Category Archives: pain reduction

August 5, 2009 · 6:24 pm

"Why Keep a Dog and Bark, Yourself?"


Another Mancunian aphorism, meaning: “Why do the thing you pay (or feed) someone else to do for you?” We now launch into a world of pain & suffering, the “fourth irritant,” which has received short shrift in this blog, so far. Since I [Lieutenant Commander Kangaroo] am at the helm, we shall first make a short detour…to the Orient.

Have you heard about the “Bow-lingual” Dog Bark Translator? It purports to analyze your dog’s utterances, and assign each of them to one of 6 mood states: “happy, sad, frustrated, on-guard, assertive, or needy.” Since, of course, it comes from Japan, it offers the dog owner (“just for fun,” the distributors insist) Japanese “translations”: a phrase to capture each of the 6 canine moods. Since, by coincidence, we have trained Lili to respond to Japanese commands, wouldn’t it be fun to find out what she is saying back to us, in Japanese? [Not $213’s worth of fun, I feel.] Just within the past month, though, she has begun to make this new, yodeling sound on her way to the hearthrug “penalty box,” for over-the-top “barkitude” at intruder dogs on our property. My own translation of it is the adolescent’s plainsong chant of protest, “Mah-am!” It’s not exactly defiance–more of a minority report on the unfairness of the sanction. [It’s a struggle not to laugh when she does it.]

Now, back to pain & suffering. Three cheeky chappies @ the University of Keele, in the UK, wished to study the “point” of swearing, in response to pain. Their research design was so cute, that it merits some attention. Undergraduates were recruited for a (supposed) study of “the degree of stress that various forms of language elicit during tense situations.” [That’s the dullest phrase in the NeuroReport article, I promise.] Each subject was asked to list “5 words you might use after hitting yourself on the thumb with a hammer,” as well as “5 words to describe a table.” Only those who listed at least one obscenity were included in the experiment. They ended up with 38 males and 29 females. [Already, we’re doing sociology & anthropology, no?] Each subject was tested twice, in randomly assigned sequence–once while repeating the first expletive they listed, and once while saying the ordinally corresponding “table” descriptor from their other list. The pain & suffering inflicted was [a maximum of 5 minutes of] their hand submerged in a bucket of ice water. So, guess under which condition each & every subject endured pain significantly longer–expletive or furniture adjective? Not surprisingly, swearing out loud is “hypogesic.” [It lessens pain perception.]

But why? The boffins from Keele are a bit baffled. The best they can do is surmise that it has to do with amygdalar arousal. Therefore, we armchair researchers can feel free to kibitz. What if there had been a third test condition, besides obscenity & Ikea cataloguery? What if the contestants had also been asked to list 5 Emotive (but genteel) outcries [you know, like “Rats!” or “Crumbs! or “Bother!”]? How do we know that such polite but vehement expressions of dismay are not equally hypogesic? [I don’t believe it for a minute, mind you; but it would have made the study’s findings more robust.]

Many dog training books assert that when a canine launches into a prolonged bout of “barkitude,” he is producing endorphins, and therefore rewarding himself with a powerful–some would say addictive–stimulus/response loop, that soon has little to do with the original cue for barking. [The UPS truck is long gone, but the stoner dog is still “self-medicating,” man.]

Maybe that’s what a human yelp of obscenity evokes in the brain: a lovely hit of endorphin, which makes the icy water much easier to handle. If so, and if the yelp is prompted by amygdalar arousal in response to pain & suffering, then (shock, horror!) maybe the amygdala is Not All Bad. Maybe, like most things found in nature, it’s a double-edged sword. And so, too, [until someone does the “Crumbs!” variation on the Keele study] is the occasional, appropriate human bark of (insert expletive).

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Filed under confounds, murky research, pain reduction, stifled wolf

August 9, 2009 · 5:29 pm

"Summat Chronic!"


Remember the British expression for a fleeting affliction–“summat and nowt”? Well, if that affliction lingers, it turns into “summat chronic,” an idiom which has morphed into a set of verbal twins [one good, one evil]. Thus, I could tell Lili the dog, “Girl, I luv you summat chronic!”; or most of the patrons in the vast waiting room at work [which we share with neurologists and Pain Management specialists] could say to one another [especially, if they happen to be from the UK], “Oooh! Me (insert body part) has been playin’ me up summat chronic!”

Given the connection between pain and anger, when the waiting room gets crowded, you can feel the pent-up rage rising. How tempting, to try to replicate the Keele experiment: “On the count of 3, everybody, yell out the expletive of your choice! You’ll feel better!” [Not gonna happen. Wouldn’t provide a longterm solution, anyway.]

The problem with any remedy for pain [be it a barked obscenity or a wallaby-endorsed opiate] is that–to quote a U. of Michigan med school classmate of my husband’s, Herb Malinoff, now the Maven of Pain in Ann Arbor–“When you start taking pain medications, the brain doesn’t like it. The ability to perceive pain is extremely important for survival. Pain keeps you from danger.”

There is an old cultural joke, made famous by Peter Cook and Dudley Moore in Beyond the Fringe, in a skit involving one of them trying to communicate with a baffled foreigner. “It’s no use. He doesn’t understand. You’ll have to shout.” Well, that’s the brain’s motto, too. If we don’t acknowledge the “howling wolf” of pain, or if we try to quash it with a pain-killer, the “howling wolf” is going to “throw a strop” [British for pitch a fit], and turn up the volume. “Oy! I’m talkin’ to you! ‘Danger,’ you thick-o! ‘DANGER!'” And so, says Herb, the battle of wills, between the Pain Messenger in our brain and the Pain Manager in our healthcare plan, escalates. The result is often hyperalgesia [hypersensitivity to pain].

So, waddaya gonna do? I shall humbly suggest an approach, based on Victoria Stillwell’s dog training method. When the dog first barks, she says, we should thank it for doing its job. [No doubt, she grew up with the motto, “Why keep a dog and bark, yourself?”] Not that we should literally express gratitude for the pain, mind you, not rejoice in it; but instead of asking the rhetorical, Existential question, “Why me?” [“This is awful!”], try asking the more useful question, “Why now?” [“Cuz this is highly inconvenient. I have other plans.“] Remember my “Always? Not always” prof’s suggestion, to identify the person whose head you’d like to bash in, as a headache remedy? That’s a “Why now?” problem-solving line of inquiry. The cliche, textbook reason for why your hand hurts now, is that you’ve inadvertently laid it on a hot stove. Sometimes, however, the cause and effect are not so proximate. The reason your head hurts now may have to do with what you drank last night. Or that you need an updated correction for your specs. Or that the air in your city is becoming more toxic. The less proximate the cause of your pain, the more inexorable [and hopeless] it seems. [“Note to Self: ‘Become rich enough to move away from New Delhi.'”]

Consider another well-worn motto: “What can’t be cured must be endured.” The next post will deal with non-pharmaceutical methods of coping with pain. Until then, consider Lili’s remedy for emotional stress–her favorite squeaky toy, “Duck”–the foot of whom you see here. She has more than 10 other squeaky toys; but “Duck” is her “Teddy bear.” Whenever she senses bad vibes in the household, or simply wants us all to go to bed so she can quit guarding us, she parades around with “Duck” in her mouth. No doubt, you have a “Teddy bear,” too. When our younger daughter was to have her tonsils out, we were instructed in the pre-op briefing to have her bring her favorite plush animal [“Gus” the cat], who was solemnly given his own scrub cap and who was in her arms from check-in to recovery. Henry Ford Hospital knows a thing or two about helping kids cope with pain, by first helping them cope with fear.

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Filed under Epictetus said..., pain reduction, transitional objects

August 12, 2009 · 7:09 pm

"Who(m) Do You Trust?"


“Me, or your lying eyes?” [goes the old-but-new-again joke]. In the spirit of the Groucho Marx quiz show, You Bet Your Life, in 1957 Johnny Carson [soon joined by Ed McMahon] hosted a daytime game show where the backstories and chemistry between the contestants [3 sets of they-never-met-before “couples”] trumped correct answers. A quiz category was announced, and the man of the mixed-doubles team was asked. “Who do you trust [to answer a question on this topic–yourself, or this dame you just met]?” Cutting-edge battle-of-the-sexes TV! Chivalry vs. machismo! It was like hearing your parents “debate” who knew the faster way to get to the Sawmill River Parkway in weekend traffic. Riveting stuff for the after-school crowd [the show’s target demographic].

[Cultural digression: My father, whose off-the-boat parents spoke Irish at home, acquired his English through grammar books, and was a stickler for correct–even archaic–usage. When, in this blog, I deviate from Fowler’s Usage into demotic speech, I am using Jakobsen’s Poetic speech function, to make a point, innit?] Thus, when my sister and I were recapping that day’s episode for our father, we referred to the show as Whom Do You Trust?

Now, back to pain. And back to one of my favorite hobby horses–“Are you going to trust every so-called research finding, just because it was published in a peer-reviewed journal?” Okay, smokers, this one’s for you. Our old friend Dr. Malinoff has research evidence that “Nicotine stimulates an area of the brain right next to the area that processes pain; smokers’ pain scores routinely exceed the pain scores of non-smokers.”

Now, for you redheads. For decades anesthesiology students were taught to use more pain-killer on their red-haired patients, because their tolerance for pain was experimentally proven to be significantly lower than blondes & brunettes. Turns out that the ever-popular bucket of ice water was used, to achieve these replicated research findings. Recent studies [using the only other ethically-approved method of inflicting pain for research purposes: electric shocks] have found that red-heads are, indeed, more sensitive to cold, but they tolerate a jolt of voltage significantly better than the other groups. I could go on, but you get my skeptical [not to say cynical] point. “It ain’t necessarily so.”

Maybe the researchers are all just [metaphoric] “drunkards, circling the lampost.” Why not let your own experience be your guide to the “truth” about your very own pain? Well, consider this finding, reported in the APA Monitor [January 07]. Using the “Cutaneous Rabbit Illusion” [where the subject’s arm is rapidly tapped, first near the wrist, then near the elbow, and soon the subject “feels” a phantom tapping sensation between the two spots–quaintly known as “the rabbit hop”], the same area of the subject’s brain lit up on the fMRI, whether the tapping sensation was “real” or only “phantom.” A similar thing happened with more painful stimuli [a rabbit-wearing-golf-shoes, sort of thing], only this time it was the dreaded S1 [primary somatosensory cortex…aka pain center] area of the brain that lit up.

Confused? Ah, then I have achieved my goal. Put your previous beliefs about what causes (and reduces) the sensation of pain “on ice” for a bit [unless you have red hair, in which case…just put them under wraps]. Maybe, some of the old-but-new-again ways of coping with pain have something to offer 21st Century sufferers.

So anyway, is that dark smudge, in the lower right quadrant of the door, the tail of a ravening wolf, or just the head of Napster, the black cat? One would be awful, the other just a little inconvenient. What if you could choose which one to experience? I think you can choose. But who ya gonna trust–me, or your [sometimes lyin’] eyes…arm…S1 pain area? Next stop, the enchanted forest. [What could it hurt?]

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Filed under confounds, murky research, pain reduction

August 16, 2009 · 12:49 am

"Your eyelids are getting heavy…"


First the boring scientific stuff. When we are wide awake, our brain is emitting Beta waves (14 to 100 hz). When we are fast asleep, Delta waves (< 4 hz) are produced. Theta waves(4 to 8 hz) combine external stimuli with internal mental images—creating Boogeymen and other monsters under the bed. But the most wonderful, useful state of mind is available when the brain puts out Alpha waves (8 to 13 hz).

This is variously referred to as “enchantment,” “hypnotic trance,” “meditation,” or (especially when playing sports) “being in the zone.” As those who work with sports psychologists will attest, being in Alpha during a tennis match (or a baseball game) seems to slow the ball down, making it much easier to hit. Everyone who has taken a car journey has been in Alpha, even the person driving! (It’s sometimes called “white-line fever,” since the repetitive dotted white lines on the highway can “entrance” a person, until the sign for his exit appears; and he jolts back into Beta, wondering “Have I been asleep at the wheel?”) Fortunately, the answer is usually “no, unless you were also intoxicated or exhausted.” One thing to notice, is that when a car swoops in front of you, requiring you to brake, you are able to do so; but often with a slight feeling of vertigo. Abrupt switches between brainwave frequencies [states of consciousness] can cause that, so when you are “going into Alpha” on purpose, it’s a good idea to plan enough time for a gradual transition back to Beta.

Back in the (surprisingly cool) 70s, the Navy sent me and my 4 fellow Clinical Psychologists @ USNA on a course to learn how to do “medical hypnosis” (as opposed to “Stage Hypnosis,” in which volunteers from the audience end up quacking like a duck). The thought was, it would be good to teach Midshipmen how to manage test anxiety, cope with pain, and…well…play sports better. In the required Intro Psych course, most of us did a little class demonstration, using a volunteer subject (for absolutely no extra credit), but inviting the skeptics in the back of the room to follow along with the suggested steps for inducing a trance. Inevitably, while the volunteer subject was able to “feel” the loft of a (pretend) helium balloon “tied” to his wrist, and let his arm float up a few inches, there was at least one Mid in the back, practically levitating off the floor, who became the most enthusiastic convert to the powers of Alpha.

When I was back @ USNA in the new millennium (as a humble civil servant), my favorite two days of each year were I-Day and I-Day-Minus-One (when roughly 1000 Young Ones were shorn, accoutered, and given a physical which included comprehensive blood work). There was usually about a 1 in 10 “hard stick” rate (as our team of phlebotomists called it), where the kid either keeled over in mid-blood-draw, or no viable vein could be found from a sitting position. Their code phrase to me was, “Doc, this one needs to go to the beach,” at which point the candidate was escorted to one of several cots, and I did my 2-minute send-you-to-the-beach trance-induction patter. In less hurried circumstances, I usually let the subject pre-select a “happy place” destination, towards which the slowed-down breathing, progressive muscle-relaxation, and “smooth descent on an escalator” leads. These kids had joined the Navy. Their choices about most things were going to be restricted in a few hours (once they were sworn in), so they all “went to the beach.” Once there, they “lay under a palm tree, with one arm out of the shade, in direct sunlight.” And, lo, the veins of the “sunlit” arm would swell up like ropes. Occasionally, the phlebotomist would need to finish the draw from the other arm; and so the first arm would be “put in the shade,” while the other would “get some sun.” Magic! The veins in the second arm would engorge.

Individuals vary as to their ability to achieve trance “on demand,” like that, although being highly motivated obviously helps. Many researchers contend that purposely “going into Alpha” is a uniquely human skill; but I doubt it. “Dog Whisperer” Cesar Millan talks about the “migration mode,” in which a pack of dogs can travel great distances, following the Alpha dog, expending the least amount of physical and emotional energy–just trusting the leader to walk point for them. I say that’s purposely “going into Alpha (wave, not power position).”

I also say, get yourself an entrancing book, or CD, or zen master that you trust–that you would be willing to follow–and let yourself be guided into Alpha. It only takes one “guided tour,” before you can get back there by yourself, whenever you want.

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Filed under altered states, leading a pack, pain reduction, secret code

August 16, 2009 · 8:22 pm

"Why don’t you come with me, little girl…?"


How long did you think it was gonna take, for me to quote a Steppenwolf song in this blog? For those of you born yesterday, this is the tag line to “Magic Carpet Ride.” Cynics will insist the invitation is to take a drug trip; but a close examination of the lyrics will reveal it to be a perfect trance induction–an invitation to go into Alpha, because “…you don’t know what we can find.”

We’re off on our own not-quite-magic-carpet-ride (on Southwest Airlines) this week, to visit the offspring, so Lili and the Cats are off to the Ashram, where they will be lovingly looked after (and perhaps shown the way to Enlightenment). I think they spend most of the time in Alpha–especially the cats. Lili stands down from her mission to guard us (since we’re not there) and “her” property (since she’s not there…she’s offsight); and it is reported that she becomes a carefree, gregarious pack member under those circumstances.

Meanwhile, a couple of pointers for how to use Alpha, once you reach the destination of your choice. To lessen your perception of various kinds of pain, you might want to think in terms of dreamwork, and construct a plotline that “accounts” for the unpleasant sensation, but tones it way down. Thus, instead of the “ravening wolf” of a root canal procedure, I transform the experience into a brisk canter on Owen the Hanoverian, on a cool Michigan morning, where sucking in the cold air creates a mild tingling sensation in all my teeth. Seriously. A magic carpet ride on my beloved horse is what I “take,” instead of whatever anesthetic the dentist is offering. I’ve had to convince all my dentists since 1978, that I will be just fine, they need not worry…but they can’t seem to stop themselves from blurting out, “Boy, that’s gotta hurt! Doesn’t it?”

But, what about the lads in Keele, and our friend Herb Malinoff, who insist that the pain center’s message must be acknowledged, or it will just “turn up the volume”? I haven’t found this to be a problem, personally; but I would be prepared to say a mental “Roger that,” (or “F&#* that!”)–to “thank my amygdalar dog” for warning me of danger–and then I’m going to “climb aboard Owen,” and take that “magic carpet ride.”

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Filed under altered states, limbic system, pain reduction