Saturday, April 26, 2014

The Optimal Pain Signature: The Foil for a Pleasurable Life?

We are in a technology-driven world where nothing seems to be impossible.  If the decades of the 1950s to 2000s were focused on electro-mechanical and mechatronic developments to help human beings achieve the unthinkable, from intra-city bullet trains to inter-planetary spaceships, the technologies of the twenty first century are focused on understanding the human biology better and enabling superior diagnosis and therapeutics through molecular biology and genetic engineering. The merger of biomedical sciences and engineering are creating new vistas of healthcare. Today, there is hope, for example, that genetic markers could help forecast the probability of cancer or enable the right choice of oncology drugs. The same technological capability could extend in several related and unrelated disease areas, nay to life itself.
If the ultimate form of impossibility is creation of human life, even that could become possible one day. Only a few days ago, a laboratory has announced that it has been able to successfully grow certain human organs in a laboratory environment using stem cells. Possibly, a full human life may also be grown or cloned one day. In the meanwhile, several companies are racing to develop a new breed of health devices or a host of healthcare applications such as heart rate tracker, fitness tracker or blood pressure monitor. There is an expectation that sooner or later smart phones and a new breed of wearable computers would turn into techno-biological foils to human beings. Yet, technology may have its own limits. The reason is that technology can help only if any physiological parameters can be characterized or measured. Surely, more biological markers which are measurable and have predictive capability will be discovered but thoughts and experiences cannot be measured, at least as of now.

Physical pain, the first frontier

Temperature, pulse rate and heart rate are three of the fundamental physical measurements of human wellbeing or illness. There are several bio-chemical markers that can be cultured or isolated through blood tests. Imaging studies, for example X-rays, ultrasounds, scans and angiograms of different types, can help identify the irregularities in the body internals. However, no technology has emerged, nor will emerge, that can measure pain, which even prior to temperature is an indicator of something going wrong or gone wrong with the human body. If only there were to be an instrument that can measure pain as it emerge and calibrates different types of pain, potentially chronic diseases like migraines and acute diseases like heart attacks be diagnosed ahead, and patients relieved or saved as the case may be. Unfortunately, pain only can be experienced and expressed but cannot be measured real time (the so called pain scales are post-facto, self-reporting, and subjective).

If medical diagnostics has to conquer the ultimate frontier, the first frontier to conquer is pain. There is so much subjectivity in pain that people tend to either understate or overstate pain, and in some cases even be incapacitated in expression. Apart from pain as a precursor of the impending physiological problem, post-operative pain is also an important marker of the pace of recovery. Without knowledge of the true state of pain, doctors dispense pain killers on an empirical basis. Apart from causing their own infamous side effects, the pain killers also mask pain making the discovery of illness even more difficult. Neuroscientists from the University of Colorado Boulder, New York University, Johns Hopkins University and the University of Michigan have identified functional Magnetic Resonance Imaging (fMRI) of the brain as an imaging technique to understand a pain level or pain signature of a person (see “An fMRI-Based Neurologic Signature of Physical Pain, The New England Journal of Medicine, 2013, 368: 1388-1397, April 11, 2013). Yet, fMRI is too sophisticated a hospital procedure to be of any use or relevance to day to day pain diagnosis and management.

Physical sensitivity

The rigors of life teach us that pain is an inescapable concomitant of human living. People experience physical pain from the early days and over years become capable of enduring pain. Sportsmen, among others, constitute a special category of people who test limits of endurance; they rebound from pain amazingly fast even as others recoil from pain involuntarily felt. To be sensitive to pain is probably not a bad thing even as an ability to endure pain is certainly a good thing. The ordeal of pain that is undergone by pregnant women prior to and during delivery is a classic instance of nature’s biology steeling the feminine gender to be sensitive and robust. Chronic diabetics, on the other hand, experience forced insensitivity with sugar levels leading neurological insensitivity to pain, and therefore resulting in ignorance of several pain markers of impending difficulties.

It is important, therefore, that a healthy human being is constantly aware of the pain frontiers one experiences. The simple tests that the earlier generation doctors employ in terms of scratch test or tongs test on parts which are served by peripheral nerves or distant blood vessels are some of the best indicators still. Barefoot walking on clean surfaces and being aware of the organic to organic and organic to inorganic touch are some of the ways in which a human being can continue to be in sensitivity to the subtle changes in body constitution. A spontaneous ability to feel and express pain is God’s gift and constitutes the body’s first defense against any harmful assault on the human body. The ability to distinguish between pain as a natural defense and pain as a route to endurance needs to be part of the pain DNA of an individual.

Emotional pain, the hidden frontier

While physical pain is easy to experience and express, emotional pain is much harder to understand and express. In today’s world where inequality is commonplace and where expectations race ahead of adequacies or endowments, it is easy to be vulnerable to emotional pain. Unseen and undiffused emotional pain leads to stress, which in turn leads to many psychosomatic and cardio-pulmonary diseases. Emotions such as anger, anxiety, worry, frustration, despondency, dejection, sorrow and sadness cause a person to experience emotional pain. While an ability to bear emotional pain is necessary, an inability to differentiate between natural emotional pain and impacted emotional pain is cause of much physical misery in individuals. High stress levels, for example, are known to cause severe migraine attacks in individuals.

Emotions are a function of attachment. Attachment is a function of biological (natural) or spontaneous (destined) chemistry. The more attached a person is (to something or someone) the more emotional he or she would tend to be. Anything that threatens or erodes the attachment would cause negative emotions and increase stress levels. Chronic stress levels cause a weakening of the immune system and cause a host of diseases. Attachments have a natural tendency of fading with time (like the attachment for schoolmates getting overshadowed by the attachment for college friends).  Attachments are a healthy part of human life but when the baggage of attachments constantly overflows (as it happens with highly social individuals) or if the baggage remains empty always bereft of attachments (as it happens with highly reclusive individuals) the emotional balance would be adversely impacted.

Sensible sensitivity

Emotional burden may seem to be lower in respect of individuals who think more through the head than through the heart, and who are impervious and insensitive. Apart from the fact that such non-emotional individuals tend to be in a minority, non-emotionalism tends to cause as grievous burden as emotionalism. The solution lies in individuals being sensitive sensibly. It is okay to cry in a movie theater watching a movie of pathos but it would not be sensible to bring the pathos into real life. It would but be natural and human to grieve over the loss of near and dear but it would not be sensible to stop enjoying anything and everything for years on in memory of the departed. The solution to coping with emotional burden lies in sensible sensitivity, which describes a holistic approach to understanding the root causes of emotional sensitivity and finding practical ways of coping with it, case by case. 

One important concept of sensible sensitivity relates to understanding the cause and response mechanism. Many times the anger that an individual has in response to criticism is not related to the criticism per se but more to the ego state of the individual. Understanding the self in terms of ego state and attachment profile is critical to minimization of adverse emotional burden. Another important concept is to apply oneself in areas where one has genuine interest. The level of interest in work facilitates a level of productivity and promotes a level of wellbeing. While it is not always possible to secure family and professional circumstances that are fully aligned with one’s interests, it is possible to choose a niche of interest that leads to a nucleus of satisfaction (like gardening in a family circumstance or mentoring in a professional circumstance). The third part of sensible sensitivity is an understanding and acceptance that, as with physical pain, a certain amount of emotional pain helps an individual operate within sensible limits of living. 

The pain signature

The foregoing leads us to consider a concept of individualized pain signature that expresses one’s threshold to pain, both physical and emotional. While at one level physical pain and emotional pain are correlated, particularly when they are chronic, they also can be viewed to occur independently. A person can have propensity to high and low levels of pain (recognition, absorption and tolerance), both physically and emotionally. A person who is low on both the counts could be insensitive to himself and his environment. A person who is high on both the counts could be a highly strung individual with significant and deleterious auto correlation between the two pains. A person who is low on physical and high on emotional could be execution-weak but intellect-secure. A person who is high on physical and low on emotional could be field-aggressive but people-insensitive. Unlike certain other grids, being stuck in the middle with an optimum balance could be the better option for a balanced life.

The pain signature is an important guidepost for any individual in the fast, technology-driven and stress-filled life of the times. While understanding one’s pain signature from biological and philosophical points of view is essential as discussed above, a day also may not be far off when there could be simpler and more accessible tools than fMRI to decode one’s pain signature. Wearable computers and services that track one’s thought and expression patterns as well as neurological electrical wave patterns could provide on-the-spot and on-the-dot guidance to individuals as well as their caretakers and mentors as the case may be.  Until then, and probably even after that, self-awareness on pain signature would be essential. The more aware and the more sensitive an individual is to his or her pain signature, the more he or she would be able to leverage it an aid to a well-balanced pleasurable life.

Posted by Dr CB Rao on April 26, 2014


1 comment:

Unknown said...

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