Pain matter sensation texts the who

A new understanding of pain

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Even 250 years after the first systematic experiments with pain medication, there is apparently still no satisfactory pharmacological answer to the challenge of chronic pain. Today more is in demand than just the next active ingredient. The way out could be a new understanding of pain.

The popular image of pain is still based on ideas from the 17th century. At that time it was assumed that pain works according to the principle of the ringing bell: If a nerve fiber is stimulated anywhere on or in the body, the signal reaches the brain via a nerve path, where the alarm bell rings. The mechanistic concept was followed by mechanistic therapeutic approaches: drugs or operations should interrupt the line and thus switch off the bell signal. In principle, doctors still treat this way today, and their patients find it plausible. There has long been a modern pain concept that not only targets the physical causes of the symptom, but also includes the psyche and the social environment.

Infobox pain theories

The evolution of pain theories: simple alarm

The French philosopher René Descartes developed the idea of ​​pain as a bell at the end of a long one in 1632 Bell pull. This mechanistic model shaped our understanding for centuries.

Signal brake

In 1965 Patrick Wall and Ronald Melzack published the theory that the brain also sends signals back to the spinal cord. in the Hinterhorn, where the nerves emerge between the vertebrae, this one can Return channel dampen the pain signals.

Pain web

Many areas of the brain contribute to the subjective sensation of pain. A stimulus reaches the gate of consciousness, the thalamus, from the dorsal horn in the spinal cord. From there, the signal reaches the sensory cortex (S1), which registers the location and intensity of the stimulus (Nociception). At the same time, the insular and anterior cingulate cortex (ACC) receive the information and color the stimulus uncomfortable emotions a. Under this influence, the amygdala fuels them Fear. All preliminary evaluations converge in the prefrontal cortex (PFC). There the pain becomes conscious; We decide what to think of the stimulus and how we react to it. The result of the analysis from PFC and amygdala is implemented in Cave gray (PAG). From there, nerve fibers run to the rear horn and can slow down the pain signal.

According to this concept, pain is primarily the result of its evaluation by the brain. The strength and localization of a stimulus are included in this analysis, as are the accompanying emotions, experiences and the conscious interpretation of the stimulus. We feel an unwanted injury more unpleasant than the deliberate stab of a tattoo needle or the targeted lash of a dominatrix.

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Pain, as one could summarize the state of research, is the result of a mental risk analysis: the more threatening a stimulus appears to us, the more it torments us.

But that also means: pain is an extremely subjective sensation. What drives one up the wall, the other may find stimulating. Pain and pleasure are closely related. Marathon runners are often left with a feeling of happiness (the runners high) rewarded; Masochists achieve orgasm thanks to pain; and apparently even the hottest Mexican chilli soups can be delightful. These high feelings are possible because pain is a teacher who not only knows the stick, but also the carrot - in the form of so-called endorphins.

The body's own messenger substances are always released in the brain when we have a positive learning experience. "Nature has placed mankind under the rule of two sovereign masters: pain and pleasure," wrote the 19th century British philosopher Jeremy Bentham, the founder of classical utilitarianism. That means: harmful actions are punished by pain, successful ones are sweetened with a pinch of endorphin. Above all, the ebbing of unpleasant experiences is seen as a reward. Wonderful when the pain subsides.

This is exactly what modern pain relief makes use of: Instead of simply trying to turn off negative emotions, it specifically tries to stimulate positive emotions and thus boost endorphin production in the brain. The experience that a spicy soup does not poison us, but releases messenger substances in the brain that give us a feeling of wellbeing, is a successful game with the teacher pain. We are happy to accept the spiciness because it makes the taste of the food more intense.

The decisive factor is the balance of emotions. The prospect of success allows us to endure all kinds of torments: Even the terrible pain of childbirth soon gives way to joy when the newborn is in the mother's arms. "Pain is not always dangerous," says the Norwegian psychologist Siri Leknes, who studies possible positive effects of pain in her laboratory. She observed that students even found moderate stimulation pleasant after a strong pain stimulus. For the psychologist, the picture of pain as a categorical torment is incomplete and in urgent need of correction. "That doesn't go down well at all in the pain scene," she says. "It is believed to be disrespectful to people with chronic pain."

But how can the uncomfortable pain be turned into a bearable experience? The first thing in therapies is to overcome the feeling of helplessness. The fear of it can be even worse than the pain. Anyone who feels themselves to be a victim of pain and who fearfully registers every pinch becomes a hostage to torture. However, those who experience themselves as actors, who can consciously influence their pain perception, are far better off. Just knowing that pain occurs in the head and that not every sting represents threatening physical damage can alleviate the pain. Strategies of modern pain therapists try to regain control of the pain sensation to the patient. In the case of acute pain, for example, it helps to specifically distract the brain from the unpleasant stimulus.