Posts Tagged ‘cold pressor task’

Our Dangerous Fear of Pain

January 10, 2020

The title of this post is identical to the title of an article by James D. Hudson in the Outlook section of the 1 December 2019 issue of the Washington Post. He writes, “It’s good to have a healthy fear of pain. It protects us from injury and reminds us to allow time for healing. Acute pain can be made more tolerable by a short course of opioid medication (the Centers for Disease Control and Prevention recommends only three to seven days, even after surgery or injury). And there is a good case for opioids over longer periods to treat end-stage cancer and other terminal ailments that can bring unbearable suffering. Palliative care in those situations is almost always necessary and compassionate.”

Dr, Hudson continues, but otherwise, the fear of pain, and the belief that a pain-free existence is optimal or even possible, has been a catastrophe for patients. Before the opioid revolution, doctors understood that pain was important to keeping us safe, to be lived with and managed. Even if this meant we bore frequent episodes of discomfort, that was better than the nationwide crisis America faces today. “Life isn’t ‘pain free.’ If we want to end the epidemic of addiction, we need to relearn that lesson.”

The opioid industry bears the ultimate responsibility for this epidemic. It did heavy lobbying of legislatures and of physicians. According to a study in the journal JAMA Network Open, this marketing correlated with overdose deaths. The CDC has thoroughly-documented the rapid rise in opioid prescriptions and deaths since 1999.

Dr. Hudson writes, “many doctors listened to the marketing campaign. In our hubris, we began to think we had the capacity to banish chronic pain. Pharmaceutical companies were developing ever stronger and longer-lasting opioids, and surgeons were replacing more and more worn-out joints. New techniques meant the pain anesthesiologists could block nerves, sever the signals to the brain, and insert catheters or electrodes into spinal columns and brains. Pain was to become a thing of the past, conquered by modern medicine.” This could have been true, but they ignored the addiction problem.

Obviously patients did not benefit. So who benefited besides the drug companies? “Physician experts” compensated by drugmakers hawked these medications at conferences, telling doctors that new and more potent analgesics were not addictive when prescribed for pain. They said that there was no upper limit on dosing, that patients would develop tolerance to medication and that some would need extremely high doses for their pain. But they said that physicians were not to worry, that this was normal. A new unsubstantiated ailment called “pseudo addiction” was offered as an explanation for patients who ran out of pills early and borrowed more from friends and family or got their drugs on the street. There is no such thing as pseudo addiction, only real addiction.

In addition to the drug companies, many got rich. There were new business opportunities. Physicians and health systems benefited from an explosion of diagnostic testing with CT and MRI scans. Unethical medical practioners were opening “pill mills,” often taking only cash for almost unlimited amounts of addictive medications with no real attempt to make a diagnosis or assess the need for such prescriptions.

The Medical Group Management Association, reported that anesthesiologists who specialize in pain management earn almost $530,000 on average annually, making this a lucrative speciality. By comparison, primary-care providers make less than half this (while the average physician makes $300,000).

Fortunately, the medical profession is maturing in educating patients about pain management However, the article makes no mention of hypnotism or meditation.

One of the most impressive surgeries HM has read about is the surgical removal of a scrotal tumor while the patient was under hypnotism.

Some research on pain perception has used buckets of ice water. This is called the cold presser task. It becomes extremely painful fairly quickly, and participants feel a need to pull their arm out of the ice water. During these experiments the participants make ratings of their pain. While hypnotized, participants were able to provide consistent ratings of their pain perception and they were able to keep their hands in the ice water at ratings they would have felt forced to pull their arms out. In fact, the experimenter had to tell them to remove their arms before tissue damage occurred.

Highly skilled meditators actually focus on the pain, but reinterpret it. Most of us deal with pain by trying to ignore it and think of something else. But if one is an experienced meditator they are likely to focus on the pain and reinterpret their perception as not being of pain.

© Douglas Griffith and, 2019. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and with appropriate and specific direction to the original content.

Pain and the Second Dart

October 16, 2016

This post is taken in part from “Siddhartha’s Brain”  by James Kingsland.   The Buddha used two darts as a metaphor to understand how to deal with pain.  “It is if a man were pierced by a dart and, following the first piercing, he is hit by a second dart.  He worries and grieves, he laments, beats his breast and is distraught.  So he experiences two kinds of feeling: a bodily and a mental feeling.  Someone who has not been taught how to cope with painful sensations resists and resents them.  The only way he knows to escape the suffering is by distracting himself with sensory pleasures, which come with dangers of their own attached.”  On the other hand, he said, “ a well-taught, noble disciple, O monks, when he is touched by a painful feeling he will not worry nor grieve and lament, he will not beat his breast and wail, nor will he be distraught.”  So even if the first dart had found its mark, the second one could no longer hurt him.

The developer of Mindfulness Based Stress Reduction (MBSR), Kabat Zin, learned as a young man enduring grueling Zen meditation sessions is that if you can turn your full attention on pain without pursuing the emotional narratives that usually accompany it, you suffer much less as a consequence.  He teaches this skill to patients with chronic pain.  He says, “We don’t just tell people, ‘accept it and it will be okay.  But paradoxically when you begin to befriend your pain—move into it, embrace it, hold it in awareness—you begin to see that the suffering lies in thinking ‘this is going to last forever’ and ‘it’s destroyed my life, I’m never going to be better again.’  That’s not actual pain, those are just thoughts.” He admits that this change in perspective is a challenging thing to ask of someone experiencing debilitating pain, but he says the key to reducing suffering associated with an intense sensation is to turn toward it rather than try to run away from it.  “That’s where the rubber meets the road.”

In 1982 Kabat-Zinn published the results of the first clinical investigation into the efficacy of mindfulness meditation for easing chronic.  The 51 patients who participated in this study were experiencing various types of pain, mostly lower back, neck and shoulder pain, and headache.  After completing a ten week course, 65% saw their pain reduced by more than a third when scored on a standard index the combines pain intensity and unpleasantness.  For half of these patients pain ratings had fallen by more than 50%.  The changes in the patients’ ability to cope with their pain were accompanied by significant improvements in mood and psychiatric symptoms.

Since then there have been thousands more studies with clear benefits established for pain, stress, and anxiety.  The program has also been successfully adapted to prevent relapse in depression and to treat addiction.

These findings reminded HM of similar finding in hypnosis research.  In the cold pressor task, a participant’s hand is immersed in ice water.  This quickly becomes very painful and participants have difficulty keeping their hands in the ice water.  The participants are also asked to provide ratings of the pain.  However, when given hypnotic suggestions, participants are able to keep their hands immersed, while also providing the pain ratings that were comparable to what they were when they were not given hypnotic suggestions.  Apparently, they were able to reinterpret the pain so it was much less distressing just as in the situations described above.  Some people have even undergone surgery while under hypnotic suggestion.  In the most impressive example of which HM is aware, a patient had a tumor removed from his scrotum while hypnotized.

The following are instructions for Open-Minded Guided Meditation that were provided at the end of the Second Dart Chapter.

“A great way to return your mind to its “ground state,” neither overexcited nor torpid, simply alert and open, is to become aware of the natural rhythm of the breath as you inhale and exhale.  This is focused attention, prerequisite for the second state of mindfulness meditation:  insight.

Start by focusing on the sensation of the breath entering and leaving you body at the nostrils.  Remember, you are observing your breathing rather than controlling it.  Follow each inhalation and exhalation from the start to the finish.  Notice any slight gap between the in-breath and out-breath.

Don’t be hard on yourself if your mind wanders or you get distracted by a noise.  This is all perfectly normal.  Just remind yourself:  “That’s how the mind works,” and return to the breath.  With repetition, you will get better at noticing when you have lost focus and develop greater mindfulness of the present moment.

Now that you have quieted your mind, allow your attention to broaden.  Whenever a positive or negative feeling arises, make it the focus of your meditation, noticing the bodily sensations associated with it:  perhaps a tightness, the heart beating faster or slower, butterflies in the stomach, relaxed or tensed muscles.  Whatever it is, address the feeling with friendly, objective curiosity.  You could silently label whatever arises in the mind, for example:  “There is anxiety,” “There is calm,: There is joy,” “There is boredom.”   Remember, everything is on the table, nothing is beneath your attention.

If you experience an ache or a pain, snitch or any other kind of discomfort, treat it in exactly the same way.  Turn the spotlight of your attention on the sensation but don’t allow yourself to get caught up in it.  Imagine that on the in-breath you are gently breathing air into the location where the sensation is strongest, then expelling it on the out-breath.  You may notice that when you explore the sensation with friendly curiosity—not trying to change it in any way, neither clinging to it or repressing it—the feeling will start to fade of its own accord.  When it has gone, return your full attention to your breath.

Mindfulness instructors will sometimes talk about “surfing” the wave of an unpleasant sensation such as pain, anxiety, or craving.  Instead of allowing yourself to be overwhelmed by the wave of feeling, you get up on your mental surfboard and ride it.  You experience it fully, but your mind remains detached, dignified, and balanced.  Knowing that the power of even the most fearsome wave eventually dissipates, you ride it out.

If a thought, emotion, or feeling becomes too strong or intrusive, you can always use the breath as a calm refuge, returning you whole attention to the breathing sensations at your nostrils.  Similarly if you feel you can’t cope with a pain such as stiffness in your legs, neck, or back, shift your posture accordingly.  But make your attention move to a mindful close rather than a reflex, and make the movement itself slow and deliberate.”

A previous healthy memory blog post, “Controlling Pain in Our Minds” explores this topic further and discusses the possibility of there being two different neural pathways processing the “two darts.”