Beautiful end-of-century horizon
“No one should suffer anymore!”. The scoop dates back to the 1990s. Philanthropism or marketing operation? I will discuss this in a complementary article. People are encouraged to dispossess themselves of their pain, take it to the doctor. Waiting, confident, that he will reduce it to ashes. Some traces would have been preserved between the pages of a medical notebook, in memory, and in order to track his possible rebirths.
People would have left completely lightened with a huge weight… the weight of life? And behind it, in the shadows, the specter of Death? The one that adds the unbearable moral pain to physics. Death, great judge of the success of our lives.
Is talking about ‘dispossession’ for the disappearance of pain provocative? To judge what we lose, let’s start with the most basic of questions:
What is physical pain?
Pain is information as unpleasant as it is essential to our body. Congenital insensitivity to pain is a disease that severely shortens life expectancy. ‘Pain’ information passes through sensitive endings to consciousness. It crosses several stages of treatment, biological, reflex, interpretive, conscious. Each stage can be pathological.
The term ‘pathological’ is used especially for the first levels. The physiology of pain, biological and neurological, is quite close from one human to another. Not completely. Genetics already causes variations in sensitivity. But the similarity is enough to establish a ‘normality’, therefore pathological deviations.
Psychological, cultural and social treatment
By climbing the pain signal processing pyramid, the differences between “normal” individuals are accentuated. Their education did not form the same reflexes. Contrasting lifestyles. Cultures sometimes have opposing discourses about pain. And above all, the level of social protection can degrade or enhance the status of painful. Catastrophe for some, return to grace for others.
Arrived at the conscious level, it is difficult to say the pain ‘normal’ or ‘pathological’. This involves judging the person’s resistance to pain, their morality, their personal history, the secondary benefits they derive from it. The doctor switches from a diagnosis of disease to personality. This is not what the patient came for. He is offended. Quickly returns to the presentation of its symptoms. “Get rid of my pain, the rest is just for me!».
Nociceptive and neuropathic
Easy to satisfy request for nociceptive pain (related to physical damage). A simple tablet of paracetamol is already effective. Unfortunately not all pains are nociceptive. None of them are exclusively. And chronic pain is very little. The ‘excitement of sensory sensors’ part has become insignificant. It is the neurological treatment that is disturbed.
The task of the chronic pain specialist is to go upstairs. Investigate the treatment of your patient’s pain, step by step. He gladly does this up to the so-called ‘central’ ways of pain, because he still has effective drugs. On this stage the pain is called neuropathic. Nothing is visible at the site of the pain. On the other hand, the eloquence of the patient is great. It describes burns, flashes, contractions, tingling, cardboard skin, insensitivity contrasting with hyperesthesia on contact, etc. A universe of unpleasant sensations from which the person has trouble getting out. She can talk about it for hours if she finds a listening ear. Feels neglected if the doctor interrupts her too quickly.
Let’s remove the big hooves
The neuropathic stage does not signal the end of the pain investigation. Unfortunately, above, it becomes conflictual, poorly codified, very dependent on the empathy of the doctor and his delicacy to set foot in the intimate places of the psyche.
Too many therapists ignore an elementary precept: When the pain had a physical origin, when it has started on a specific place of the body, this is where it is necessary to enter the patient. Even when suffering is fully perpetuated in the psyche. The person, in presenting his symptoms, holds the door open in this place, and often closes all the others.
Take what is handed to you
Practical consequence: difficult to climb into the psyche without being a good physical doctor! Basic techniques of analgesic counter-stimulation are essential. Many specialties revolving around pain offer: osteopathy, acupuncture, mesotherapy, physiotherapies for physiotherapists. This is why the painful is more easily indulged in confidences to these therapists than to prescribers of tablets.
We come to the upper levels: the awareness of pain. Psychotropic drugs are a very poor help. Instead, they block access. By being an easy refuge that discourages climbing, both the doctor and the patient. And by confusing the consciousness of the main interested party. She becomes less efficient to examine her past life, her destiny, the impact of the disease.
What discourse should be attached to this consciousness?
I’m right in it, in case you haven’t noticed! The article is too complicated for your feet 😉 The consciousness of a chronic pain has a very bad opinion of pain. It must convince itself once again of the unwavering interest of the painful signal.
It is vital for our body physiology to maintain a range of stability. Sensory signals ensure a correct response to incidents, accidents, external aggressions. All of them are important. Pain is one of the basic alerts. This is quantitative information certainly (the doctor evaluates it with a scale of 1 to 10), but also qualitative: The pain has different “flavors”, comes from different places, has a history. Less complex than visual images, it is easier to process information effectively. The crudest of animals is capable of this. Survives through pain. Decisive signal in behavior, when a host of choices constantly presents itself. More than impediment, it is a selector of action. To deprive oneself of such essential information is to put a blindfold on one’s eyes.
Remake the tyrant a sophisticated servant
Assessing pain with a slider graduated from 1 to 10 is too reductive. The person who experiences it perceives a rich palette of its variations, according to minute changes in posture, orientation of movements, corrected habits, alternations from one side to the other, retraining efforts. It should be encouraged to refine these perceptions, not to reduce it to a number or a questionnaire.
The most difficult thing is to appropriate the investigation of the psychic stages of pain. Felt as blows against personal identity. This is not wrong. But if the body has healed or regained health, that it is no longer directly responsible for this intolerable pain, does it not deserve a psyche that corresponds to it? Our identity is in this body as well. An inappropriate perception of pain assaults it, deteriorates it. Consciousness is an arbiter. Charged with saying who is right or wrong to complain. Do not chain oneself in an altered perception.
Retro-control instead of aggression
A convincing evidence of pain staging is analgognosia or asymboly to pain. The person perceives the pain but does not feel the emotional component. Neither pleasant nor unpleasant, information is no longer incentive. Lost connections to the upper levels, in the networks of the insula and parietal cortex. Should we propose to the painful chronicles the destruction of these connections, a characterized bodily aggression? Or encourage consciousness to improve its retro-control?
Note that I didn’t say ‘control’. Pain is not controllable. That would be to deny its existence. impossible. Even if it no longer has a physical origin, or hardly anymore, its mental intensity is very real. Constitutive of the conscious experience of the painful. No hope of ejecting it. You have to accept its presence.
Back-control is something else. Consciousness can change the weight of its contents. It does this thanks to its characteristic property: attention. Attention reinforces the presence of mental content and diminishes others. Reducing the impact of a celebrity such as pain is not easy. You need the presence of equally moving challengers.
Second fundamental precept
Chronic pain is not treated with painkillers but with competitive pleasures. The life of the painful is deserted by other sensations. Attention is entirely devoted to the pain signal. Which decides everything. Which avoids any enterprise. Under the pretext that it could be amplified? Passivity never makes it disappear. Passivity is thus revealed as an ally of pain. It includes unnecessary actions: taking an ineffective drug, describing for the thousandth time the same symptom, exhausting the patience of loved ones, yelling at the helpless doctor!
To reconnect with pleasures is already to allow oneself. Does the painful allow them? Does she have a good enough opinion of herself? Which closet should she get out of? What disastrous labels should she get off?
The ‘pain-otherwise’ centers
Pain centers have understood the need for alternative sensations. They have broadened the spectrum of care: music therapy, art therapy, gentle gymnastics, group therapy. Hypnosis? When attention cannot be diverted from the pain, it is better to erase it.
Nevertheless, medicine quickly reaches its limits in terms of providing pleasures. Cabinets are not brothels. Associative environments are the essential relay of care. To find qualities in one’s pain is to socialize it, to compare it, to philosophize it, to judge it more dramatic in people physically or psychically more dilapidated than oneself.
And sometimes find a different passion around pain, taking care of it in others. The great wounded make the future great caregivers.