The Pain Frontier

by Paulette Avery, R.N., M.S.N.

I'll bet you didn't know that Congress has declared this to be the "Decade of Pain Control and Research." Neither did I until I read a recent article in Newsweek, but it seems like good news. Although pain can be of great benefit by sounding the alarm to let us know when we are heading for trouble, as when we touch a hot stove, it is not a pleasant sensation. And when it is severe and/or chronic, pain can steal the joy from our lives. Thanks to rapid advances in brain science and medical technology, doctors, scientists, and engineers are conquering the pain frontier and providing more and better ways to deal with its disabling effects.

Just 25 years ago scientists believed that pain traveled one-way from the spinal cord to the brain. Today pain experts know the process is much more complex and that many factors affect the way an individual experiences pain. Our gender, emotional state, the current circumstance, and heredity all play a role in how much pain we feel. Scientists have found that in women, pain-fighting factors function better at the time in their menstrual cycle when estrogen levels are higher and that certain painkillers called kappa opioids work more effectively in women than in men. We deal with pain more successfully when our emotional state is high, less well when we feel low. Dr. Catherine Bushnell, of McGill University in Montreal, has found that volunteers subjected to pain experience it less when they are distracted by sounds or by pleasant odors such as cookie dough or perfume. On the other hand, smelling something unpleasant when you are in pain may increase your discomfort. According to Dr. Bushnell, who was quoted in the Newsweek article, "Your psychological state can clearly change the way pain is processed in the brain. We can have some control over our pain in a way that we don't necessarily realize."

As for genetic factors, scientists have recently isolated genes linked to pain. With this knowledge comes a new understanding of why individuals respond differently to the same pain stimulus. For example, a gene called COMT is now known to help regulate the brain chemicals dopamine and noradrenaline. The COMT proteins contain many amino acids, including two called valine and methionine. According to a study done on people with jaw pain, those with two copies of valine were better able to deal with the pain than those with two copies of methionine. Brain scans done on these subjects found that the people who handled the pain better had more active painkilling systems. As knowledge about how we respond to pain increases, new drugs and the technology for treating the pain are also expanding.

And as the understanding of pain increases, attitudes about it are changing. For instance, not too long ago doctors believed that newborns did not feel pain because of their immature nervous systems. Thankfully, doctors now know that babies do feel pain and need to be medicated for painful procedures such as circumcision that, for many years, were done with no pain relief. Research found that the babies who underwent circumcision without analgesia remained more sensitive to pain than their peers even four to six months after the circumcision. Other studies have found that premature infants who undergo repeated painful procedures may suffer permanent damage, resulting in dysfunctional pain systems that fail to register pain normally.

Fortunately, there has also been research to help medical professionals identify pain in infants and children too young to verbally express it. More and more methods, both low and hightech, have been developed to help children deal with their pain. In some cases, simple deep breathing, or encouraging children to use their imagination during an uncomfortable procedure, may be the best way to make them more comfortable.

Someday in the not-too-distant future, we may go to the doctor when we have pain and be given a pill for our particular genetic makeup and gender that will have few, if any, side effects. Won't that be great!

Paulette Avery is a registered nurse and a freelance writer who specializes in health issues.