Neurology

All about pain

It is better to increase tolerance to pain and treat the source rather than treat the symptoms alone, says Dr N K Venkataramana

It is common for executives to pop pills at the slightest provocation. Many keep a regular stock of pain killers at their workplaces and home medicine boxes. And they can hardly be blamed. The stress of modern work life has taken a toll on people and left them with little time to take care of themselves. The result is aches and pains


But should pain be a normal part of life? Certainly not. It is far better to work at rooting out pain by treating the root cause – invariable lifestyle – rather than trying to suppress it with pain killers. To begin this process, one needs to strengthen his pain tolerance levels first.

What is pain?

The body has thousands of nerve endings connected to nerves that carry all pleasurable and painful sensations to the brain through the spinal cord. There are three forms of pain perception: primary, supplementary and cortical. Pain perceived by stimulation of nerve endings is transmitted to the thalamus, which is the primary sensory area in the brain. It is this area of the brain that primarily perceives and reacts to pain. From thalamus the sensation travels further to the sensory area of the cerebral cortex. The basal ganglia and limbic system sub-serve the complimentary functions and contribute to emotional reactions.

Pain has a physical subscript and an emotional component. Hence the intensity of pain as also reactions to it can vary from one individual to another. The physical factors that influence pain is mechanical intensity, number of pain receptors and the integrity of the pain pathway.

The reaction to pain and tolerance is predominantly through cortical and limbic pathways. Environmental and psychological factors do play a significant role in pain tolerance. In chronic pain, tolerance gradually diminishes and the efficacy of the drugs also dwindles. Eventually psychological factors dominate leading to reactive depression. Despite several advances in medicine, there are no gadgets to assess the intensity of the pain. Hence the severity of the pain remains purely subjective.

Pain management essentially includes identification of root cause treating the cause and modifying all the influencing factors so that pain can be effectively modulated. By suitably correction of these factors, tolerance can be enhanced. When all the physical psychological, pharmacological methods fail, one may resort to surgical methods of treatment. Deep brain stimulation (DBS) is one of the innovative newer technique available for this.

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