1. The secret life of pain: Central Sensitisation makes brain addicted to pain long after injury is healed

The secret life of pain: Central Sensitisation makes brain addicted to pain long after injury is healed

Studies have shown, for example, that people can develop a general hypersensitivity to pain after an injury a condition called central sensitisation that can persist long after the injury has healed.

Published: August 6, 2017 3:03 AM
The brain becomes addicted to dramatising pain; and the more you feed it, the stronger the addiction.

David C Roberts

Five years ago, I still lived a double life. I was 35, looking out over the Gulf of Thailand and a few weathered beach tenders. Inside, where dark suits filled the conference room, I could feel the eyes of my fellow diplomats. No doubt they were wondering why I was sitting on my briefcase. “My nuclear codes,” I joked to no one in particular, trying to deflect awkwardness. The case actually concealed an orthotic sitting cushion that muffled the pain in my lower back; without it, silent shrieking was all I heard. Or maybe they had noticed I was the only one sweating. The air-conditioning tempered the tropical heat, but it was no match for the corset heat wrap that lay discreetly under my tailored suit. Over the previous decade, I had become adept at hiding the unexplained pain that racked my back and joints. To all appearances, I was a fit 6-foot-3-inch man with an easy gait. No one in that conference room knew my suit pants disguised a lace-up ankle brace and a strap velcroed around my left knee.

Nor did they know that during breaks I would sneak back to my hotel room where my wife, an artist who moonlighted as my one-person pit crew, waited to press my quadratus lumborum muscle back into submission. I lasted through that meeting as I had through countless others. But in the months that followed, sitting and walking became increasingly difficult. I started to stand during meetings, avoid plane travel and take motorcycle taxis to go just a couple of buildings’ distance. Eventually, I let the doctors at the embassy in on my secret. They deemed me unfit for work and medevac’ed me from Bangkok back to the United States for treatment. I left quickly, without awkward explanations or goodbyes.

It turned out that my salvation had always been within reach. But, it took an agonising series of flights to the Mayo Clinic in Rochester, Minnesota, to find that out. For a month, the doctors there pushed, prodded and ran their tests. But they found nothing remarkable. They had no fix. Out of options, I joined the other no-hopers at Mayo’s pain rehabilitation center. There, chronic pain, unlike the acute variety, was treated as a malfunction in perception, whether or not an ongoing physical cause had been identified. The brain becomes addicted to dramatising pain, they said; and the more you feed it, the stronger the addiction. So don’t dwell on the pain, and don’t try to fix it — no props, no pills. Eventually, the mind should let go.

I was skeptical at first. But the more I learned about chronic pain, the more sense it made. Studies have shown, for example, that people can develop a general hypersensitivity to pain after an injury — a condition called central sensitisation — that can persist long after the injury has healed. Other research demonstrates that the neural activity triggered by a given physical stimulus can vary greatly among individuals; what some find unbearable, others register as only a mild annoyance. “Pain is an interpretation by the brain,” explained Wesley Gilliam, the center’s clinical director. For me, buying into the Mayo pain program meant giving up my braces and straps and, with the greatest reluctance, my sitting cushion. Without it, I shifted constantly in my chair, “bucking like a rodeo horse,” observed a clinic hand.

For the guy sitting next to me, a former college football player who talked like Earnest Hemingway and grew up treeing mountain lions with his forest ranger dad, it meant giving up the opioids he’d become dependent on after his spine had been messed up by an unlicensed quack. Seeing his transformation gave me hope of finding a path forward. Although I had known that a third of Americans were afflicted with chronic pain, more than cancer, diabetes and heart disease combined, it was only at this point that I started to shake my sense of isolation. Stripped of my props, I tried one of the clinic’s suggestions, to turn my mind toward my breath. As someone who had grown up on creamed corn and chicken fried steak, this conscious breathing — what hippies call meditation — was a brand of new age hooey that I couldn’t easily stomach. But even after I left the month long programme, I worked on making it a daily ritual. And gradually, I could feel my relationship with the pain change. As I sat and concentrated on my breath, flickers of awareness began to emerge like a picture through the snow of an old TV set.

After a month or two (and I never missed a day), I was able to step back and note, like a disinterested observer, how it felt like a tiny creature was gnawing its way out of my hip socket, or how my organs seemed to be stirred by a ladle through my back. Then, after several months, I noticed that these sensations rose and fell; the constancy of the aggression had been a fantasy. Emboldened, I took my wife to a matinee one lazy afternoon — my first time in a movie theatre in years. Surprised that I had sat for such a long stretch, she broke one of Mayo’s commandments and blurted out:

“Does it still hurt?”

A few seconds passed before it slowly came back into view: a deep ache in my right hip, a burn dancing between my ankle and outer foot, a slow chewing in my lower back. The old panic rose. But this time I didn’t try to attack or run, and it didn’t bark or bite back; we simply eyed each other warily. “Yeah,” I said curtly, afraid that the truce would not last. Yet somehow, it has. Today, not quite three years after being medevac’ed, I not only look the part of a healthy man but manage to act it too: hiking Great Gable in the Lake District and neighbourhood hopping around New York City, though admittedly I tend toward yoga, swimming and epic walks rather than the macho sports of my youth. My wife tells me I sit “like a champ,” but we avoid talking about how the pain still shadows me, though at a greater distance. And while I haven’t thrown out my props, they are carefully boxed away in my closet, out of view. NUT

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