A wide ranging interview with Dr Natasha Curran, Consultant in Anaesthesia and Pain Medicine at University College London Hospitals, and Professor John Wood, a neuroscientist at UCL, in the latest episode of The Guardian’s Science Weekly podcast. Listen via the website or via iTunes.
Interesting to hear Professor Wood, whose work “combines recombinant DNA technology, electrophysiology, gene targeting and behavioural approaches to explore the channels, receptors, transcription factors and regulatory pathways that control nociceptor excitability” explain that while quite a bit is known about (for instance) the molecular behaviour of nociceptors, we really have no idea how the experience of pain actually occurs – “there are various parts of the brain which have been correlated with the experience of pain, but this is very, very weakly done…“
Worth a listen.
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Thanks for the link. Fascinating insight into the latest thinking on chronic pain. I was particularly glad to hear that the Neuros are now interested in ‘low-dose’ opioids as stimulants for increased natural production of endorphins. This process is already being tested in LDN (Low-dose Naltrexone) treatments (see http://www.ldnresearchtrust.org/) for auto-immune and other conditions, although, as stated in the podcast, because Naltrexone is out of patent, the pharma companies are reluctant to fund research because of low profit expectations. The theory behind LDN treatment is that by prescribing LDN over a few months, the subsequent increase in endorphin production helps to stabilise the worst painful symptoms, and this allows the immune system to re-establish its normal protective functioning. There have recently been signed petitions to the British and Scottish Parliaments for LDN research funding, but I’m not sure what the outcome has been. if any. I think it’s good to hear that the Neuros at UCL are becoming aware that low-dose opioids might have a significant role to play in control of future chronic pain for many conditions.
On the other hand, it still doesn’t address the ‘missing link’ between the pain event and consciousness. Treatments that work in the ‘awake’ state are really only half the story. Although LDN might seem to encourage greater endorphin production whilst asleep, and sleeping is a requirement for the process to work, the entire equation is seemingly reliant on both ‘awake’ and ‘asleep’ states achieving a synchronicity which allows natural endorphin production to increase….apparently, too much, or too little, prescribed Naltrexone can have negative effects. Further testing is required to establish correct dosages for different conditions. On the plus side, the dosages are so tiny (one thirtieth of normal Naltrexone dose as prescribed for opiate withdrawal symptoms) there is little chance of misadventure. I have, personally, witnessed a MS sufferer whose painful symptoms went into almost complete remission on prescribed LDN treatment, and that, alone, encouraged an interest.
Some good points Ger.
Low dose opiates are probably saving a lot of lives. I was just reading a study this morning*, which looks at how low dose buprenophine effectively bolsters self-image. Further evidence that self and pain are linked.
Clinically, membrane stabilizers seem quite useless, and anti-depressants only midly effective for chronic pain. I’d never discourage anyone from considering low dose opiates if they were in real strife.
Probably no doubt that pain and self-image are linked. Maybe some dispute over which comes first in any equation i.e. ……does pain diminish or undermine self-image ?, or can a confident self-image increase pain toleration levels or even cause less pain to register consciously ?. Both are difficult to define by virtue of the subjective nature of both. I tend to see them both as inhabiting different realms of consciousness, one an internal illusion of self, and the other an externally instigated perception, and that would seem to make their relationships and interactions tenuous or ephemeral.
A confident self-image is usually almost completely reliant on a robust healing expectation overview. That’s not always apparent…..but without such a confidence, wouldn’t we all be perpetually anxious about the slightest injury or infection. And anxiety and a confident self-image are polar opposites. Pain causes anxiety where there is any doubt about healing expectations, and self-image will suffer accordingly. Self-image, being a conscious construct, can obviously be manipulated, but I’m not sure it can be manipulated to the point of creating an unquestioned purpose that might result in less pain. Greater toleration of pain doesn’t necessarily equate with a lesser chronic pain perception……although it can serve well as a perceptive distraction.
However, having said all that, and being a bit of a history buff, I have to say that in the many personalised accounts I’ve read of horrendous executions, battle injuries etc, it’s quite remarkable how little attention is given to subjective suffering. It would seem that the dominant mindset of the time was dismissive of such trivialities, to the point where they were forever inventing new excruciating horrors to match the resilience to extreme pain. Quite odd really, when compared to today’s squeamish tolerant society. There must have been some communally accepted understanding of super-resilience which was self-convincing to each individual. But, glad things have moved on !