Pain is an extremely complicated thing. I assume most of you reading this do not think of pain as complicated. What's so complicated? I hit my thumb with the hammer - it hurts. I stub my toe - it hurts.But what about those soldiers in the field (right at this very moment, perhaps), wounded in battle but not experiencing the feeling of their pain, in order to help out their buddy? At the other extreme, what about those who have lost limbs in some accident or bombing (also, sadly, probably at this very moment), only to continue with pain where the lost appendage used to be (known as "phantom pain")?
The truth is we have very few complete answers. We have some for sure, but we definitely do not have all the answers. A comprehensive definition of pain could be this: an emotionally driven response to adequate stimulation of pain fibers. This definition, though simple and obvious to some, covers many bases. First, it acknowledges that our perception of a situation may very well alter our perception of pain. So, the soldier tending to that wounded buddy does not have the time to worry about his injuries; he does not perceive his pain until his adrenaline levels lower and his brain can focus on his own system.
This is a very important example in that a brain, properly fired, actually will suppress pain perception. This occurs, of course, within limits. I would rather not hit my thumb with a hammer, even though I may have a good brain (I like to think). A weak brain, however, will be less likely to be able to suppress pain responses at a higher level. The other side of this is that a very weak brain, such as someone in a deep coma, may not be able to perceive pain at all, regardless of the pain stimuli presented. (See the commentary at the end of this article.)
Phantom pain is a whole other story. The brain perceives pain in a limb that no longer exists. V. Ramachandran did some very interesting experiments regarding this phenomenon. He found that if a person missing a limb and experiencing phantom pain was allowed, with mirrors, to cortically perceive that limb was still there, the pain would stop. The implication was that the brain was generating the pain response simply to figure out where the limb was. If I hit my thumb with the proverbial hammer, besides some very bad words coming out of my mouth, I probably will shake my hand vigorously back and forth (movement inhibits pain) and perhaps rub it and kiss it (don't knock it until you try it) to make it feel better. (Mechanical stimulation at an injured site also inhibits pain at the level of the spinal cord.) If the brain realizes it is missing a whole limb, it may generate pain signals simply to get the person to "tell it where it is." Even more interesting is that, after a time, it seems the brain gives up and uses that brain tissue for other areas of perception. There was another case of an amputee who would actually "feel" his lost hand when certain parts of his face were stroked (the face and hand areas are next to each other in the brain).
This whole dialogue opens up a completely new world for those suffering from pain, particularly chronic pain. The first questions that need to be answered are:
- Does my pain have to do with a slow-firing brain? If so, how can I fire my brain so I can inhibit my pain?
- Does my pain have to do with an increased firing of my brain, in which case, what do I have to do to inhibit my pain?
This is where understanding the clinical concepts of hemisphericity and transneural degeneration become very important. Explaining the concepts of both would be way beyond the scope of this paper, but understand that there are times when the brain fires too much and thus, we may perceive pain when normally there should be none (allodynia), and there are times when the brain will fire too slowly (hemisphericity and various other brain disorders, including depression) and we will experience pain as a case of the brain trying to maintain its own connection to its body and the world around it.
The treatment, of course, will be opposite. For an irritable, highly sensitive brain, the worse possible thing you can do is to adjust that patient aggressively and subject their systems to many therapies and stimulatory treatments. These patients will benefit best from relaxation techniques, nutrition to increase circulation to the brain (the seeds for a future article - a "fed" brain is a happy brain) and low-force adjustments. The hemispheric brain, however, would very likely benefit from a strong coupled adjustment to the appropriate side, and will feel an immediate relief as opposed to the mild and soft treatments to which they have been subjected.
The concept of what comatose people can or cannot perceive is open to debate. There are those who have emerged from a deep coma and stated they felt everything and heard everything around them while they were in their coma. The ability to perceive sensations was intact; it was the ability to react to those sensations that was hampered. In our arrogance in assuming we know more than we do about the brain, we take for granted that these poor patients have no idea what is going on around them at any given time. Dr. Carrick had one particular patient he brought out of coma who stated he not only felt everything around him in the six years he was in a coma, but also that after he came out, he could recount to the day who had said things and done procedures to him with, let's say, less compassion than perhaps they should have. As this patient had been a powerful head of state, many people, particularly a few physicians, got in big trouble for assuming the patient's brain damaged his ability to perceive.
Dr. Edgar Romero practices in Miami. He is a diplomate of the American Chiropractic Neurology Board. For questions or comments regarding this article, contact him at