have an inflammatory response, so things like histamine
show up and they start setting off other nerve fibers too,
So it's more than just the you know, the cut hand. No,
susceptor is telling the brain that something's happening. Like a
whole bunch of different responses from the area are going
(19:32):
to arrive at the brain and produce this really complex,
rich message saying here's generally what's going on, and here's
how bad it is. You ever had a bad burn? Yes, man,
that's the worst. They are pretty bad. I don't even
remember what happened, but um, I definitely have burned myself
pretty bad. You may has this same spot on her
(19:54):
hand that she gets in like the confection of it.
Like basically every time it heals, she just re upset again.
She's always got this little little thing on like I
think it's her pinky knuckle on her right hand, and
she always like hits the same spot on the yep.
Oh man, every time you get that lady a glove
a hot myth. Yeah, I think by now it's just
so callous that she is dead. She fights sailors with
(20:17):
it these days. Yeah, those burns really linger. And that's
like every time I hear someone or see somebody that
has has you know, had been in a fire and
had really really bad burns over a lot of their body.
I just I can't imagine the lingering pain that they
go through. I know we've talked about this on some
episode before, but uh, just those burns that it seems
(20:38):
like they hurt forever. Yeah, I mean, you've got exposed
nerves fibers to just the air, which you know, as
we'll also see, when you undergo a particularly brilliant experience
of acute pain, it can be so thorough and it's
energizing of your nerves that they actually become sense of tized,
(21:01):
so like they become more sensitive than they would have
before that, which is actually also a problem with with
chronic pain too. But if you if you experience burns
like that deep over all of your body, not only
are you going through the normal pain, you're probably more
sensitive now to normal stuff like air blowing on your
exposed nerves than you wouldn't otherwise, and that just makes
(21:23):
it that much worse. Yeah. And then some things that
you might think really hurt don't hurt. Um, like cuts,
I've had cuts before that don't hurt. They might freak
you out, uh to look at it and to see,
you know, like your skin exposed and some people are
really freaked out by the blood. Um, I've had other
people I know I've never broken bones that have had
some pretty gnarly injuries like that. That said, it didn't
(21:45):
really hurt that much. Yeah, they're walking around like a skeleton.
You hang on the door with their arms just flopping
back and forth. It's really interesting how it all works.
But it really underscores, you know, how the brain can
get its opinion um of what's wrong with the body
based on the pain information wrong sometimes a lot of times,
like think about a hangnail. Hangnail is no threat whatsoever
(22:06):
to your survival, but those things hurt. Or a paper cut.
No one's going to die from a paper cut, but
it really really hurts too. Um. It can be overblown,
it can be underblown, but it really goes to show
like it's the brain taking all this different information together
and saying, here's how bad I think this is. Yeah,
it's pretty cool and painful. Uh. So let's say you
(22:28):
get hurt. Let's say you you slam your your hand
in the window like I was talking about, which I
think has happened. I don't know why I keep going
to that got your worst fear. I don't know, it's
I don't I don't think it's better not your worst fear.
That is not that bad. That'd be hard. It's a
lot easier to shut your hand in a car door
than a window. But O, man, that hurts either way. Yeah, man,
I had a knock wood. That hasn't happened to me
(22:49):
in a long time. Yeah. Every time my daughter shuts
the door, which I tried to let her do whatever
she can on her own, I'm always just like, don't
do it. Do you put ovenmits her hands first? No? No,
nanny stayed at our house. Uh. So you you get
hurt on your hand, Let's say, Um, the signal that
is gonna travel it travels through the into the gray
(23:11):
matter of your spinal cord, and there are gonna be
a lot of different connections made with the spinal neurons there,
and it's going to cover a broad area of the body,
which is why sometimes if you get hurt, um, especially
if it's like an internal injury, you don't know exactly
where the pain's coming from. You might tell your doctor
you just might rub around your whole torso when in
(23:31):
fact what's actually hurt is a fairly small area. Yeah,
or it could be like a completely different part of
your your body or kind of near. It's called referred pain,
like if you're having a heart attack, usually feel pain
in your arm. Yeah. If you have brain freeze, that's
your blood vessels on the roof of your mouth expanding
because they're cold. But you feel it unlike your forehead
(23:52):
really terribly, which doesn't make any sense. So yeah, I
think that's from those the nerve or the sea fiber
information where it makes it tough to also figure out
where it's coming from. Have you ever been to a cardiologist? No,
I'm going I'm going to one this week. Man. I
had I've known two people in the past like a
(24:12):
month that have dropped dead that are like my age.
What uh. One friend of mine from college had been
experiencing chess pains and he went to drove drove himself
to the hospital like collapse and died on the way
into the hospital. Just terrible. And I haven't been out
of touch since college, but it really hit me hard
to where I was like, you know what, I I
(24:34):
want to go, like just see what's going on in
there and get some preventative or not. Preventative, but just
some proactive tests done. Uh, you know where they see
how your arteries are doing. Because I've got cholesterol issues
because of my my family history and stuff, and I
wanted to be one of those things where they're like, oh, well,
it turns out that you know you were clogged this
(24:56):
whole time. So I don't I don't care what they say.
I'm going to demand those tests. Yeah. I think you
probably will have to pay for them out of pocket,
but that's not the end of the world. If, like
you have, you have concerns about it, no want of
genuine concerns, cardiologists might actually go ahead and prescribe it anyway. Well,
I don't have concerns in that I have chest pains
or anything, but but if you have a family history,
(25:19):
they may. Yeah, I just I want to know what's
going on. I'll I think that's great. And actually it's
funny like you me had suggested we do something like
that too, So maybe we'll see you at the cardiologists office. Well,
I think for women you can go get heart screenings
for women, um, very easily. Uh. And I don't know
if it's because I thought it was for both and
I talked to the lady on the phone. She said, O,
and then that's only for women. And I guess that's
(25:41):
because women are less likely to talk to doctors about
their heart because I think it's maybe generally thought of
as something that men experience more. Yeah, I guess now
that you say that, it does seem like more of
a man. So I think they're trying to be proactive
and saying like, hey, women, you need to think about
this stuff too, so we'll offer it's like a hundred
(26:01):
dollar heart screening or something like that. Gosh, is there
anything socialized medicine can't do? So, uh, we were talking
about those first um, those first set of spinal neurons.
Then you have secondary neurons that are going to send
their signals up through the white matter of the spinal cord.
And this is an expressway where all the traffic from
(26:23):
all of these lower segments just just speed up the
spinal cord. Yeah yeah, which is you know, normal for
any kind of sensory information. But um, the pain, the
pain information follows the same super highway and it goes
through your brain stem, your medula, and then it synapses
again onto a third set of neurons. Um in your thalamus,
(26:44):
which is your brain's relay center, and then from there
things start to get kind of market. It goes out
to different parts of the brain, and we'll talk about
pain in the brain in a second, but one thing
that it does it was helpful for me to imagine
pain a pain signal as like a pinball when when
you hit it with the flippers, say that's like you're
you cutting your hand. That pinball goes up and it's
(27:06):
going up to the top of the pinball machine. But
on the way, it goes through all these other things,
like these gates that it flips around three and sixty
degrees a bunch of time. Imagine that it's, you know,
doing that in your in your brain stem, or in
the gray matter of your spinal cord. It's going through
all these different things, and as it does on its
way to that final destination of the brain's somato sensory cortex,
it can have effects on the way to Like if
(27:30):
it's bad enough, it may enter what's called a spinal
reflex loop, where that pain signal doesn't even make it
to the brain before part of it gets redirected back
down to say, your hand to make your hand jerk
away from that hot stove before it even hit your brain.
Literally before your brain even knows that there's pain going on.
You're you have a signal going down to your arm
(27:51):
to say, move that move that hand, dummy. Yeah, because
if you think about burning your hand, the burn, I
mean it's very fast and very fast succession. The actual
burn pain burn happens after you've jerked your hand away. Uh.
And like I said, it's pretty lickety split, but you
jerk that hand away. It's not like you keep it
(28:11):
there and you're like, oh my goodness, I feel pain
on my hand. Oh my lord, it's got fire on it.
I should probably move it eventually. Another thing that can
happen is pain signals can set off your fight or
flight pathways as it's going through the medulla. It's been
a long time since we talked about or fight. Yeah,
it's it's been so long. They added a third one freeze. Ye.
(28:32):
It's like an old friend coming back to visit, but
bringing a new obnoxious friend with it. Yeah. So um,
it could set that off through the medulla. And you
know what happens there is you're gonna your heart rate
is gonna go up. Your blood pressure is gonna shoot up.
You're gonna start sweating if you're me rapid breathing, and
it really can. Um, it really depends on the intensity
(28:54):
of the pain, but it can definitely set off that
fight or flight or I guess freeze. And again, all
this is before it even gets to the brain. And
then finally when I, like I said, when it does
get to the brain, we're not quite sure what happens there.
We know from observations that the brain is definitely involved.
And um, one of the ways that we know this
is because, um, you will move your hands. Sometimes it's
(29:16):
not an immediate reaction, but sometimes it's a little later.
So clearly some of those signals get sent to the
motor cortex to say, Okay, get the hand out of there. Um.
But we also can tell from things like the fact
that if you consciously distract yourself from thinking about the
pain with something else, like do you remember how um,
Edward Norton in Fight Club when he had that lie
(29:38):
on his on the on his hand, he kept trying
to think of like a snow covered like forest or something.
He went to his his happy animal I think was
a penguin. That's right, that's right. He started to try
to concentrate on that and that it didn't work then,
but it could have worked depending on what other kind
of tissue damage was going on. And it really kind
of underscores the fact that if you think about something else,
(30:01):
your pain may decrease. Well, if the brain has nothing
to do with pain or controlling pain, then that wouldn't
happen at all. And so observations like that and some
other ones show us that, Okay, the brain is definitely
involved in this in some way, shape or form, and
pain is not just the reception of um a pain
signal coming from the lower parts of the body up
(30:23):
to the brain. But there's also a reciprocal thing, like
you were saying, where the brain descends um or, there's
descending pathways that the brain uses to say, Okay, alright,
let's just all chill out down there, Okay, let me
figure this out. Everybody, just shut up, shut up. I
can't think when you're all screaming at me. Yeah. And
as those signals are on the way down, there might
(30:43):
be those uh, ascending nerve signals going up right, and
those descending signals could overpower and say hold on, you
stop right there, buddy, I'm trying to calm this person down.
You just you just stay put, right, And so there's um,
there's other things that that we figured out that can
actually influence your experience of pain. Like to say that
(31:06):
it's subjective is just no joke. There's probably no experience
more subjective than the experience of pain. And there's all
these different factors that are involved that will have an
impact on how much or how little pain you experience.
You know. I think improv comedy is the first that's right,
man to see good improv is just it's just so rare,
(31:30):
but it's so good when it is good. Yeah, I mean,
I've seen a handful in my life that just blew
me away, and I've seen a bunch more that. Uh,
it's tough to get through. It's like horror movies, Like
a truly great horror movie is really tough to beat.
But there's a lot of really bad horror movies out there. Yeah,
a lot of good ones these days, Thoughnas what you
(31:53):
got well, I mean in the past five or six years,
I think, uh, it follows and the and Hereditary, and
I think there's been a bunch of new horror masters
So now, this was not a horror movie, but I
want to shout out Um and Nola Holmes on Netflix.
(32:15):
Have you seen it? It's a coming of age movie
about Sherlock Holmes's younger sister. Interesting and it's super cute,
but it's also really smart, like very smart, and it
takes the takes it for granted that the viewers smart
and paying attention. It's a really great, great movie, great movie.
(32:35):
You have to check that out. It's um Millie Bobby
Brown as Nola Homes just about She's about as charming
as they come. She's wonderful. So yeah, not a horror movie,
but definitely worth watching regardless. Is that based on any
uh literature or anything or did they just say, like, hey,
what if he had a little sister. I hadn't thought
about it, but I think it's the ladder of the two,
(32:58):
which makes it all the more amazing because they did
such a great job of capturing that whole um, that
whole world. Very cool. Yeah, where should we take a break? Yeah?
Why not? Let's let's take a break and we'll come
back and talk about a few of the factors that
influence your experience of pain. So, um, we're saying before
(33:44):
we started talking about in Nola Holmes and horror movies,
that there's like a lot of different things that will
influence an individual's experience of pain. Um. And it has
to do with not just you biologically, but weirdly also
you sociologic le too. Yeah, and this first one um
age is to me a little counterintuitive. Um. In some ways,
(34:08):
your you know, as you age, your brain circuitry is
gonna it's just gonna degenerate a little bit. That's just
that's sad fact of the matter. And if you are
one of our seniors, and if you're a senior that's listening. Hello,
got an email from a lovely eight year old lady
the other day that just warmed my heart. Oh yes,
(34:28):
she was great. She was great. So, um, if you
are one of our senior listeners and you, um, you
might have a lower pain threshold and more problems dealing
with pain. Um. This seemed a little counterintuitive because I
could also see a case where, uh, the neurons don't
fire in the correct way, such that you could be
feeling something painful and not really realize it. So the
(34:51):
way I took it was a little different that it
was almost like you know how when you form a
habit or a memory or something, it's because the neural
connection has gone over again and again. So like that
pathways is kind of blazed a little more clearly. My
interpretation was that the same can be true with pain,
to where once you fire a few times are over
and over again, it becomes easier to conduct that pain
(35:13):
signal more efficiently, and so that would account for sensitization.
That's how I took it. You know, hey, I'm no
vs rama sham drawn. Uh. There's also gender, and because
we're talking about medical research, they are basically still saying
men and women, and they're not doing research along the
gender spectrum. So having said that, research shows that women
(35:37):
have a higher sensitivity to pain than men. Uh, could
be maybe physic psychosocial stuff at work, because you know,
men are supposed to not show their pain or not
report pain or just suck it up. Dude. Uh, there
could be that at work. It also could be sex
linked genetic traits or hormonal changes that might change that
(35:58):
pain perception, right, or even the culture you're raised in,
like um women in Uganda, I read are expected to
be stoic in the face of pain. Um, whereas men
in Ukraine are expected to not h experience pain at
all or show any kind of pain whatsoever. Um. So
like the idea that culture can affect your interpretation or
(36:18):
how you experience pain is kind of weird if you
think about it. It's also weird because I know many
many women who would say, are you kidding me? My
husband is the biggest whiny baby every time he gets sick. Uh,
And I generally suck it up as the wife, So
you gandon and so you gandon. There's also memory, like
if you've experienced pain before, your memory of going through
that pain can impact how you experience it a follow
(36:41):
up time too. Yeah, and for both ways. Like I
used to be really, really really scared of needles, and
I think that was because I went a long time
without getting shots. Um. I think when you know, when
I was younger and in college, like I wasn't giving
blood like I should, and I wasn't getting flu shot
it's like I should. But now that I'm a real
(37:02):
sentient adult and responsible adult, I have needles in me
all the time, and it's I'm not They don't really
hurt that bad anymore. So when I go back I
get that initial fear of the needle because I've always
had it, But then my brain tells me, hey, Chuck,
it's not that bad, remember do you just just suck
it up and get the shot. My my sister in
law is like a genuine shout no and run out
(37:26):
of the room, like, yeah, needle Phobe, that's a great
band name. Oh my god, that's the best band name
in years, Chuck. What kind of band is that? Uh?
Needle Phobe is clearly some sort of metal, maybe new
metal if it were going to be ruined. But there's
(37:47):
definitely something, and there may be along the lines of
like Queens Rich or something. Yeah, I could see that,
or maybe even like horror metal. Oh yeah, like that
Norwegian stuff. Sure, Okay, so it's about to get weirder, Chuck.
So you're talking about needles. If you look at a
needle injected into your arm, it hurts more than if
(38:09):
you're not looking. Even if you're thinking about the needle
injecting into your arm being injected in your arm, just
not looking at it makes it hurt less, studies have shown,
which is weird, but in a sense it also makes
sense because you're being provided with additional information about that
through your eyes, so your brain has more information than
(38:29):
it otherwise would have, which can actually make it hurt more. Yeah,
and I know I've mentioned this, I still gotta look. Um.
I used to request a mirror to look at dental
work as it was going on. I don't do that anymore.
I try and just check out, but I always have
to look at the needle. There's no way. Yeah. Same here,
I'm like, do it slower. You're not a needle fobe,
(38:50):
You're a needle uh whatever. The opposite is file a
needle file. Um. So. And then there's emotions too, and
not just you know, like you were saying earlier, there's something.
There's a different thing psychic pain. Where you are your
emotions are so overwrought that you actually feel physically uncomfortable
or hurt from it. That's different. Your emotions can actually
(39:13):
affect physical pain as well. Yeah, and back when we
were trying to understand and we're still trying to understand this,
but um, why emotions and stuff might influence pain. In
the sixties, of course, when all this kind of cool
research was going on, there were a couple of dudes
named Ronald mel Zack and Patrick Wall, who threw up
(39:35):
a proposal about a gating mechanism existing among the connections
in the body sensory pathways that can help determine how
you're gonna feel pain and how that works with the brain. Yeah,
because so there's the ascending painful pathways and then the
descending let's all just mellow out pathways. And I don't
(39:55):
know if we knew that before um Melzack and Wall,
or if we know it as a result to them,
But the current general understanding of pain is this gate
control theory, where this there's stimulation of these pathways going
up to the brain and they have to be of
like a certain amount to overcome an inhibitory neuron. And
(40:19):
so if you I just like press you know, my arm,
I'm sending somato sensory information through those same pain pathways,
but that the inhibitory neuron that keeps those the pain
projector neurons from firing, are not overcome. But if I,
if I, you know, took a butcher knife and cut
(40:40):
that same part of my arm, they would be overcome.
The inhibitory neuron would basically be turned off by the
signal the intensity of the signal, and that projector neuron
would fire, and now our brains would have that pain signal, saying,
in that case, the gate is fully open for business.
And when otherwise, when there's no pain, no no sensory information,
(41:02):
the gates closed, or if it's just normal somatosensory information,
the gates still closed. It's just when it's that that
intensity of the pain information that the gate flies open. Yeah,
and this is interesting because it doesn't explain everything, but
it does explain like when you um, like if you
smash your thumb with a hammer, and your reaction is
(41:23):
to go and shake your hand really hard or too
or to suck on it. Maybe if you smash your
finger with a hammer. It seems like a weird thing
to do. I know it is, but it works. It does.
That stimulates your normal somatosensory input to those projector neurons,
and that's going to help override the projection neurons that
uh and you know, basically kind of close that gate down. Okay,
(41:45):
So now that you understand the gate theory of pain,
and this is the general understanding among Western science medicine
of pain. This is pretty much the common knowledge. Now
you can understand how it can go wrong, and so
they think that this also explain how the how you
can experience psychogenic pain where people have fibro mayalgia or
(42:06):
chronic pelvic pain, or tenitis or t mj or um
chronic back pain when there's no reason whatsoever for them
to experience this. The Um the really great author in
Surgeon a Tool go on Day, I believe he rights
for The New Yorker. He's also he writes some books
as well. He's one of one of the best writers
(42:26):
out there right now, and he's also a very accomplished surgeon.
And he he likens that situation to a faulty car sensor,
where if you have a sensor on your dashboard coming
on saying like, hey you got an engine problem, and
you go to the mechanic and the mechanics like you
don't have an engine problem. Eventually they're going to figure
out that the problems with the sensor itself, and they
(42:46):
think that this is because of this gate being opened.
The sensor um is open, even though there's nothing tripping it. Um,
that that is the problem, that that is what it
counts for psychogenic pain. Very interesting and it's gonna make sense, Yeah, definitely.
So when it comes to managing pain. Uh, there are
a bunch of different routes you can go, UM, depending
(43:09):
on what your doctor might recommend, depending on what you
as a human, UM, what what road you want to
go down? Uh, and these very uh and we'll you know,
we'll get into these, but these very from like over
the counter medications to prescription medications to surgery, to go
into a massage therapist or a uh an acupuncture specialist, acupuncturist.
(43:33):
But as far as the medications go, you've got a
couple of different kinds. UM. You've got your non opioid
analgesic like this is a tail in all or in
a lever or an advil or something like that, and
it's going to act at the side of the pain. UM.
When you have that damaged tissue, it releases enzymes that
stimulate the pain receptors locally. And what these do is
(43:55):
they interfere with those enzymes are going to reduce inflammation
and hopefully reduce pain. Yeah, which is really interesting because
that is your mind saying this pain is not nothing
that my brain needs to worry about. I'm going to
actually go to the site and cancel out those those
pain signals where they're beginning, because I'm judging that they're
(44:16):
not that important. Pretty cool, Yeah, it is cool, but
these can have effects on the liver and kidneys if
you use them a lot. So you know, you don't
want to, uh, you don't want to pop an advil
every day if you have like back pain, that kind
of thing. Um. And then there's opioids which, um they
actually go to the gate um and they can close
(44:38):
the gate on the one hand, and then they can
also go to your brain and um excite in the
descending pathways which will bind with like opioid receptors. And
of course those are hugely addictive and have a huge
um possibility of of overdose as well, but they do
(44:59):
help treat pain a lot. Yeah, we should do one
of opioids and the opioid epidemic. It's I agree. It's
been one of the darker spots of the new era. Yes,
the new era, I don't even know the last ten
or fifteen years. That's what I call that. A new era.
The modern era is what I meant. Uh, what else
(45:21):
do we have there? Um, you can actually use medicines
that aren't meant for treating pain to treat pain, like
anti epileptic drugs, brand stuff, antidepressants, anesthetics. They all do
things like they block can like nerve conduction in some
specific area, and so they weren't Yeah, they weren't meant
to be treated for or used for pain, but they
(45:42):
actually can come in handy for things like chronic pain
or neuropathic pain. Yeah. You can also have surgery is
a kind of a last resort um if you have
severe I've not had a couple of friends, actually you
have had back surgery where let's say you have a
herniated disk and that thing is compressing on a nerve.
As a last resort, they can go in there and
(46:03):
maybe remove a little bit of that disk that's hitting
that nerve and relieve that pressure. Yeah, and from what
I've seen, yes, that is meant to be a last resort.
There's also like cord ectomies where they go in and
say we're just gonna snip that gate so that it
just doesn't function at all anymore and make you a
super soldier. And then there's also alternative therapies and mental
control techniques and these work of varying degrees um. One
(46:26):
of my favorite alternative therapies. Is the TENS unit transcutaneous
electrical nerve stimulation and it sends electrical impulses from the
site of pain to base. It's basically like a defibrillator
for your pain gate. It's saying your pain gate is
is it's open, and it shouldn't be open. So we're
gonna We're gonna send some nerve stimulation and the hopes
(46:48):
that we can restart that inhibitory neuron and get it
closing that pain gate, or and or we can make
it all the way up to the brain and get
the brains descending pathways kick started as well. Is that
like when uh, like I had a back thing about
five years ago where they gave me this electro stimulator
thing that I put these little pads on the and
(47:09):
there's like a little handheld thing about the size of
a game boy that was connected to uh, not mine,
but I'm sure they're all different kinds. But you could
basically level the amount of sort of low level shock
and uh when you turn that thing all the way up, man,
it was it was pretty intense. Yeah, that's a TENS unit,
And as a matter of fact, that's based on some
really ancient thinking Apparently the pre Dynastic Egyptians from like
(47:31):
five thousand years ago used electric catfish from the Nile
for the same effect and impact. It's pretty amazing. Yeah. Uh.
And then you know we mentioned going to the chiropractor,
massage therapist. Um. Obviously they're hot compresses and cold compresses.
There's acupuncture, Um, there is you know, relaxation and hypnosis.
(47:53):
And we've already talked about distraction. If you want to
know what you think about hypnosis, we did a pretty
good episode on it a while back. Um. So, yeah,
they are all sorts of mental ways because they've shown
that that oh I'm blanking out what do you call
the drugs that aren't real drugs? What are the sugar bills? Placebos? Yeah,
(48:15):
that that placebos have been shown to work sometimes with
with limiting pain. Yeah yeah, And I mean you can
trick the brain for sure into not feeling pain. Like
Phantom limb treatment usually or sometimes involves a mirror where
you put a mirror over the amputated limb that's experienced pain,
and you move the other limb while you're looking in
the mirror, so it looks like you're amputated limb is
(48:35):
back and you're tricking your brain into being like, Okay,
it's there, it's fine, I don't have to experience pain anymore.
And it actually works. Yeah, but there's there's a you know,
there's a threshold there, like you can mind over matter
it to a certain degree. But um, as you say
in the article, like your mind and your brain are
two different things, so like you can't shut down that
(48:57):
gateway just by thinking it away. No, And there's a
real like push to to believe that over the last
few decades. But it's just it's becoming clear you can
impact it to some degree, but just not to to
a full degree. Yeah, And I think the mind over
matter is a person like the pain doesn't go away.
You're just able to mentally overcome it such that you're
(49:18):
not gonna either show it or let it get to
you or let it affect you. Right, you have actually
a lower stress response, and at the same time it
also cuts down on suffering, which is different from the
experience of pain. It's like associated with pain, and that's
like like that whole y Me thing and that seems
to be fixated on anticipating more pain in the immediate future.
(49:40):
And people who are mindful and meditate can actually cut
down and alleviate that suffering. So they experience pain, but
it goes away a lot faster in their response to
it is it nearly is pronounced, so it does have
an effect. You know, Chuck, this is a good one
man pain pain in the house. And if you want
to know more about pain, well, I'm not even going
(50:00):
to suggest what you can do. How about you just
go read up on it a little more. Uh. And
since I said that it's time for a listener meal,
I'm just gonna call this the Las Vegas Beavers. I
just got done listening to the Beaver podcast, which, by
the way, we got a lot of response on that one.
People love their beavers, especially baby beavers. Oh yeah, they're
(50:23):
the best. I just wanted to give you a fun
little tidbit of information. Chuck said that you can't find
or that you can find beavers almost everywhere except the desert,
which is somewhat true. Uh, they can't live out in
the open amongst the cacti. But the sizeable population of
beavers in Las Vegas is testament to their ability to
survive the heat. They're about eighty to one beavers living
(50:46):
in the Clark County, Wetlands, just just about twenty to
thirty minutes from the strip. It was a shock when
I first heard of this, but have since taken several
trips to see them. Thanks for all the work, enjoy
the show. That's from Josh. Very short and sweet us
from Josh uh Eretics. That's a great great first name,
great last name, Josh, and I love how that email
(51:07):
just kind of petered out at the end there, so
we're gonna we're His new name is Josh Peter Eretics. Okay, great.
Thanks for the email, JP, And if you want to
be like JP and send us an email, you can
do so. Wrap it up, spank it on the bottom,
and send it off to Stuff podcast at iHeart radio
dot com. Stuff you Should Know is a production of
(51:30):
iHeart Radios How Stuff Works. For more podcasts for my
heart Radio, visit the iHeart Radio app. Apple podcasts are
wherever you listen to your favorite shows.
Welcome to Stuff You Should Know, a production of five
Heart Radios How Stuff Works. Hey, and welcome to the podcast.
I'm Josh Clark. There's Charles W. Chuck Bryan over there,
and Jerry's out there running around somewhere. We just gave
her a hot foot. It's hilarious. Uh, and this is
(00:22):
stuff you should not tried. Are continuing exploration of pain? Mhm.
What else have we talked about with paint? We did
one on the pain scales, okay a couple of years ago,
and uh, then we did one on something about perceiving pain. Well,
this one, this one, this is just totally stuff you
(00:43):
should know them because we did a bunch of like
more niche stuff and now we're going back and doing
like the umbrella topic and we're talking about pain, which, Um,
is there a super ancient old evolutionary Um, right, I
guess that's shared basically throughout all living things. I would
(01:05):
say it's a pretty fair guess. I think so, Yeah,
because um, there's something that pain pain specifically, which is this.
We'll get into defining it and how hard that is
in a second, but um, it seems to be a
a fairly universal, almost universal process where our body says, hey,
there's something really bad going on, say on your hand,
(01:28):
So move your hand away from wherever it is in
space right now, and hopefully that will help keep it
from getting further damage. Like pain is a signal saying, um,
do something, dummy, move and it's it. I mean, that's
that's you know, you see it in and basically any
animal we've ever encountered, including the beaver and the porcupine.
(01:49):
That's right. And by the way, we did other people
who can't feel pain ten years ago. Yeah, it actually
seems longer ago than that. That's funny because I thought
pain Scales was forever ago and it was so Yeah,
I have no sense of time anymore. So, so we
are talking about pain, Chuck, you feel pain right or
do you have a high pain threshold? Are you sensitive? Uh? Well,
(02:11):
you know it's funny because I went back and listen
to the Pain Scales and I kind of chatted about
that for a bit. But I have a pretty high
pain threshold. Yeah, okay, I would say mine's average. Let's
just go with that. I wonder what I said in
the Pain Scales app because there's no way I didn't
respond to your your thing you know it will be
(02:33):
a mystery. So um. Apparently pain is the most common
reason that people, um go seek medical attention. But when
they go seek medical attention, as we talked about in
the pain Scales episode, the whole reason there is such
a thing as a pain scale is because it's a
fully subjective experience and it's really difficult to describe. And
(02:55):
it's taken medicine, like many, many years to get to
a point where they tell the people their training, doctors
and nurse practitioners and medical staff, like, if somebody tells
you they're in pain, they're experiencing pain, you have to
take them at their word. Um. And that's actually kind
of a new development because there are plenty of times
(03:15):
when it appears that there's absolutely nothing wrong and that
the person shouldn't be in pain. And for years doctors
just kind of treated people like like that like kooks
and didn't believe them, which was very sad. And now
we're finally figuring out there's situations where you can be
experiencing pain even though there's no reason for you to
be experiencing pain, which really underscores just how subjective it is.
(03:38):
That's right. Uh. In three, there was an actual definition
for pain that was introduced that has a couple of
really important caveats that will kind of play out through
this episode. Pain is an unpleasant, sensory and emotional experience.
There's the first caveat associated with actual or potential tissue
damage or described in terms of such damage, which is
(04:03):
a big caveat there, because you can walk into a
doctor's office and say, I've got some big time tissue damage. Doc,
I'm experiencing big time pain, and they can look you
over and be like, this guy didn't have any tissue
damage at all. So that's in the actual definition of
pain of pain. So I think that the reason they
caveatted that was for the very simple reason that pain
(04:28):
can be emotional. And I don't mean like real emotional pain.
I mean a physical pain that is may be made
worse by emotion or brought on by emotion, or that
you're you know, you really don't have a pain, like
you've got a chronic pain, let's say, but nothing's going
on under the hood to cause it. Yeah, And like
(04:48):
we've learned so much about pain since nineteen seventy three
that I saw that just this past July, um the
International Association for the Study of Pain updated and revised
their their definition. It's still basically the same, but they've
included a lot of stuff that we talk we're going
to talk about in this episode. Does it say pain
whatever you say, dude, right yea, they said pain is uh, yeah,
(05:14):
it is so far at least. Um. There's a bunch
of different types of pain, though actually not that many,
but there's a few. Acute pain, which is very short lasting.
If you if you put your finger on the burner
of the stove or something like that, or um, slam
it in a window, that's going to be an acute
pain where you know it's really helpful, so you know
(05:38):
your body is gonna say, wait a minute, that's super hot.
Or by the way, dummy, you just put your finger
in a window and you immediately have a reaction to
stop that immediate acute thing from happening, even though the
pain is gonna still be there. It's not like you
slam your finger in the window, yank your thing away
and shake it a little bit and it's gone. Right. Well,
it can be depending on the level of pain, but
(05:59):
it makes sense that it would still linger even in
acute paint, which from what I can tell, is like
the ideal version of pain. It's, like you said, it
makes you stop doing whatever you're doing, but the fact
that it still hangs around for another minute, it's almost
like it's teaching you a lesson, like not only stop
doing that, don't do that again. Yeah, and there's some
overlap in these, by the way, So when we talk
(06:20):
about the next one, no susceptive pain, this comes about
from tissue damage, like real tissue damaged by like physical
or a chemical agent. We're talking a chemical burn, or
a trauma or a surgery. This can also include slamming
that finger in the window. It can also include you
worked out really hard the day before and you're really
(06:40):
sore the next day. Yeah, as long as there's some
sort of like mechanical reason or some sort of damage
to tissue, or even temporary damage like a sore sore muscle.
Um And it also includes malignant pain, which is cancer pain,
which is where tumor starts growing in your tissue, impresses
on nerves and blood vessels and create pain like that.
(07:01):
And no, no susceptive pain is what most people think
of when they think about pain. Um And it can
be both acute and chronic. But I guess the best
way to kind of differentiate no susceptive pain from the
rest of it, there's actually something going on that is
causing the pain signal to be created. Um And it,
like I said, it can be short lasting or long lasting. Um.
(07:24):
And it's different from a different type of pain, appropriately
enough called neuropathic pain. Whereas no susceptive arise from arises
from tissue damage, neuropathic arises from damage to the actual
nerves themselves. Yeah. Like, uh, I don't know if you
remember this story from almost a year ago. It was
last October when I hit my shin on my bed
(07:48):
so hard that water started leaking out of my eyes.
I wasn't crying, it was just literally water coming out
of my eyes. And I've never felt pain like that before.
And it was clearly some kind of literal nerve damage
because for three or four months, I had like a
three uh three inch by three inch square on my
(08:10):
shin that was completely numb. And uh, it's it's the
worst pain, like physical pain I've ever felt in my life.
They I mean, that would definitely qualifies neuropathic pain. You
clearly messed up the nerves in that little area. UM,
and you're lucky that it only lasted three months, because
apparently neuropathic pain, which can include everything from hitting your
shin to banging your funny bone, your elbow UM two
(08:33):
things like sciatica or even multiple sclerosis. Anytime the neurons
in your nerve fibers are are damaged. UM, that's neuropathic pain,
and it can last. It can very easily translate from
acute pain over to chronic pain, which is pain that
last six months or longer um, which can itself be
no susceptive or neuropathic. Uh. It can also, unfortunately be psychogenic.
(08:57):
Chronic pain can be, which is where you have lasting, uh,
sustained pain over six months or longer um for no
good reason whatsoever. Yeah, and this is you know, it
gets really sort of murky and confusing. Here. We are
not saying that chronic pain is all in your head,
but we're saying that in some cases that there there
(09:20):
is no reason behind you continuing to feel chronic pain.
But so many people suffer from chronic pain. I think
roughly it kind of varies, you know, depending on the year.
But somewhere in the neighborhood of twenty adult Americans suffer
chronic pain every single year. Um, And it's when you
(09:41):
hear people talk about that, like, uh, I just feel
bad for him. I can't imagine what it's like to
walk around in constant pain, and it's probably even more
frustrating when a doctor can't trace it to a thing like, hey,
we fixed that. It shouldn't be hurting anymore, right, especially
if they're being patronizing and treating you like your cook, Well,
that's a bad doctor. You should not go. Sure, But again,
(10:04):
I mean, like I feel like people with fibromyalgia or
chronic fatigue. I don't know if you experience pain with
chronic fatigue, but have long been treated like their nuts,
like it's all in their heads, just because you know,
science has not been able to identify exactly what the
deal is. Yeah, I would say, if your doctor is
like that, go to a doctor with a little better
bedside manner. At least they might be saying the same thing.
(10:26):
But they would should treat you with respect. And if
if they're wearing oversized clown shoes, so much the better.
That's usually it did give way for a great doctor,
that's right. Um, I don't think we said that, uh,
we we talked about no susceptive pain, but no susception
is taken from the Latin word for hurt, and um
(10:48):
pain is its own thing like pain perception. We're talking
about what's going on with the central nervous system, uh
the peripheral central nervous system as well, and how it
processes this information is really uh interesting and still cloudy
because the brain is involved. And we've done dozens and
(11:09):
dozens of podcasts that involved the brain, and at some
point during all of them we usually say something like,
this is kind of their best guess right now, because
the brain is still such a mystery. Yeah, we have
made like advances by leaps and bounds since the sixties
when we kind of started to change our understanding of
pain and definitely refining it. But one of the things
we figured out is that no susception itself is separate
(11:33):
from the experience of pain. It's like the body giving
the brain information about something that's going on with your
body right now, but it's not pain itself. Pain is
the brain responding to that information, and so no susception,
as we'll see, is kind of this process where your
(11:53):
body um detects some sort of noxious stimuli UH, and
the no susceptors your specific kind of UM little sense
receptors that are tuned to pain. As we'll talk about UM.
They send a signal to your brain saying, hey, there's
something going on here, and then in your brain, your
your brain starts sort through the whole thing and decides
how to respond. So no susception and pain they're very
(12:15):
much intertwined, but they're definitely different things, and we've actually
seen that one can exist without the other. Yeah, I
mean they've done studies that UM and I. I mean
we had to have talked about this and other people
that can't feel pain UM congenital analgesia. I don't remember
ever saying those words before. I think we had to
have There's no way, although knowing us, it's possible we
(12:40):
walked around that one. Well maybe so. But there are studies,
including ones on that people who can't feel pain, that
have shown that no susception can occur without the experience
of pain, and UM pain can be experienced with the
absence of no susception. So it's sort of a two
way street. Yeah, that's like that psychogenic pain where you
there's no reason for you to be feeling that pain
(13:02):
right then, right, yeah, And because it's the brain, it's
um and you put in here it's like it sounds funny,
but your brain is what's feeling the pain. Like when
you smash that hand in a window. Um, you might
think that your hand feeling the pain, but technically it's
your brain, if that makes sense. Yeah, or even that
like you're you're that hand that window smashing your hand
(13:26):
set off a specific unique kind of um uh signal
that that transmits a pain signal directly your brain. Your
brain experiences the pain. That's just not quite right. That's
actually Renee des cartes interpretation of it, and can so well.
Considering he was working in the first half of the
sixteen hundreds, he wasn't that far off the mark, especially
(13:49):
considering that before him the Greeks had thought up basically
up to day car, everyone had thought, starting with the Greeks,
that pain was like a spirit intrusion, it was like
something external at all. And in fact, our word pain
comes from uh pena like subpoena, which means penalty. So
this like pain was considered a punishment from the gods
(14:11):
um And Dave Carr was like, no, I think this
is an internal process, and he had like the broad
strokes of it. It's just that he didn't have the
details that we have now today. Yeah, he kind of
got well he got one half of it pretty right. Um,
but I mentioned it was a two way street. It's
a two way street in a lot of ways. Because
what we've learned since decart is that we do have
(14:33):
pain signals that go up from nerves in the body
to the brain to say hey, I'm hurt. Those are
called ascending signals. But then we also have another signal
going I'm just gonna call it downstream for lack of
a better term, descending signals that come from the brain
that can kind of mute the pain or turn off
the pain signals. And that's you know, as we'll see
(14:56):
later when it comes to medication and stuff. It's sort
of managing that way, like whatever traffic light is on
that two way street. Yeah, well that was like a
huge thing, Chuck, like to figure out that. Wait a minute, Like,
first of all, the experience of pain is totally in
the in the brain. Right, your hand itself isn't actually hurting.
Your brain is hurt is what hurts. It just feels
(15:17):
like it's coming from your hand. And then secondly, the
idea that your brain can influence this the experience of pain,
that was just revolutionary. And so as a result, we've
come to kind of see pain as the brain. There's
a neuroscentist name vs. Rama Shan Droton who's just brilliant
and he um, he said that pain. This is paraphrasing him.
(15:40):
He said that pain is the brain's opinion of the
current state of your health. You got no pain, It's
all good. You've got pain. Your brain is interpreting there's
something wrong with like your hand or your leg, or
your guts or something like that. And it's just an opinion.
And the opinion can be gotten wrong too. Well, you
know what they say about opinions. Yeah, everybody's got an
(16:02):
elbow of them. All right, I think we should take
a break and we're gonna come back and dive into
some hard science right after this. Alrighty, so your brain
(16:38):
has an opinion about the current state of your health. Um,
we're still at the stage where we're sort of testing
out how pain is generated and how we experience it.
But what we kind of think right now is what
we mentioned a little bit earlier is that some of
the sense receptors located on the nerve endings are really
(16:58):
finely tuned two different kinds of UM, different kinds of pain,
but really tuned to different kinds of thing that might
cause pain, like a hot stove or a needle going
to your arm. Yeah. And you can pretty much divide
them into three categories. Mechanical which is pulling, stretching, tearing, cutting, chemical,
which say like exposure to acid or something, and then
(17:21):
thermal like like heat or cold. Um. And the idea
that these no susceptors are capable of being triggered by
exposure to those kind of stimuli from the external world,
that that is what kicks off the no susception process. Yeah.
And they, uh, they're all very different and they have
(17:42):
different ways of communicating with the brain. Um. There are
some that do things really really fast. Uh. These U
there are some called a fibers. They have a little
it's kind of like a little express train instead of
having to make stops along the way, has a fatty
mile in sheath that's going to insulate the electro conduction
(18:04):
basically on the wire and it really just zaps it.
They're really really fast not a lot of information losses
going on. And that's like that first really intense pain
you feel when you burn your hand or when you
slam it into the window. Is that's kind of what's
going on with the A fibers, right, And then you've
got sea fibers, which aren't insulated and they are slower conducting,
(18:28):
but they also have a bunch of they recruit a
bunch of them to conduct signals from different parts of
different areas um to the brain to say, hey, this
is this is actually pretty pretty problematic. We got a
real thing going on here. And they account for the
follow up like usually burning, throbbing kind of sensation that
(18:48):
can be followed by that first like bolt of pain
that the A fibers deliver, and then that's from the
actual like like uh no susceptors. There's other stuff that
spens to like if you cut open your hand, those
damage cells you know, spill their guts and so like
potassium and glutamate and substance peace starch start like change
(19:10):
start firing off, like other neurons in the area um
you might have an inflammatory response, so things like histamine
show up and they start setting off other nerve fibers too,
So it's more than just the you know, the cut hand. No,
susceptor is telling the brain that something's happening. Like a
whole bunch of different responses from the area are going
(19:32):
to arrive at the brain and produce this really complex,
rich message saying here's generally what's going on, and here's
how bad it is. You ever had a bad burn? Yes, man,
that's the worst. They are pretty bad. I don't even
remember what happened, but um, I definitely have burned myself
pretty bad. You may has this same spot on her
(19:54):
hand that she gets in like the confection of it.
Like basically every time it heals, she just re upset again.
She's always got this little little thing on like I
think it's her pinky knuckle on her right hand, and
she always like hits the same spot on the yep.
Oh man, every time you get that lady a glove
a hot myth. Yeah, I think by now it's just
so callous that she is dead. She fights sailors with
(20:17):
it these days. Yeah, those burns really linger. And that's
like every time I hear someone or see somebody that
has has you know, had been in a fire and
had really really bad burns over a lot of their body.
I just I can't imagine the lingering pain that they
go through. I know we've talked about this on some
episode before, but uh, just those burns that it seems
(20:38):
like they hurt forever. Yeah, I mean, you've got exposed
nerves fibers to just the air, which you know, as
we'll also see, when you undergo a particularly brilliant experience
of acute pain, it can be so thorough and it's
energizing of your nerves that they actually become sense of tized,
(21:01):
so like they become more sensitive than they would have
before that, which is actually also a problem with with
chronic pain too. But if you if you experience burns
like that deep over all of your body, not only
are you going through the normal pain, you're probably more
sensitive now to normal stuff like air blowing on your
exposed nerves than you wouldn't otherwise, and that just makes
(21:23):
it that much worse. Yeah. And then some things that
you might think really hurt don't hurt. Um, like cuts,
I've had cuts before that don't hurt. They might freak
you out, uh to look at it and to see,
you know, like your skin exposed and some people are
really freaked out by the blood. Um, I've had other
people I know I've never broken bones that have had
some pretty gnarly injuries like that. That said, it didn't
(21:45):
really hurt that much. Yeah, they're walking around like a skeleton.
You hang on the door with their arms just flopping
back and forth. It's really interesting how it all works.
But it really underscores, you know, how the brain can
get its opinion um of what's wrong with the body
based on the pain information wrong sometimes a lot of times,
like think about a hangnail. Hangnail is no threat whatsoever
(22:06):
to your survival, but those things hurt. Or a paper cut.
No one's going to die from a paper cut, but
it really really hurts too. Um. It can be overblown,
it can be underblown, but it really goes to show
like it's the brain taking all this different information together
and saying, here's how bad I think this is. Yeah,
it's pretty cool and painful. Uh. So let's say you
(22:28):
get hurt. Let's say you you slam your your hand
in the window like I was talking about, which I
think has happened. I don't know why I keep going
to that got your worst fear. I don't know, it's
I don't I don't think it's better not your worst fear.
That is not that bad. That'd be hard. It's a
lot easier to shut your hand in a car door
than a window. But O, man, that hurts either way. Yeah, man,
I had a knock wood. That hasn't happened to me
(22:49):
in a long time. Yeah. Every time my daughter shuts
the door, which I tried to let her do whatever
she can on her own, I'm always just like, don't
do it. Do you put ovenmits her hands first? No? No,
nanny stayed at our house. Uh. So you you get
hurt on your hand, Let's say, Um, the signal that
is gonna travel it travels through the into the gray
(23:11):
matter of your spinal cord, and there are gonna be
a lot of different connections made with the spinal neurons there,
and it's going to cover a broad area of the body,
which is why sometimes if you get hurt, um, especially
if it's like an internal injury, you don't know exactly
where the pain's coming from. You might tell your doctor
you just might rub around your whole torso when in
(23:31):
fact what's actually hurt is a fairly small area. Yeah,
or it could be like a completely different part of
your your body or kind of near. It's called referred pain,
like if you're having a heart attack, usually feel pain
in your arm. Yeah. If you have brain freeze, that's
your blood vessels on the roof of your mouth expanding
because they're cold. But you feel it unlike your forehead
(23:52):
really terribly, which doesn't make any sense. So yeah, I
think that's from those the nerve or the sea fiber
information where it makes it tough to also figure out
where it's coming from. Have you ever been to a cardiologist? No,
I'm going I'm going to one this week. Man. I
had I've known two people in the past like a
(24:12):
month that have dropped dead that are like my age.
What uh. One friend of mine from college had been
experiencing chess pains and he went to drove drove himself
to the hospital like collapse and died on the way
into the hospital. Just terrible. And I haven't been out
of touch since college, but it really hit me hard
to where I was like, you know what, I I
(24:34):
want to go, like just see what's going on in
there and get some preventative or not. Preventative, but just
some proactive tests done. Uh, you know where they see
how your arteries are doing. Because I've got cholesterol issues
because of my my family history and stuff, and I
wanted to be one of those things where they're like, oh, well,
it turns out that you know you were clogged this
(24:56):
whole time. So I don't I don't care what they say.
I'm going to demand those tests. Yeah. I think you
probably will have to pay for them out of pocket,
but that's not the end of the world. If, like
you have, you have concerns about it, no want of
genuine concerns, cardiologists might actually go ahead and prescribe it anyway. Well,
I don't have concerns in that I have chest pains
or anything, but but if you have a family history,
(25:19):
they may. Yeah, I just I want to know what's
going on. I'll I think that's great. And actually it's
funny like you me had suggested we do something like
that too, So maybe we'll see you at the cardiologists office. Well,
I think for women you can go get heart screenings
for women, um, very easily. Uh. And I don't know
if it's because I thought it was for both and
I talked to the lady on the phone. She said, O,
and then that's only for women. And I guess that's
(25:41):
because women are less likely to talk to doctors about
their heart because I think it's maybe generally thought of
as something that men experience more. Yeah, I guess now
that you say that, it does seem like more of
a man. So I think they're trying to be proactive
and saying like, hey, women, you need to think about
this stuff too, so we'll offer it's like a hundred
(26:01):
dollar heart screening or something like that. Gosh, is there
anything socialized medicine can't do? So, uh, we were talking
about those first um, those first set of spinal neurons.
Then you have secondary neurons that are going to send
their signals up through the white matter of the spinal cord.
And this is an expressway where all the traffic from
(26:23):
all of these lower segments just just speed up the
spinal cord. Yeah yeah, which is you know, normal for
any kind of sensory information. But um, the pain, the
pain information follows the same super highway and it goes
through your brain stem, your medula, and then it synapses
again onto a third set of neurons. Um in your thalamus,
(26:44):
which is your brain's relay center, and then from there
things start to get kind of market. It goes out
to different parts of the brain, and we'll talk about
pain in the brain in a second, but one thing
that it does it was helpful for me to imagine
pain a pain signal as like a pinball when when
you hit it with the flippers, say that's like you're
you cutting your hand. That pinball goes up and it's
(27:06):
going up to the top of the pinball machine. But
on the way, it goes through all these other things,
like these gates that it flips around three and sixty
degrees a bunch of time. Imagine that it's, you know,
doing that in your in your brain stem, or in
the gray matter of your spinal cord. It's going through
all these different things, and as it does on its
way to that final destination of the brain's somato sensory cortex,
it can have effects on the way to Like if
(27:30):
it's bad enough, it may enter what's called a spinal
reflex loop, where that pain signal doesn't even make it
to the brain before part of it gets redirected back
down to say, your hand to make your hand jerk
away from that hot stove before it even hit your brain.
Literally before your brain even knows that there's pain going on.
You're you have a signal going down to your arm
(27:51):
to say, move that move that hand, dummy. Yeah, because
if you think about burning your hand, the burn, I
mean it's very fast and very fast succession. The actual
burn pain burn happens after you've jerked your hand away. Uh.
And like I said, it's pretty lickety split, but you
jerk that hand away. It's not like you keep it
(28:11):
there and you're like, oh my goodness, I feel pain
on my hand. Oh my lord, it's got fire on it.
I should probably move it eventually. Another thing that can
happen is pain signals can set off your fight or
flight pathways as it's going through the medulla. It's been
a long time since we talked about or fight. Yeah,
it's it's been so long. They added a third one freeze. Ye.
(28:32):
It's like an old friend coming back to visit, but
bringing a new obnoxious friend with it. Yeah. So um,
it could set that off through the medulla. And you
know what happens there is you're gonna your heart rate
is gonna go up. Your blood pressure is gonna shoot up.
You're gonna start sweating if you're me rapid breathing, and
it really can. Um, it really depends on the intensity
(28:54):
of the pain, but it can definitely set off that
fight or flight or I guess freeze. And again, all
this is before it even gets to the brain. And
then finally when I, like I said, when it does
get to the brain, we're not quite sure what happens there.
We know from observations that the brain is definitely involved.
And um, one of the ways that we know this
is because, um, you will move your hands. Sometimes it's
(29:16):
not an immediate reaction, but sometimes it's a little later.
So clearly some of those signals get sent to the
motor cortex to say, Okay, get the hand out of there. Um.
But we also can tell from things like the fact
that if you consciously distract yourself from thinking about the
pain with something else, like do you remember how um,
Edward Norton in Fight Club when he had that lie
(29:38):
on his on the on his hand, he kept trying
to think of like a snow covered like forest or something.
He went to his his happy animal I think was
a penguin. That's right, that's right. He started to try
to concentrate on that and that it didn't work then,
but it could have worked depending on what other kind
of tissue damage was going on. And it really kind
of underscores the fact that if you think about something else,
(30:01):
your pain may decrease. Well, if the brain has nothing
to do with pain or controlling pain, then that wouldn't
happen at all. And so observations like that and some
other ones show us that, Okay, the brain is definitely
involved in this in some way, shape or form, and
pain is not just the reception of um a pain
signal coming from the lower parts of the body up
(30:23):
to the brain. But there's also a reciprocal thing, like
you were saying, where the brain descends um or, there's
descending pathways that the brain uses to say, Okay, alright,
let's just all chill out down there, Okay, let me
figure this out. Everybody, just shut up, shut up. I
can't think when you're all screaming at me. Yeah. And
as those signals are on the way down, there might
(30:43):
be those uh, ascending nerve signals going up right, and
those descending signals could overpower and say hold on, you
stop right there, buddy, I'm trying to calm this person down.
You just you just stay put, right, And so there's um,
there's other things that that we figured out that can
actually influence your experience of pain. Like to say that
(31:06):
it's subjective is just no joke. There's probably no experience
more subjective than the experience of pain. And there's all
these different factors that are involved that will have an
impact on how much or how little pain you experience.
You know. I think improv comedy is the first that's right,
man to see good improv is just it's just so rare,
(31:30):
but it's so good when it is good. Yeah, I mean,
I've seen a handful in my life that just blew
me away, and I've seen a bunch more that. Uh,
it's tough to get through. It's like horror movies, Like
a truly great horror movie is really tough to beat.
But there's a lot of really bad horror movies out there. Yeah,
a lot of good ones these days, Thoughnas what you
(31:53):
got well, I mean in the past five or six years,
I think, uh, it follows and the and Hereditary, and
I think there's been a bunch of new horror masters
So now, this was not a horror movie, but I
want to shout out Um and Nola Holmes on Netflix.
(32:15):
Have you seen it? It's a coming of age movie
about Sherlock Holmes's younger sister. Interesting and it's super cute,
but it's also really smart, like very smart, and it
takes the takes it for granted that the viewers smart
and paying attention. It's a really great, great movie, great movie.
(32:35):
You have to check that out. It's um Millie Bobby
Brown as Nola Homes just about She's about as charming
as they come. She's wonderful. So yeah, not a horror movie,
but definitely worth watching regardless. Is that based on any
uh literature or anything or did they just say, like, hey,
what if he had a little sister. I hadn't thought
about it, but I think it's the ladder of the two,
(32:58):
which makes it all the more amazing because they did
such a great job of capturing that whole um, that
whole world. Very cool. Yeah, where should we take a break? Yeah?
Why not? Let's let's take a break and we'll come
back and talk about a few of the factors that
influence your experience of pain. So, um, we're saying before
(33:44):
we started talking about in Nola Holmes and horror movies,
that there's like a lot of different things that will
influence an individual's experience of pain. Um. And it has
to do with not just you biologically, but weirdly also
you sociologic le too. Yeah, and this first one um
age is to me a little counterintuitive. Um. In some ways,
(34:08):
your you know, as you age, your brain circuitry is
gonna it's just gonna degenerate a little bit. That's just
that's sad fact of the matter. And if you are
one of our seniors, and if you're a senior that's listening. Hello,
got an email from a lovely eight year old lady
the other day that just warmed my heart. Oh yes,
(34:28):
she was great. She was great. So, um, if you
are one of our senior listeners and you, um, you
might have a lower pain threshold and more problems dealing
with pain. Um. This seemed a little counterintuitive because I
could also see a case where, uh, the neurons don't
fire in the correct way, such that you could be
feeling something painful and not really realize it. So the
(34:51):
way I took it was a little different that it
was almost like you know how when you form a
habit or a memory or something, it's because the neural
connection has gone over again and again. So like that
pathways is kind of blazed a little more clearly. My
interpretation was that the same can be true with pain,
to where once you fire a few times are over
and over again, it becomes easier to conduct that pain
(35:13):
signal more efficiently, and so that would account for sensitization.
That's how I took it. You know, hey, I'm no
vs rama sham drawn. Uh. There's also gender, and because
we're talking about medical research, they are basically still saying
men and women, and they're not doing research along the
gender spectrum. So having said that, research shows that women
(35:37):
have a higher sensitivity to pain than men. Uh, could
be maybe physic psychosocial stuff at work, because you know,
men are supposed to not show their pain or not
report pain or just suck it up. Dude. Uh, there
could be that at work. It also could be sex
linked genetic traits or hormonal changes that might change that
(35:58):
pain perception, right, or even the culture you're raised in,
like um women in Uganda, I read are expected to
be stoic in the face of pain. Um, whereas men
in Ukraine are expected to not h experience pain at
all or show any kind of pain whatsoever. Um. So
like the idea that culture can affect your interpretation or
(36:18):
how you experience pain is kind of weird if you
think about it. It's also weird because I know many
many women who would say, are you kidding me? My
husband is the biggest whiny baby every time he gets sick. Uh,
And I generally suck it up as the wife, So
you gandon and so you gandon. There's also memory, like
if you've experienced pain before, your memory of going through
that pain can impact how you experience it a follow
(36:41):
up time too. Yeah, and for both ways. Like I
used to be really, really really scared of needles, and
I think that was because I went a long time
without getting shots. Um. I think when you know, when
I was younger and in college, like I wasn't giving
blood like I should, and I wasn't getting flu shot
it's like I should. But now that I'm a real
(37:02):
sentient adult and responsible adult, I have needles in me
all the time, and it's I'm not They don't really
hurt that bad anymore. So when I go back I
get that initial fear of the needle because I've always
had it, But then my brain tells me, hey, Chuck,
it's not that bad, remember do you just just suck
it up and get the shot. My my sister in
law is like a genuine shout no and run out
(37:26):
of the room, like, yeah, needle Phobe, that's a great
band name. Oh my god, that's the best band name
in years, Chuck. What kind of band is that? Uh?
Needle Phobe is clearly some sort of metal, maybe new
metal if it were going to be ruined. But there's
(37:47):
definitely something, and there may be along the lines of
like Queens Rich or something. Yeah, I could see that,
or maybe even like horror metal. Oh yeah, like that
Norwegian stuff. Sure, Okay, so it's about to get weirder, Chuck.
So you're talking about needles. If you look at a
needle injected into your arm, it hurts more than if
(38:09):
you're not looking. Even if you're thinking about the needle
injecting into your arm being injected in your arm, just
not looking at it makes it hurt less, studies have shown,
which is weird, but in a sense it also makes
sense because you're being provided with additional information about that
through your eyes, so your brain has more information than
(38:29):
it otherwise would have, which can actually make it hurt more. Yeah,
and I know I've mentioned this, I still gotta look. Um.
I used to request a mirror to look at dental
work as it was going on. I don't do that anymore.
I try and just check out, but I always have
to look at the needle. There's no way. Yeah. Same here,
I'm like, do it slower. You're not a needle fobe,
(38:50):
You're a needle uh whatever. The opposite is file a
needle file. Um. So. And then there's emotions too, and
not just you know, like you were saying earlier, there's something.
There's a different thing psychic pain. Where you are your
emotions are so overwrought that you actually feel physically uncomfortable
or hurt from it. That's different. Your emotions can actually
(39:13):
affect physical pain as well. Yeah, and back when we
were trying to understand and we're still trying to understand this,
but um, why emotions and stuff might influence pain. In
the sixties, of course, when all this kind of cool
research was going on, there were a couple of dudes
named Ronald mel Zack and Patrick Wall, who threw up
(39:35):
a proposal about a gating mechanism existing among the connections
in the body sensory pathways that can help determine how
you're gonna feel pain and how that works with the brain. Yeah,
because so there's the ascending painful pathways and then the
descending let's all just mellow out pathways. And I don't
(39:55):
know if we knew that before um Melzack and Wall,
or if we know it as a result to them,
But the current general understanding of pain is this gate
control theory, where this there's stimulation of these pathways going
up to the brain and they have to be of
like a certain amount to overcome an inhibitory neuron. And
(40:19):
so if you I just like press you know, my arm,
I'm sending somato sensory information through those same pain pathways,
but that the inhibitory neuron that keeps those the pain
projector neurons from firing, are not overcome. But if I,
if I, you know, took a butcher knife and cut
(40:40):
that same part of my arm, they would be overcome.
The inhibitory neuron would basically be turned off by the
signal the intensity of the signal, and that projector neuron
would fire, and now our brains would have that pain signal, saying,
in that case, the gate is fully open for business.
And when otherwise, when there's no pain, no no sensory information,
(41:02):
the gates closed, or if it's just normal somatosensory information,
the gates still closed. It's just when it's that that
intensity of the pain information that the gate flies open. Yeah,
and this is interesting because it doesn't explain everything, but
it does explain like when you um, like if you
smash your thumb with a hammer, and your reaction is
(41:23):
to go and shake your hand really hard or too
or to suck on it. Maybe if you smash your
finger with a hammer. It seems like a weird thing
to do. I know it is, but it works. It does.
That stimulates your normal somatosensory input to those projector neurons,
and that's going to help override the projection neurons that
uh and you know, basically kind of close that gate down. Okay,
(41:45):
So now that you understand the gate theory of pain,
and this is the general understanding among Western science medicine
of pain. This is pretty much the common knowledge. Now
you can understand how it can go wrong, and so
they think that this also explain how the how you
can experience psychogenic pain where people have fibro mayalgia or
(42:06):
chronic pelvic pain, or tenitis or t mj or um
chronic back pain when there's no reason whatsoever for them
to experience this. The Um the really great author in
Surgeon a Tool go on Day, I believe he rights
for The New Yorker. He's also he writes some books
as well. He's one of one of the best writers
(42:26):
out there right now, and he's also a very accomplished surgeon.
And he he likens that situation to a faulty car sensor,
where if you have a sensor on your dashboard coming
on saying like, hey you got an engine problem, and
you go to the mechanic and the mechanics like you
don't have an engine problem. Eventually they're going to figure
out that the problems with the sensor itself, and they
(42:46):
think that this is because of this gate being opened.
The sensor um is open, even though there's nothing tripping it. Um,
that that is the problem, that that is what it
counts for psychogenic pain. Very interesting and it's gonna make sense, Yeah, definitely.
So when it comes to managing pain. Uh, there are
a bunch of different routes you can go, UM, depending
(43:09):
on what your doctor might recommend, depending on what you
as a human, UM, what what road you want to
go down? Uh, and these very uh and we'll you know,
we'll get into these, but these very from like over
the counter medications to prescription medications to surgery, to go
into a massage therapist or a uh an acupuncture specialist, acupuncturist.
(43:33):
But as far as the medications go, you've got a
couple of different kinds. UM. You've got your non opioid
analgesic like this is a tail in all or in
a lever or an advil or something like that, and
it's going to act at the side of the pain. UM.
When you have that damaged tissue, it releases enzymes that
stimulate the pain receptors locally. And what these do is
(43:55):
they interfere with those enzymes are going to reduce inflammation
and hopefully reduce pain. Yeah, which is really interesting because
that is your mind saying this pain is not nothing
that my brain needs to worry about. I'm going to
actually go to the site and cancel out those those
pain signals where they're beginning, because I'm judging that they're
(44:16):
not that important. Pretty cool, Yeah, it is cool, but
these can have effects on the liver and kidneys if
you use them a lot. So you know, you don't
want to, uh, you don't want to pop an advil
every day if you have like back pain, that kind
of thing. Um. And then there's opioids which, um they
actually go to the gate um and they can close
(44:38):
the gate on the one hand, and then they can
also go to your brain and um excite in the
descending pathways which will bind with like opioid receptors. And
of course those are hugely addictive and have a huge
um possibility of of overdose as well, but they do
(44:59):
help treat pain a lot. Yeah, we should do one
of opioids and the opioid epidemic. It's I agree. It's
been one of the darker spots of the new era. Yes,
the new era, I don't even know the last ten
or fifteen years. That's what I call that. A new era.
The modern era is what I meant. Uh, what else
(45:21):
do we have there? Um, you can actually use medicines
that aren't meant for treating pain to treat pain, like
anti epileptic drugs, brand stuff, antidepressants, anesthetics. They all do
things like they block can like nerve conduction in some
specific area, and so they weren't Yeah, they weren't meant
to be treated for or used for pain, but they
(45:42):
actually can come in handy for things like chronic pain
or neuropathic pain. Yeah. You can also have surgery is
a kind of a last resort um if you have
severe I've not had a couple of friends, actually you
have had back surgery where let's say you have a
herniated disk and that thing is compressing on a nerve.
As a last resort, they can go in there and
(46:03):
maybe remove a little bit of that disk that's hitting
that nerve and relieve that pressure. Yeah, and from what
I've seen, yes, that is meant to be a last resort.
There's also like cord ectomies where they go in and
say we're just gonna snip that gate so that it
just doesn't function at all anymore and make you a
super soldier. And then there's also alternative therapies and mental
control techniques and these work of varying degrees um. One
(46:26):
of my favorite alternative therapies. Is the TENS unit transcutaneous
electrical nerve stimulation and it sends electrical impulses from the
site of pain to base. It's basically like a defibrillator
for your pain gate. It's saying your pain gate is
is it's open, and it shouldn't be open. So we're
gonna We're gonna send some nerve stimulation and the hopes
(46:48):
that we can restart that inhibitory neuron and get it
closing that pain gate, or and or we can make
it all the way up to the brain and get
the brains descending pathways kick started as well. Is that
like when uh, like I had a back thing about
five years ago where they gave me this electro stimulator
thing that I put these little pads on the and
(47:09):
there's like a little handheld thing about the size of
a game boy that was connected to uh, not mine,
but I'm sure they're all different kinds. But you could
basically level the amount of sort of low level shock
and uh when you turn that thing all the way up, man,
it was it was pretty intense. Yeah, that's a TENS unit,
And as a matter of fact, that's based on some
really ancient thinking Apparently the pre Dynastic Egyptians from like
(47:31):
five thousand years ago used electric catfish from the Nile
for the same effect and impact. It's pretty amazing. Yeah. Uh.
And then you know we mentioned going to the chiropractor,
massage therapist. Um. Obviously they're hot compresses and cold compresses.
There's acupuncture, Um, there is you know, relaxation and hypnosis.
(47:53):
And we've already talked about distraction. If you want to
know what you think about hypnosis, we did a pretty
good episode on it a while back. Um. So, yeah,
they are all sorts of mental ways because they've shown
that that oh I'm blanking out what do you call
the drugs that aren't real drugs? What are the sugar bills? Placebos? Yeah,
(48:15):
that that placebos have been shown to work sometimes with
with limiting pain. Yeah yeah, And I mean you can
trick the brain for sure into not feeling pain. Like
Phantom limb treatment usually or sometimes involves a mirror where
you put a mirror over the amputated limb that's experienced pain,
and you move the other limb while you're looking in
the mirror, so it looks like you're amputated limb is
(48:35):
back and you're tricking your brain into being like, Okay,
it's there, it's fine, I don't have to experience pain anymore.
And it actually works. Yeah, but there's there's a you know,
there's a threshold there, like you can mind over matter
it to a certain degree. But um, as you say
in the article, like your mind and your brain are
two different things, so like you can't shut down that
(48:57):
gateway just by thinking it away. No, And there's a
real like push to to believe that over the last
few decades. But it's just it's becoming clear you can
impact it to some degree, but just not to to
a full degree. Yeah, And I think the mind over
matter is a person like the pain doesn't go away.
You're just able to mentally overcome it such that you're
(49:18):
not gonna either show it or let it get to
you or let it affect you. Right, you have actually
a lower stress response, and at the same time it
also cuts down on suffering, which is different from the
experience of pain. It's like associated with pain, and that's
like like that whole y Me thing and that seems
to be fixated on anticipating more pain in the immediate future.
(49:40):
And people who are mindful and meditate can actually cut
down and alleviate that suffering. So they experience pain, but
it goes away a lot faster in their response to
it is it nearly is pronounced, so it does have
an effect. You know, Chuck, this is a good one
man pain pain in the house. And if you want
to know more about pain, well, I'm not even going
(50:00):
to suggest what you can do. How about you just
go read up on it a little more. Uh. And
since I said that it's time for a listener meal,
I'm just gonna call this the Las Vegas Beavers. I
just got done listening to the Beaver podcast, which, by
the way, we got a lot of response on that one.
People love their beavers, especially baby beavers. Oh yeah, they're
(50:23):
the best. I just wanted to give you a fun
little tidbit of information. Chuck said that you can't find
or that you can find beavers almost everywhere except the desert,
which is somewhat true. Uh, they can't live out in
the open amongst the cacti. But the sizeable population of
beavers in Las Vegas is testament to their ability to
survive the heat. They're about eighty to one beavers living
(50:46):
in the Clark County, Wetlands, just just about twenty to
thirty minutes from the strip. It was a shock when
I first heard of this, but have since taken several
trips to see them. Thanks for all the work, enjoy
the show. That's from Josh. Very short and sweet us
from Josh uh Eretics. That's a great great first name,
great last name, Josh, and I love how that email
(51:07):
just kind of petered out at the end there, so
we're gonna we're His new name is Josh Peter Eretics. Okay, great.
Thanks for the email, JP, And if you want to
be like JP and send us an email, you can
do so. Wrap it up, spank it on the bottom,
and send it off to Stuff podcast at iHeart radio
dot com. Stuff you Should Know is a production of
(51:30):
iHeart Radios How Stuff Works. For more podcasts for my
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