How Pain Works
Pain is often a huge part of our lives with rheumatoid disease. It’s exceedingly difficult to ignore. It horns in on our every waking thought and hampers everything we do throughout the day. And if that’s not enough, it interferes with our sleep, too, a miserable bed-companion, unwanted but there just the same.
We know it well, this invisible intruder in our daily lives. Pain is often different for each of us and it’s aggravatingly hard to describe. But what is it, exactly? What is pain? I thought it might be worthwhile to find out.
According to the Oxford English Dictionary, pain is “physical suffering or discomfort caused by illness or injury.” Its root is the Latin word “poena,” meaning “penalty.” “Mmmhmm,” I thought when I read that. Many of us wonder, at one time or another, what we did to deserve our RD and the pain that comes with it. Is it a penalty for some terrible wrongdoing? Naw--I don’t believe that. I think there’s always a scientific, medical explanation for pain. Inflammation in the joints and the soft tissues surrounding them is the basic, underlying cause of RD pain. Damage from the inflammation is the second cause; this pain occurs even when the inflammation is gone. But the real cause of our RD pain is our own brains.
You read that right: our brains. Who hasn’t had someone—even a doctor!—tell them that their pain is “all in your head?” It’s hurtful and insulting, this insinuation that our pain isn’t real, that we only think we’re in pain. They’re wrong, but they’re right, too. We aren’t hypochondriacs or needy sorts trolling for attention by complaining of pain that doesn’t exist. Yet as grimly, seriously real as our pain is, it really is all in our heads.
Here’s why. All pain, no matter what causes it, is a sensory perception generated by certain synapses in our brains to help us survive. When our body is injured or inflamed, special receptors in the nervous system, called “nociceptors” transmit urgent, do-something-about-this emergency signals to the spinal cord, where they’re fast-tracked to the brain. And the brain, in turn, converts those signals into the sensory discomfort we call “pain.” We react instantly, doing whatever we can to stop whatever is causing the pain, and limiting the damage.
There are two types of nociceptive pain. The first is somatic, pain caused by a traumatic injury and/or inflammation. It can feel stinging, burning, prickling, dull, or aching. It’s usually temporary. It can take five minutes or five weeks, but as the injury heals, or the infection/ inflammation subside, the pain fades away. Chronic illnesses, such as rheumatoid disease, are exceptions, since the inflammation the disease causes doesn’t disappear over time. It’s still somatic.
The second type of nociceptive pain is visceral pain. This is pain that occurs within the viscera—the organs. It includes pain in the heart, the stomach, the guts, the urinary tract, and other body cavity organs with nerve endings. Who hasn’t had indigestion or nausea? Here again, the pain itself is in our heads, but we perceive it as originating in the organs that are affected by eating too much spicy food. Cramping, deep pressure, and stabbing are words that describe visceral pain.
Changes in—or damage to—the nervous system causes neuropathic pain. It may result from injury, such as a traumatic accident that severs nerve endings, or from diseases like diabetes, shingles, post-stroke pain, or complex regional pain syndromes. RD may also cause neuropathic pain when the nerves embedded in inflamed tissues are damaged or destroyed. Neuropathic pain is usually burning, stinging, buzzing, or electric.
Anxiety and depression are fairly common among people with RD—and why not? Faced with an incurable disease that causes relentless pain and tissue damage, even the toughest may become anxious and/or downhearted. The trouble is that emotions like these can enhance or worsen how we perceive pain. Doctors call this psychogenic pain. This type of pain is just as real as somatic, visceral, and neuropathic pain. But psychogenic pain is linked in with our emotions and other psychological processes. Psychogenic pain can still exist when we’ve healed, controlled, or even cured physical injuries, illnesses, and diseases.
It’s on this sort of pain that things like meditation, biofeedback, guided imagery, acupuncture, exercise, and other alternative pain relief methods work the best. They teach us to control our emotions, distract ourselves from our pain, and strengthen our bodies, thereby setting our brains up to release pain-relieving endorphins.
I’ve only begun to explore the enigma that is pain. I have more to tell you next time.
Check-in: As we start a new year, how are you feeling?