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A lecture in pain

When I walked into the room, I immediately categorized everyone who was sitting and waiting for the lecture to start into two groups – bright young medical students and old people in pain. I could have been wrong since I myself was a young person in pain, but regardless, as I looked into the audience I thought, “My people! I’ve found my people! Let’s turn off the lights and moan together!”

I attended a free seminar last Wednesday at the IUPUI student center called “Myths and Facts of Pain: Is it all in your head?” that is part of the IU Mini Medical School 2009. I heard about the series on a local radio show, Sound Medicine, after they did a segment about chronic pain. The lecture was free, and I work downtown anyway, so I decided to stop by. Plus, they had free snacks! The caterers were even considerate and included a veggie tray along with the brownies and cookies, a true rarity in modern society.

The first speaker was Dr. Palmer MacKie, Assistant Professor of Clinical Medicine in the IU Department of Internal Medicine with clinical interests in treating those with persistent pain. I learned several new things about chronic pain from his talk and his multiple PowerPoint slides, and even more of it went flying over my head splatting into the wall behind me.

First, as I’m sure it’s made absolutely crystal clear by this diagram, chronic pain and acute pain function differently in the central nervous system.

Pain diagram

The left half of the diagram shows how the body is supposed to react to pain, and the right side of the diagram shows how screwed up your body’s response becomes during chronic pain. Even more depressing is the fact that the brain changes after you’ve been in pain a long time, a phenomena called neuroplasticity. “Plasticity” refers to the ability to change and “Neuro” refers to your brain. Your body learns how to be in pain. The common English translation of this is, “Jennette, you are totally fucked.”

Other interesting things I learned:

  • Portions of your brain start to shrink over time if you’re in chronic pain. (I doubt this will make the feeling of constant pressure in my head go away, but maybe I’ll get lucky!)
  • Our brains contain mu receptors which bind to morphine to make you feel better and combat pain. Men have a lot more mu receptors than women, the bastards. Seriously, a lot more. I don’t have the slide to show you, but it was like the difference between a blizzard and a few flakes of snow.
  • Not only do men have more mu receptors, but women’s mu receptor response varies during the menstrual cycle, making your body’s ability to gobble up feel-good morphine vary depending on the time of the month. Again, the bastards!
  • Dr. MacKai spoke about the difference between pain and suffering, which is probably worthy of a whole entry in itself. Basically, even if you are constantly in pain, how much you suffer from the pain depends on your emotional state, your attitude, your environment, and how much the ACC (anterior cingulate cortex) portion of your brain is lighting up to tell you to PAY ATTENTION! to the pain. This was driven home by the fact that listening to all this talk about pain made my headache seem worse.

There was another speaker after Dr. MacKai, but he was an OBGYN who was talking about pelvic pain. Thankfully I do not have pelvic pain, at least not yet, so I decided to grab a cookie and drove home in a windstorm that knocked out several traffic lights instead. After all, I had a headache, and there was only so long I could concentrate before I had to lie under the table.

During the lecture, Dr. MacKai asked the question, “How many people have been in pain for over…” and I started to raise my hand, “…10 years.” Then I put down my hand, turned around and saw several people with their limbs raised. At that moment I wanted to get up and give them all a hug and tell them, “I am so, so, so incredibly sorry.” Because I am so sorry for those people. Now when I see a man walking slowly with a cane in front of me, I don’t think, “I wish he’d walk faster,” I think, “He must be in a lot of pain.” At least I know there are a lot of us.

* BTW, I am not a doctor. I related this information as I best understood and remembered it, but it’s possible I made some errors because I do not fully understand the processes I wrote about.

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25 Comments

debby • February 17, 2009 at 10:03 am

Wow, I am a nurse, and I did not know all that stuff about chronic pain vs. acute pain. Especially the mu receptors that the bastards have more of–you are still a very funny writer, Pastaqueen!

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Lilbet • February 17, 2009 at 10:38 am

We just had a conversation yesterday about this very thing. No no no, we don’t sit around discussing the scientific reasons for pain. But, we were talking about my pseudotumor cerebri and my mom’s arthritis. I told her, I’m at 9 years after diagnosis (yikes! cause it took me 2 years to get diagnosed!) and I’m still the same. She looked at me like I was crazy. You’re kidding? She said. I said nope. Still the same pain, I’ve learned to live with it better and no one asks anymore about how I feel because pain is invisible and if you smile, you must be better.

But, NO, we smile and carry on because life marches on and you don’t want to get left behind.

Mom talked about her arthritis and how she used to think about old people, just suck it up, it can’t be that bad. And now she’s one of them.

We all need to be more compassionate. Your comment about the man with the cane was spot on.

Great post. Brava!

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Kyle • February 17, 2009 at 11:16 am

This is my favorite way to read medical info…dumbed down and funny’ed up by someone who already did the hard part of listening to the medical science vocab and then translated it into real English.

You’re so funny, even in pain, that it amazes me. I found myself with a new respect for you when I had a headache for four days and it shut me down completely.

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Mara @ What's For Dinner? • February 17, 2009 at 11:21 am

Very interesting stuff here… I’m going to show it to my fiance who’s “always” in pain.

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Tina • February 17, 2009 at 11:28 am

Nice writing and great info. As for the facts about men and pain response, we all know that they need a more effective personal pain management system because they’re p*ssies. At least that’s what my grandmother says. And it’s what I think everytime my bf claims he’s dying from a normal head cold.

:)

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Beth Moore • February 17, 2009 at 11:52 am

I loved this post! I always thought that being told that my hip had a “pain memory” was hog wash, but it turns out, not so much! If it gives you any hope, they were able to shut off the memory and after living 3 years in pain, I have been pain free for 8 years. =)

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s • February 17, 2009 at 12:31 pm

i think this post rules. just sayin’.

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Meg • February 17, 2009 at 12:49 pm

Wow. Lots of new info to absorb. You’re inspiring me to be more proactive regarding my chronic vertigo (which most of the time is easy to ignore.)

You’re positive attitude throughout this has been amazing. I hope you get answers soon.

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Jenny • February 17, 2009 at 12:58 pm

If nothing else, today I will spend a few moments being grateful for what I have and don’t have: chronic pain. I had shingles ten years ago and experienced the most intense pain of my life for six weeks. I was lucky, I recovered. Since then, when I see someone who is suffering, I want to do what you wanted to do: hug them and tell them I’m sorry. Nice post.

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Mrs Lard • February 17, 2009 at 1:27 pm

Thank you for posting about this; I was captivated. When I saw the mention of pelvic pain (which I have), I got excited…

I am so sorry your headache caused you to leave – pain is no fun, however interesting the speaker. : (

BUT this has given me a hook to go to find out more.

: )

Thanks to one of your earlier posts (and comments), I’m already trying to understand (and find out more) more about pain and hormones.

It’s a complex issue so well done for translating it and making it understandable for us.

I can’t think of anything witty to say about the male factor but I loved your take on it! It made me smile.

As ever, hope the pain diminishes.

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Katie • February 17, 2009 at 2:16 pm

I’ve just finished reading all of your archives. I know you’ve heard it before, but you are an inspiration!

I’m so sorry to hear that you are still in pain. I won’t make any suggestions because I know how much you hate that, but I hope they figure it out soon and you don’t have to live with a headache anymore.

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Becky • February 17, 2009 at 2:22 pm

The bit about pain vs suffering made a lot of sense to me. I have Crohn’s and Fibromyalgia, and I (usually) feel better in social situations. I can focus on other people and forget about the pain for a while. The effect doesn’t last forever, and if I push it too far I really pay for it when I get home. But spending concentrating on others instead of myself helps.

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Wakati • February 17, 2009 at 3:19 pm

At least you still have you sense of humor. Probably no consolation at all, but it makes you a great writer:-)

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Angel • February 17, 2009 at 3:34 pm

Interesting…

I really feel for you. I have had a constant headache for 2 weeks that medication isn’t helping so I can only imagine a year. (Isn’t today your headache painiversary?)

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PastaQueen • February 17, 2009 at 3:39 pm

@Angel – Aw, you remembered :)

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Margalit • February 17, 2009 at 5:01 pm

I hope some day soon Feb 17 gets to be just another mid winter day for you and I thank you so much for this post. The information is not totally new to me but you put it together in such a great and even funny way. I appreciate all your posts but since this one goes to where I live too, it really helps. As one of those people with a cane and the pain that goes with arthritis, I am glad to be reminded that some are thinking empathic thoughts. I’ll try to remember that and not worry so much that I am in someone’s way.

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victoria • February 17, 2009 at 6:27 pm

Oh, man. That sounds like it was really depressing. I’m sorry, PQ.

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anji • February 17, 2009 at 6:27 pm

Amen sistah.

I don’t think we’re crazy… just unfortunate with our pain levels and being able to bear it. I’m six years into my pain (well, 5.5 but who’s counting????) … some days are good, some are bad, some are horrendous. I think I have generally less tolerance to pain now than I used to. What I used to have no problems with, now would take me down.

*sigh*

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nora • February 17, 2009 at 8:23 pm

great post… it is so difficult sometimes living in a world where many people have never been in pain and just don’t understand how unpleasant life can be sometimes when you go through it with a gnawing headache all the time. I spent most of my high school years with migraines… I missed so much school because of them that I was asked to leave… and I pushed myself though so much school while I was in pain. The thing that always shocked me though is how clueless people were about how painful a migraine really is and how it was all I could do to get myself though the day. People who didn’t get it treated me like i was making it all up, and like I was a slacker or something and that’s why I wasn’t in school… but now when I see someone who is in pain or when my children are sick or hurt, I have so much more compassion than when I was younger and didn’t really get it. In high school, though, I just wanted to kick some of my teachers in the head repeatedly and then ask them to do their science homework as their head throbbed… see… I wasn’t very nice back then

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Mich • February 17, 2009 at 9:43 pm

Thank you for this post. It reminded me that I should check out the local medical schools for free science lectures.

If you are interested in the subject of neuroplasticity, my favorite book on the subject is “The Brain that Changes Itself” by Norman Doidge. Fascinating and very readable.

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Dawn! • February 19, 2009 at 1:09 pm

Well, this mu receptor business explains why my EX-husband is such a pothead. However, this does not explain why men whine more when they’re in pain than women.

Great site by the way. I intend to let it suck more of my time when I’m not on the clock!

Your new fan,

Dawn!

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anji • February 19, 2009 at 6:42 pm

Actually, reminds me of this article i saw a while back….

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20081126/pain_brainmatter_081126/20081126?hub=TopStories

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psychsarah • February 23, 2009 at 2:22 pm

Kudos on your description.I teach people about pain all the time, and if everyone got that much out of my spiels I would be thrilled!!

I actually attended a workshop just yesterday about chronic pain treatment, and there are some promising neuroimaging studies that could really help a lot of people better understand and diagnose chronic pain. I hope it happens quickly in order to benefit you, and the multitude of others out there who experience chronic pain.

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Sadie • February 24, 2009 at 8:31 pm

I have chronic facial pain from botched dental work, and I have had it for five years. One thing it has really changed about me is my response to other people and to animals: I now understand, as you mentioned, that when people have canes or other support devices, it usually signals that they have some kind of chronic pain. When I hear about animals and suffering, I feel overwhelmed with sadness; I can’t stand to watch Animal Planet or other programs about abuse of animals, because I find it so painful to think of them in pain. I have a friend I met at a conference who also has chronic pain, and she said the same thing — she found herself saving bugs from her windshield because she couldn’t bear the thought that they were suffering. It really changes your brain to feel pain all the time. The only good thing to come out of this, at least from the perspective of my cats, is that they are completely indulged at all moments! All they have to do is mew and I leap up, ready to do whatever they want. I started reading your blog out of interest in your weight loss, and I remember the day when you first wrote about pain. As with losing the weight, your attitude toward your pain has been wonderfully pragmatic, and I’m sure it has helped a lot of people to hear about the steps you have taken, like going to this lecture. It certainly inspires me to keep taking steps like that; it is so easy when you have pain to stay home and try not to aggravate it. Thanks a lot for everything.

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Headacheslayer • March 7, 2009 at 4:27 am

I’m going on 14 years, 4 1/2 yrs of chronic daily headache.

I long for the day when I can get a kick ass cane–and I’m thinking of finding Harley stickers for my wheelchair LOL

Pain definitely changes you, in so many ways. I’m relieved to see it has not changed your brilliant writing or your amazing sense of humor and compassion.

((((Hugs)))))

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Comments are now closed on all PastaQueen entries. The blog is an archive only so I don't have to deal with spammers. For fresh discussions please visit my new blog JenFul.

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Jennette Fulda tells stories to the Internet about her life as a smartass, writer, weight-loss inspiration, chronic headache sufferer, and overall nice person (who is silently judging you). She does this at JenFul now, but you can still have fun perusing her past here.

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