Chronic Pain

Tylenol, the New Mood Elevator?

http://pss.sagepub.com/content/early/2013/04/23/0956797612464786.full.pdf+html

It has long been known that Acetaminophen (Tylenol) treats pain. I give it to my daughter when she has a fever, or pain that is too much to bear. It is mixed into pills containing opioids in order to improve the pain relieving qualities of those drugs and it is known to have opiate sparing properties. That is, it relieves pain even when a stronger pain reliever is also being used.

Not all pain comes from the body. When you injure yourself, your brain and spinal cord go through changes that amplify your pain. This has some advantages for survival.  If you break your arm, the brain will make your pain feel more intense to encourage you to rest and let the broken bones knit. Acetaminophen will also relieve this type of pain and help prevent this amplification from occurring. It is a well established pain reliever.

In the study above, researchers found that acetaminophen doesn’t just ease physical pain. It eases psychic pain.  People who were given the drug before being exposed to emotional stress handled it more easily than those who weren’t given acetaminophen.  Pain doesn’t just come from the body; it also comes from the brain. The suffering that we feel is directly linked to the pain we feel. Things that ease suffering will ease pain and vice versa. It doesn’t have to just be a pill.

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Chronic Pain

Mood is Contagious

http://cpx.sagepub.com/content/early/2013/04/15/2167702613485075

I have discussed this topic in my book. It was noted by Paul Eckman that simply frowning all day left him feeling poorly. Dr. Eckman is well known for learning how to read faces. He spent his entire career describing what muscles were responsible for displaying a specific mood and conducted experiments in how to read mood by observing the expressions on someone’s face.  He and his colleagues noted that after spending a day displaying sadness on their faces, they actually felt sad. Simply expressing sadness on your face will change the way your brain is functioning.

Similarly, it has been noted in the literature, and also in my book, that botulinum toxin type A (Botox) injected into facial muscles has the potential to blunt feelings.  Being unable to frown or smile, because of the botulinum toxin that was injected to reduce the appearance of wrinkles on the face, left subjects feeling blunted as well. Again a link between how we look and how we feel.

Now the authors of the study above find that living with someone who is depressed can make you feel depressed, especially if you are prone to moodiness yourself. So the old saying “smile and the world smiles with you, frown and you frown alone” isn’t completely true. It should read “smile and the world smiles with you, frown and you can make the world frown too.”

Just as it has been shown that frowning and looking sad can worsen your mood and being depressed can be contagious, the opposite is also true. If you smile, you will feel better and smiling is also contagious.

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Chronic Pain

Seeing Pain

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1204471

fMRI is a technique that allow us to see inside your mind. Other studies such as CT and MRI let us visualize anatomy.  They take a snapshot of what the brain looks like. fMRI, on the other hand, superimposes an image of which parts of the brain are metabolically active on the anatomy of the brain.  This technique allows us to see which parts of the brain are thinking.  Keep in mind that the brain is active in a lot of ways that we don’t realize. When you feel the joy of victory or the agony of defeat, many parts of the brain are active to create those feelings.

With fMRI, we are able to see the brain in action. We can see what parts of the brain are active and by controlling what the subject experiences, we are able to see what parts of the brain are responsible for what experience.

Up until very recently, when someone told me they were experiencing pain, I had no way to confirm or disprove it.  I had to take someone at their word. Unlike a symptom with a sign I can see-like a rash, there is nothing to look at when someone is having pain.  Sometimes there is a broken bone that accompanies the pain that I can point to as the cause, but very often, figuring out what is causing the pain is not so clear cut and often I am unable to find anything at all to explain the symptom. Things are becoming much clearer now. In the case of pain, I can pinch you to induce it, or shock you to cause pain and then look and see which parts of your brain are involved in the experience of pain you feel from my pinch, or electric shock. This study demonstrates that it is becoming very possible to see experimental pain as it is being experienced. Soon we will be able to see any pain, not just experimental pain. Finally we will have a test to determine not just where the pain is coming from, but how much pain you are actually experiencing.

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