Pain is a thing nobody can escape. There is probably no person in the world who has never felt pain. Doctors, researchers, scientists, biologists for centuries have tried to understand this phenomenon and uncover mechanisms to control it. Descartes defined a pain as an alarm signal of some serious problem in the organism. It’s true because pain is not a separate phenomenon. In the most of the cases it exists in combination with other distinctions of an organism. There are cases when pain signals don’t tell about any kind of dysfunction. In these cases we talk about false alarms. Some specialists imply the term “psychogenic pain” to this kind of signals. This term is used in contrast to real pain. When the topic about the origin of pain is discussed, the question about perception and sensation appears. The International Association for the Study of Pain defines it as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (Merskey, 1986). From this definition we can see that pain is treated rather like perception than sensation. At the same time, the process of pain perception involves sensations, which are interpreted as harmful.
Perception of pain is real despite the harm has occurred or not in reality. It’s also necessary to mention about emotional consequences of pain. Sometimes they are not less important than physical ones. There is a separate branch of the sensory system, which is specialized on pain detection. The brain perceives the pain, but at the same time, the results of perception are influenced by the brain itself. Sensations we have don’t necessarily come straight to our consciousness and brain.
The main brain aims to choose and filter the sensory information that we perceive and to find out if it’s necessary or not. People can perceive or not perceive certain signals. We do not feel the weight of clothes we wear or pay no attention to the noise in the street until it attracts our attention. This means that our brain can filter sensations. The sensory pain system is very alike to the somatic sensory system. That is why some keys, received through the investigations of pain perception, can give a better understanding of the functioning of the sensory system in general. At the same time, there still is a difference between these two systems. When the stimulus is a pain, different kinds of neurons come into action. These neurons are sometimes defined as nociceptors because they react only to hurtful stimulus. Nociceptors are activated only after some limit is overcome, and there is a danger for the organism. Also, these kinds of neurons protect damaged place sometime after the trauma. That is the reason people feel pain for some time after the damage. This is a protective function of the organism to escape reinjury.
Research and experiments show that the level of pain sensation can be regulated by the nervous system of an individual. People, who are in the state of stress or, vice versa are very calm very often feel less pain than those, who are irritated or expect pain. This different level of pain perception became the basement for the so-called “gate control theory,” introduced by Melzack and Wall in 1960. They stated that inputs from ordinary somatic sensory neurons made inhibitory inputs into the nociceptive neurons of the second order in the spinal cord. In this way, they block the transmission of the sensory pain information. Neurons made inhibitory inputs onto the second order nociceptive neurons in the dorsal horn of the spinal cord, thus blocking, or at least inhibiting, the transmission of sensory pain information (Melzack). This is one of the possible explanations of the reduction of pain caused by the rubbing of the hurt place.
Gate control theory was very popular during the long period. Finally, the data collected with the help of this theory gave birth to the new one. There is evidence which supports this theory and proves thesis put forward by Melzack and Wall, but there is some data which doesn’t fit this theory. It doesn’t contradict it but requires some amendments to the existing one. There is no doubt that peripheral and spinal processes are important components of the mechanism, which is responsible for the pain. Their further study can give us a better insight into the mechanism of pain. New data about the peripheral inflammation, midbrain descending control and spinal modulation can expand the understanding of pain. But there is information about painful phantoms and this information is below the level of the total spinal section. The new theory about the functioning of the brain explains the nature of phantom pain. Phantom pain occurs when people feel pain in the parts of the body, which were amputated. For example, patients can feel burning, cramping or some other kind of the pain in the amputated leg or arm. Statistics shows that more than 70 percent of the patients after amputation feel this kind of pain. This pain is hard to treat, as it has no physical nature. The nature of this pain can be explained by the study of the brain mechanisms.
An attempt to remove sensory areas of the cortex to decrease phantom pain showed that pain didn’t disappear. Newest’s theory (Whit, Sweet), which states that there are areas responsible for the pain reactions all over the human brain explain this failure. That is why the removal of separate parts of the brain cannot stop the pain sensations. Deep and detailed study of the different areas of the brain and searching for the connections between these areas and pain mechanisms can shed light on this phenomenon and give possible ways to treat phantom pain. It means that the tools of pain and the way they influence human brain need a more detailed study (Melzack, 1989). So, the future of treating pain can be determined by new data collected from the way to influence pain. The spinal projection systems do not lose their importance, but brain reactions should also be considered. Such specialists as White and Sweet give an assumption that cortex and thalamus aren’t the centers responsible for pain reactions. There are other parts of the brain, involved in the process of experiencing pain and pain behavior. These areas are responsible for somatosensory projections and limbic system. Body perceptions include visual and vestibular mechanisms and cognitive processes.
It means that the number of brain areas responsible for the pain perception is bigger than it was thought before. Unfortunately, the mechanisms of the brain are not uncovered yet. This understanding of the nature of brain is a clue to the knowledge of the pain mechanisms and new data in this area will give new opportunities for the pain treatment. New facts achieved with the help of new science called cognitive neuroscience prove this hypothesis. Of course, the meaning of spinal cord and midbrain descending systems shouldn’t be underestimated, but the perspectives discovered in the field of brain reactions are stunning.
Different people have the mixed reaction to pain. It’s still a vague question about the reasons, which cause this difference in perception. Latest research shed light on this difference, though.
The number of scientists believes that fear and anxiety have the significant influence on the process of pain perception. It influences the type and extensity of pain. It means that if we center on the aspect of fear about pain and learn how to deal with it, we will be able to influence pain. Different anxiety levels and different levels of pain fear provide different reactions to pain. The study traced great correlation between brain activity and pain perception. The pain was stronger in the cases when right lateral orbital frontal cortex was active. This area of the brain is responsible for fear. It means that fear added unpleasant sensations and made the pain stronger. Even different types and anxieties about the pain can cause the difference in its perceptions. For example, if the person is afraid of physical pain, the reaction can be different from the case when a person is more afraid of some incurable disease, like cancer. These new findings give a lot of food for thought as codependence of pain and fear provide an opportunity to influence pain by influencing fear.
Expectations of pain and pain perception made research think about the influence of brain on the pain intensity.
Placebo effect proves this thesis. Innocuous drugs can cause the reduction or even disappearance of pain. This is a so-called placebo effect. In the series of experiments when people were given water pills or made and injections of physiological saline, the results showed the reduction of pain sensation for about 25 percent of individuals. The expectation of relief caused by the taking medicines turns to be more important than the medicine itself. All these research and experiments give only additional proves of the importance of the brain mechanisms responsible for pain perception and interpretation.
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