A Better Way Of Managing Chronic Pain—Courtesy Of Pavlov
Pain and I have a long history. I have experienced it firsthand, basically every day since high school. I've dealt with it second hand, too—in the two-plus decades I practiced as a primary care physician, pain was the most common problem I addressed with my patients.
For all those decades, I held on to a flawed and unrealistic goal of finding pills or procedures that would abolish pain. I am not the only person striving for that goal. A huge number of medical interventions are designed to relieve people of pain: physical therapy treatments, over-the-counter medications, surgical procedures, and of course prescription medications, including opiates like Oxycontin.
But it is not always possible to abolish people's pain. Sometimes, no amount of physical therapy or surgery or [place your favorite treatment here] will cure people of their pain. Nor is it wise to dull people's pain with long-term use of medications like narcotics.
Fortunately, there are promising ways to manage chronic pain so people, when they do feel pain, aren't so bothered by. In fact, a creative study led by a neuroscientist, Susanne Becker, uses insights from none other than Ivan Pavlov to show the possibility of uncoupling the sensation of pain from the experience of pain.
First, a quick reminder about Pavlov. Born in Russia in 1849, Pavlov is most famous for his work on conditioned reflexes – ring a bell before giving dogs their food and, after enough bell-then-food pairings, the dogs begin to salivate upon hearing the bell, even though they have yet to see their dinner.
Becker and colleagues employed a Pavlov-like research design to figure out whether people can decouple the sensation of pain from the experience of that pain. The study started with repeated pairings of pain and reward. The researchers placed thermal probes on people's thumbs and, intermittently, hit them with a burst of painful heat – quick spikes in temperature that caused pain without damaging people's bodies. For some people, Becker's team coupled the heat with a monetary reward.
Heat, pain, reward… Heat, pain, reward. Etc.
For other people, there was no such coupling.
Heat, pain, no reward… Heat, pain, no reward. Etc.
With this research design, Becker's team was able to determine what happens to people's sensation of pain after that pain has or hasn't been paired with a reward. Becker already knew from earlier research that such a pairing will inhibit pain, what psychologists call motivational opponency. When pain and reward are repeatedly coupled, people report a weaker pain response. The pain is not experienced as being quite so bothersome.
But bear with me while I break down that opponency. Think of your response to pain as being made up of three things.
1. Sensation: your body's ability to recognize the location and intensity of a noxious stimuli – 'That was kind of hot, and it was in my thumb.'
2. Affect and motivation: how you feel about a noxious stimuli – 'That jolt of heat makes me miserable' or 'that heat doesn't bother me very much.'
3. Cognition: how you think about a noxious stimuli – 'That heat is a sign of trouble in my thumb' or 'that heat has nothing to do with the well-being of my thumb.'
Becker wondered whether the coupling of pain and reward would cause people to become insensitive to their pain (process No. 1 above). That is, whether people would lose the ability to sense when their body is experiencing a noxious stimuli, if enough of those stimuli are paired with a pleasurable reward.
Or, instead, she wondered whether people remain sensitive to pain while changing their emotional and cognitive responses to noxious stimuli (Nos. 2 and 3 above).
Becker discovered (and I love this finding) that people actually become more sensitive to pain after these Pavlovian pairings. People get better at noticing when they are getting hit by quick bursts of heat, maybe because they now interpret (emotionally and cognitively) those painful jolts as being good things. Sure, the blasts of heat hurt. But they also mean a reward is on its way.
My take on this research? Sometimes we cannot avoid painful stimuli. That bulging disc, that arthritic knee… these bodily problems will send signals to our brains, telling us that our bodies are damaged or inflamed or whatever. We will continue to sense the pain. But we don't have to be bothered by the pain. We can rethink and re-feel the pain.
If you have pain that is impervious to a medical fix, don't give up hope. If you cannot free yourself of pain, you should work with a pain expert to find a way to reduce the emotional and cognitive impact that pain has on your life.
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