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Welcome to Stuff You Should Know. A production of Radio's HowStuffWorks. Hey, and welcome to the podcast, I'm Josh Clark. There's Charles to be Chuck Brown over there, and Jerry's out there running around somewhere, which gave her a foot. It's hilarious. And this is stuff you shouldn't trade our continuing exploration of pain.

What else have we talked about with pain?

We did one of the pain scales, OK, a couple of years ago, and then we did one on. Something about perceiving pain. Well, this one, this one, this is just totally stuff you 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.

Right. And we're talking about pain, which is a super ancient old evolutionary trait, I guess, that shared basically throughout all living things. I would say it's a pretty fair guess. Is it? I think so, yeah. Because 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 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.

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 do something, dummy move. And it's I mean, that's you know, you see it in basically any animal we've ever encountered, including the beaver and the porcupine.

That's right.

And by the way, we did other people who can't feel pain. Yeah. Ten years ago.

Yeah. It actually seems longer than that.

That's funny because I thought Pain Scales was forever ago and it was twenty seventeen 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.

Well 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, I have a pretty high pain threshold. Yeah, OK.

I would say mine's average. Let's just go with that. I wonder what I said in the paint skills up because there's no way I didn't respond to your your thing. You know, I will be a mystery.

So apparently, pain is the most common reason that people go seek medical attention. But when they go seek medical attention, as we talked about, the pain scales up. So 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 it's taken medicine like many, many years to get to a point where they they tell the people they're 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. And that's actually kind of a new development because there are plenty of times 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 cukes and didn't believe them, which is very sad.

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.

That's right. In 1973, 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 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, and this guy didn't have any tissue damage and.

All right, so that's in the actual definition of pain. So I think the reason they caveated that was for the very simple reason that pain can be emotional. And I don't mean like real emotional pain. I mean a physical pain that is maybe made worse by emotion or broader by emotion. Yeah. Or that you're you know, you really don't have a pain, like you've got a chronic pain, let's say. Yeah, but nothing's going on under the hood to cause it.

Yeah.

And like we've learned so much about pain since 1973 that I saw that just this past July 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? Yeah, that's all good.

And they said pain is 20, 20.

Yeah, it is. So far at least there's a bunch of different types of pain, though. We're actually not that many, but there's a few. Yeah. 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 slam it in a window, that's going to be an acute pain where, you know, it's really helpful. So, you know, your body's going to 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 going to 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 it makes sense that it would still linger even in acute pain, 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 about the next one, nociceptors pain, this comes about from tissue damage, like real tissue damaged by like physical or 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 sort of 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 and also includes malignant pain, which is cancer pain, which is where a tumor starts growing in your tissue and presses on nerves and blood vessels and creates pain like that. Yeah, knows deceptive pain is what most people think of when they think about pain, and it can be both acute and chronic. But I guess the best way to kind of differentiate nociceptors pain from the rest of it is there is actually something going on that is causing the pain signal to be created.

And like I said, it can be short lasting or long lasting. And it's different from a different type of pain. Appropriately enough, called neuropathic pain, whereas no perceptive arrives from arises from tissue damage, neuropathic arises from damage to the actual nerves themselves.

Yeah, like, 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 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'd 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 three inch by three inch square on my shin. That was completely numb. Wow. And it's the worst pain, like physical pain I've ever felt in my life.

I mean, that were definitely qualify as neuropathic pain. You clearly messed up the nerves in that little area. 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 funnybone, your elbow to things like sciatica, even multiple sclerosis, any time the neurons in your nerve fibres are damaged, 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, which can itself be knows deceptive or neuropathic.

It can also, unfortunately, be psychogenic. Chronic pain can be, which is where you have lasting sustained pain over six months or longer 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 is no reason behind you continuing to feel chronic pain. Right. 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 20 to 25 percent of adult Americans suffer chronic pain every single year.

And it's when you hear people talk about that, like 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 fix that. It shouldn't be hurting anymore.

Right. Especially if they're being patronizing and treating you like your kooky. Well, that's the bad doctor. You should not go.

Sure. But again, 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 they're 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, but they would should treat you with respect. Yeah.

If they're wearing oversized clown shoes, so much the better. That's usually a dead giveaway for a great doctor.

That's right. I don't think we said that. We talked about nurses up to pain, but no perception is taken from the Latin word for hurt.

And pain is its own thing, like pain perception. We're talking about what's going on with the central nervous system, the peripheral central nervous system as well. And how it processes this information is really interesting and still cloudy because the brain is involved and we've done dozens and dozens of podcasts that involve 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 60s 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 nose perception itself is separate 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 now it's perception, as we'll see, is kind of this process where your body detects some sort of noxious stimuli in the nociceptors, your specific kind of little sense receptors that are attuned to pain.

As we'll talk about, they send a signal to your brain saying, hey, there's something going on here. And then in your brain, your brain starts to sort through the whole thing and decides how to respond. So no perception and pain, they're very much intertwined, but they're definitely different things that we've actually seen that one can exist without the other.

Yeah, I mean, they've done studies that. And I mean, we had to have talked about this and other people that can't feel pain, right, congenital analgesia. I don't remember ever saying those words before.

I think we had to have sure, there's no way can split it, although knowing us, it's possible we 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 deception can occur without the experience of pain and pain can be experience with the absence of no deception. So it's sort of a two way street.

Yeah, that's like that psychogenic pain where there's no reason for you to be feeling that pain right there.

Right. Yeah. And because it's the brain, it's and you put it 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, 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 that hand, that window smashing your hand, set off a specific, unique kind of signal that that transmits a pain signal directly. Your brain, your brain experiences the pain. That's just not quite right. That's actually Rene Descartes interpretation of it. And what you can say. Well, considering he was working in the first half of the sixteen hundreds, he wasn't that far off the mark, especially considering that before him, the Greeks had thought basically up to Descartes.

Everyone had thought, starting with the Greeks, that pain was like a spirit intrusion. It was like something external. And in fact, our word pain comes from Penha, like subpena, which means penalty. So this like pain was considered a punishment from the gods. And Descartes was like, no, I think this is an internal process. And he had like the broad strokes of it. It's just they didn't have the details that we have now today.

Yeah, he kind of got well, he got one half of it pretty right. But I mentioned it was a two way street. It's a two way street. And a lot of ways because what we've learned since Descartes is that we do have pain signals that go up from nerves in the body to the brain to say, hey, I'm hurt. Those are called the sending signals. But then we also have another signal going. I'm just going to 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 later when it comes to medication and stuff, it's sort of managing that to a 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 like it's coming from your hand. And then secondly, the idea that your brain can influence 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 neuroscientist named Vice Ramachandran who's just brilliant, and he he said that pain this is paraphrasing him. 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 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 elbow room. All right. I think we should take a break and we're going to come back and dive into some hard science right after this. Nearly 600 years after the invention of the printing press, the most important book in the history of the world has arrived.

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All righty, so your brain has an opinion about the current state of your health. 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 finely tuned to different kinds of different kinds of pain, but really tuned to different kinds of thing that might cause pain like a hot stove or a needle going into 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 thermal like like heat or cold. And the idea that these nociceptors are capable of being triggered by exposure to those kind of stimuli from the external world, that that is what kicks off the no ception process.

Yeah. And they they're all very different and they have different ways of communicating with the brain. There are some that do things really, really fast. These 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, it has a fatty myelin sheath that's going to insulate the the electro conduction basically on the wire. And it really just zaps it there really, really fast.

Not a lot of information loss is going on. And that's like that first really intense pain you feel when you burn your hand or any slam it into the window is that's kind of what's going on with the fibers.

Right. And then you get see fibers which aren't insulated and they are slower conducting, but they also have a bunch of they recruit a bunch of them to conduct signals from different parts, different areas 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 the follow up, like usually burning, throbbing kind of sensation that can be followed by that first, like, bolt of pain that the fibers deliver.

And then that's from the actual like like nociceptors. There's other stuff that happens to like if you cut open your hand, those damaged cells, you know, spill their guts. And so like potassium in glutamate, in substance p search, start firing off like other neurons in the area. You might have an inflammatory response to things like histamine show up and they start setting off other nerve fibers too. So it's more than just the you know, the hand nociceptors telling the brain that something's happening.

Like a whole bunch of different responses from the area are going to arrive at the brain and produce this really complex, rich message saying here's generally what's going on. Here's how bad it is.

You ever had a bad burn? Yes, those are the worst. They are pretty bad.

I don't even remember what happened, but I definitely have burned myself pretty bad. You mean has this same spot on her hand that she gets in like the conviction of it? Like basically every time it heals, she's just really upset. Again, she's always got this little little thing like I think it's her pinky knuckle and her right hand.

And she always like hits the same spot on the. Yep. Oh, man. Every day you get that lady a glove, a hot mess.

Yeah. I think by now it's just so callous that she just did she fight sailors with it these days. Just shows. Yeah. Those burns really linger and that's like every time I hear of 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 just those burns that it seems like they hurt forever.

Yeah. I mean, you've got exposed nerve fibres 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 sensitized. 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 will.

Sure. Wise. Yeah, and that just makes it that much worse. Yeah. And then some things that you might think really hurt don't hurt like cuts. I've had cuts before that don't hurt. They might freak you out. Right. To look at it and to see, you know. Like your skin exposed, some people are really freaked out by the blood. 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 really hurt that much.

And they're walking around like a skeleton. You hang on the door, their arm 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 of what's wrong with the body based on the pain information wrong sometimes. A lot of times, like think about a hangnail. A hangnail is no threat whatsoever to your survival. But those things hurt or a paper cut it. No one's going to die from a paper cut. But it really, really hurts, too. It can be overblown.

It can be under blown. 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. So let's say you get hurt. Let's say you slam your your hand in the window like it was talking about, which I think has happened. I don't know why I keep going to that. Your worst fear. I don't know. It's I don't I don't think it's that or not. But your worst fear, though is not that bad.

Would be hard. It's a lot easier to shut your hand in a car door than a window. But me. And that hurts either way. Yeah, man, I had knock wood. That hasn't happened to me in a long time. Yes. Every time my daughter shuts the door, which I try to let her do whatever she can on her own, I'm always just like know do it.

You put oven mitts our hands first. No, no nanny stayed at our house.

OK, so you get hurt on your hand. Let's say the signal that is going to travel, it travels through the into the grey matter of your spinal cord and they're going to 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, 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 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. 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 on your forehead really terribly, which doesn't make any sense. So yeah, I think that's from the nerve or the C fiber information where it makes it tough to also figure out where it's coming from.

You ever been to a cardiologist? I know I'm going.

No, I have you. I'm going to one this week, man. I had I've known two people in the past, like a month that have dropped dead, that are like my age. What one friend of mine from college had. Oh, no. Been experiencing chest pains. And he went to drove himself the hospital like collapsed and died on the way into the hospital. Oh, my gosh. 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 want to go like, just see what's going on in there.

That's great. Yeah. And then get some preventative or not preventative, but just some proactive tests done, you know, where they see how your arteries are doing, because I've got cholesterol issues because of my my family history and stuff. Oh yeah. And I don't want it to be one of those things where they're like, oh, well, it turns out that, you know, you were 90 percent clogged this whole time. Right. 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 genuine concerns. A cardiologist might actually go ahead and prescribe it anyway.

Well, I don't have concerns in that I have chest pains or anything, but. Right. But if you have a family history, they make it. Yeah, I just I want to know what's going on. 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 we'll see at the cardiologists office.

Well, I think for women you can go get heart screenings for women very easily. 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, oh, that's only for women.

And I guess that's 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, 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 is like one hundred dollar heart screening or something like that cost.

Is there anything socialized medicine can't do?

So, uh, we were talking about those first 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 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 the pain, the pain information follows. The same super highway and it goes through your brain stem, your medulla, and then it's synapses again onto a third set of neurons in your thalamus, which is your brain's relay center. And then from there, things start to get kind of market 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 is it was helpful to me to imagine pain, a pain signal as like a pinball when when you hit it with the flippers. See, that's like you're you cutting your hand, that pinball goes up and it's going up to the top of the pinball machine. But on the way it goes through all these other things, like these gates that flips around 360 degrees much of times. Imagine that it's, you know, doing that in your in your brainstem or in the gray matter of your spinal cord is going through all these different things.

And as it does on its way to that final destination of the brain somatosensory cortex, it can have effects on the way, too. Like if 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.

Your you have a signal going down your arm to say, move that move that hand, dummy.

Yeah. Because if you think about burning your hand, the I mean, it's very fast and very fast succession. The actual burn pain burn happens after you've jerked your hand away. Right. And like I said, it's pretty lickety split. But you jerk that hand away, it's not like you keep it 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 here as it's going through the module. It's been a long time since we talked about it.

Yeah, it's it's been so long. They added a third one freeze. Yeah. Last time we talked about, it's like an old friend coming back to visit, but bringing a new obnoxious friend with it. Yeah. So it could set that off through the medulla. And you know, what happens there is you're going to your heart rate's going to go up, your blood pressure is going to shoot up, you're going to start sweating if you're me and rapid breathing.

And it really can it really depends on the intensity of the pain, but it can definitely set off that fight or flight or I guess freeze.

And again, all of 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 one of the ways that we know this is because you will move your hand sometimes it's 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, OK, get the hand out of there.

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 you remember how Edward Norton in Fight Club, when he had that lie on his his hand, he kept trying to think of like a snow covered like forest or something.

Yeah. 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 that 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, 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, OK, the brain is definitely involved in this in some way, shape or form.

And pain is not just the reception of a pain signal coming from the lower parts of the body up to the brain. But there's also a reciprocal thing like you were saying, where the brain descends or there's descending pathways that the brain uses to say, OK, all right, let's just all chill out down there.

OK, 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 the signals are on the way down, there might be those 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 there's other things that that we figured out that can actually influence your experience of pain. Like to say that 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, but it's so good when it is good. Oh, yeah. I mean, I've seen a handful of. In my life, that just blew me away and I've seen a bunch more that 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, though, we're in a new renaissance. What you got to. Well, I mean, in the past five or six years, I think it follows and The Babadook and I didn't like the Barbie 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 Winola Holmes on Netflix. Have you seen it? Now it's a coming of age movie about Sherlock Holmes is younger sister. Oh, 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 are smart and paying attention. It's a really great, great movie. Great movie. I have to check that out.

It's Millie. Bobby Brown. As you know, the homeless, she's just about she's about as charming as they come.

Yeah, she's wonderful.

So, yeah, not a horror movie, but definitely worth watching regardless.

Is that based on any 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 latter of the two which makes it all the more amazing because they did such a great job of capturing that whole the whole world. Very cool. Yeah. Where 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.

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So we were saying before we started talking about Winola homes and horror movies that there is like a lot of different things that will influence an individual's experience of pain. And it has to do with not just you biologically, but weirdly also you sociologically, too.

Yeah. And this first one age is to me, a little counterintuitive in some ways. You know, as you age, your brain circuitry is going to it's just going to generate a little bit. That's just the 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 80 year old lady the other day that just warmed my heart. Oh, yes, she was great.

She was great. So if you are one of our senior listeners and you you might have a lower pain threshold and more problems dealing with pain. Right. This seemed a little counterintuitive because I could also see a case where the neurons don't fire and the correct way such that you could be feeling something painful and not really realize it.

So the 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 pathway 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 signal more efficiently.

And so that would account for sensitisation. That's how I took it. I you know, hey, I'm no V.S. Ramachandran.

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 have a higher sensitivity to pain than men could be. Maybe if it's a 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, there could be that at work.

It also could be sex linked genetic traits or hormonal changes that might change that pain perception. Right.

Or even the culture you're raised in, like Imja, women in Uganda, I read, are expected to be stoic in the face of pain. Yeah, whereas men in Ukraine are expected to not experience pain at all or show any kind of pain whatsoever. So like the idea that culture can affect your interpretation or 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 whiney baby every time he gets sick. And I generally suck it up as the wife, so Ugandan and so Ugandan. There's also a memory like if you've experienced pain before, your memory of going through that pain can impact how you experience it. A follow up. Time to 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. Right.

I think, you know, when I was younger and in college, like, I wasn't giving blood like I should and I wasn't getting flu shots like I should. But now that I'm a real sentient adult and a responsible adult, I have needles in me all the time. And it's a 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 of the room like needles.

Needle person. Yeah. Needle phobia.

It's a great band name. Oh my gosh. Pretty good. That's the best band name in years. Chuck, what kind of band is that?

Uh, needle thobe is clearly some sort of metal, maybe new metal if it were going to be ruined. But there's definitely something in there, maybe along the lines of like Queen's Reich or something.

Yeah, I could see that. Or maybe even like horror metal. Oh yeah. Like that Norwegian stuff. Sure.

OK, 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 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 it otherwise would have, which can actually make it hurt more.

Yeah, and I know I've mentioned this. I still got a look. 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. Yeah. You're not a needle phobe. You're a needle.

Whatever the opposite is, I'll write a needle file.

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 affect physical pain as well.

Yeah. And back when we were trying to understand and we're still trying to understand this, but why emotions and stuff might influence pain in the 60s, of course, when all this kind of cool research was going on, there were a couple of dudes named Ronald Amelle, Zach and Patrick Wall, who threw up a proposal about a gating mechanism existing among the connections in the body, sensory pathways that can help determine how you're going to 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 know if we knew that before Mels that Kanwal or if we know it as a result of 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 so if I just like press, you know, my arm, I'm sending somatosensory 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 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 yes.

So in that case, the gate is fully open for business. And when otherwise, when there's no pain, no no sensory information, the gates closed or if it's just normal somatosensory information, the gate 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 like if you smash your thumb with a hammer and your reaction is to go and shake your hand really hard or 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 in, you know, basically kind of close that gate down.

OK, so now that you understand the game theory of pain and this is the general understanding among Western science and 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 explains how the how you can experience psychogenic pain where people have fibromyalgia or chronic pelvic pain or tinnitus or TMJ or chronic back pain when there's no reason whatsoever for them to experience this. The the really great author and surgeon, Atul Gawande, I believe he writes for The New Yorker.

He's also he writes some books as well. He's one of one of the best writers 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, you go to the mechanic and 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 think that this is because of this gate being open, the sensor is open, even though there's nothing tripping it, that that is the problem, that that is what it counts for psychogenic pain.

Very interesting. And that makes sense. Yeah, definitely. So when it comes to managing pain, there are a bunch of different routes you can go depending on what your doctor might recommend, depending on what you as a human what road you want to go down. And these vary and we'll you know, we'll get into these.

But these vary from like over the counter medications to prescription medications to surgery to go into a massage therapist or an acupuncture specialist acupuncturist. But as far as the medications go, you've got a couple of different kinds. You've got your non opioid analgesic like this. A Tylenol or an 11 Advil or something like that, and it's going to act at the side of the pain when you have that damaged tissue, it releases enzymes that stimulate the pain receptors locally. And what these do is they interfere with those enzymes.

They're 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 not that important. Right.

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 you don't want to pop an Advil every day if you have like back pain, that kind of thing.

Yeah. And then there's opioids which they actually go to the gate and they can close the gate on the one hand, and then they can also go to your brain and excite the descending pathways, which will bind with like opioid receptors. And of course, those are hugely addictive and have a huge possibility of overdose as well. But they do help treat pain a lot.

Yeah, we should do want opioids in the opioid epidemic. It's I agree. I agree. It's been one of the darker spots of the new era. Yes.

The new era is that we don't even know of the last 10 or 15 years. It's what I call that a new er the modern era is what I meant. Sure. Uh, what else do we have there?

You can actually use medicines that aren't meant for treating pain to treat pain. Sure. Antiepileptic drug, brand stuff, anti-depressants, anesthetics, they all do things like they block 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 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 if you have severe. I've had a couple of friends actually who have had back surgery where let's say you have a herniated disc and that thing is compressing on a nerve at as a last resort. They can go in there and maybe remove a little bit of that disc 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 Codecademy, where they go in and say we're just going to 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 to varying degrees. One of my favorite alternative therapies is the tens unit trains, cutaneous electrical nerve stimulation. And it sends electrical impulses from the site of pain to base. It's basically like a defibrillator for your pain gait. It's saying your pain gait is it's open and it shouldn't be open. So we're going to we're going to send some nerve stimulation in the hopes 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 I got it back thing about five years ago where they gave me this electro stimulator thing that I put these little pads on and there was like a little handheld thing about the size of a Gameboy 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 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 pre dynastic Egyptians from like 5000 years ago used electric catfish from the Nile for the same effect and impact. Wow. Like that.

It's pretty amazing. Amazing. Yeah. And then, you know, we mentioned going to the chiropractor massage therapist. Obviously, they're hot compresses and cold compresses. There's acupuncture. There is, you know, relaxation and hypnosis. 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. Yeah.

So, yeah, there 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 about what are the sugar pills. Placebos. Yeah. Yeah. The placebos have been shown to work sometimes with, with limiting pain.

Yeah. Yeah.

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 experience pain and you move the other limb while you're looking in the mirror. So it looks like you're amputated. Limb is back and you're tricking your brain into being like, oh, OK, it's there. It's fine. I don't have to experience pain anymore in it I. 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. Right. But as you say in the article, like your mind and your brain are two different things. So, like, you can't shut down that gateway just by thinking it away now.

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 not going to 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. Yeah, 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 and their response to it isn't nearly as pronounced.

Right. So it does have an effect, you know. Yeah.

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 to suggest what you can do. How about you just go read up on it a little more? And since I said that, it's time for listener Mel.

I'm just going to 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. Sure, people love their beavers, especially baby beavers, and did the best. 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. They can't live out in the open amongst the cacti.

But the sizable population of beavers in Las Vegas is testament to their ability to survive the heat. They're about 80 to 100 beavers living in the Clark County wetlands, just about 20 to 30 minutes from the strip. That's great. It was a shock when I first heard of this, but I've since taken several trips to see them. Uh, thanks for all the work. Enjoy the show. That's from Josh. Very short and sweet. That's from Josh Erotics.

That's a great, great first name. Great last name, Josh. And I love how that email just kind of petered out at the end there. Yeah. So we're going to his new name is Josh Peter Erotics. OK, great. Thanks for the email, J-P. And if you want to be like J-P and send us an email, you can do so wrap it up spankin on the bottom and send it off to Stuff podcast that I heart.

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