How pain affects focus and attention

Here are three scientific articles about the effect of “pain” on brain functions, like focus and attention, proving that the “sensation of pain” we feel is a very “real” physiological state, not a psychological issue.

• Assessment of heart rate variability in the patients suffering with chronic pain of musculoskeletal origin
• Pain Affects Visual Orientation: an Eye-Tracking Study
• Does experimentally induced pain affect attention? A meta-analytical review

Pain Affects Visual Orientation: an Eye-Tracking Study – PubMed – Feb 2019

Because of its unique evolutionary relevance, it is understood that pain automatically attracts attention.

Maximum Opioid Doses are an Abomination

Maximum Opioid Doses: A Pharmacological Abomination – By Josh Bloom — June 22, 2020

Despite irrefutable pharmacological evidence of the wide range in individuals’ metabolism of opioid drugs, states continue to impose “one-size-fits-none” laws.

It’s safe to say that no one is really paying attention to the science. So, here it is. Again.

The American Medical Association was two years late to the party when it issued its first statement (1) about the inappropriate use of CDC Guidelines to establish, among other things, laws that define a dose and duration limits for opioid analgesics. No one was listening. Since then things have gotten worse, not better, for pain patients.  

The Surprising Science of Walking

Book Review: The Surprising Science of Walking – By M.R. O’Connor – June 2020

Walking on two legs remains a special adaptation of our species; it freed our hands to engage in other activities such as carrying food or weapons, which further fueled our exceptional evolution.

walking has not only been crucial to human evolution but is essential to our health.

We are always told that walking is good exercise and we should do more of it, but  I can’t walk too long because of the repetitive hip motion. Why is that aspect of walking never mentioned?

hEDS Deficit in Pain Control Mechanisms

hEDS-related Pain May Be Linked to Deficit in Pain Control Mechanisms – by Marta Figueiredo – June 2020

Pain in people with hypermobile Ehlers-Danlos syndrome (hEDS) likely is the result of an impaired pain suppression system that may lead to widespread pain, a study shows.

Well, that would certainly explain a lot!

contradict a previous theory that EDS-related pain was caused by damage in nerve fibers.

Neuropathic Pain & Wind-Up Phenomenon

Managing Difficult Pain Cases: Neuropathic Pain & Wind-Up Phenomenon – WSAVA2013 – VIN – 2013

I was looking for information on the “pain wind-up” phenomenon and found this veterinary paper that explains it well – and without any special fuss about opioids, treating them the same as any other pain-relieving medication. What a refreshing change!

And with animals, there are no “biopsychosocial” factors to blame for increasing pain, so vets take it seriously and don’t just discount it as an attitude problem.

The options for analgesia are ever increasing as our understanding of pain physiology improves.

Yet for humans, there is still little understanding of chronic pain and few new treatments significantly different from the old. 

Self-administration of Hydrocortisone for Pain

General theory of inflammation: patient self-administration of hydrocortisone safely achieves superior control of hydrocortisone-responding disorders by matching dosage with symptom intensity – free full-text /PMC6581742/ – J Inflamm Res. 2019;

Objective: To determine if patient self-administration of hydrocortisone will safely achieve superior symptom control for all hydrocortisone-responding disorders as it does for Addison’s disease and rheumatoid arthritis.

Methods: 2,480 participants with hydrocortisone-responding disorders were brought to a minimum symptom state using daily administered hydrocortisone tablets in a 24-week, open study.

Thereafter, participants used 5-day, low-dose hydrocortisone regimens to quench subsequent disorder exacerbations (flares) to maintain the minimum symptom state. Stressors such as emotional traumas, infections, allergies, and injuries were minimized to reduce disorder intensity, hydrocortisone consumption, and participant discomfort.  

Microglia and Pain

Microglia may be the missing clue to solve the opioid epidemic – Sara Whitestone – Neuroscience – Université de Bordeaux – May 2019

…neuroscientists have discovered a new therapeutic target for managing pain: microglia.

Pain, as an acute sensation, serves as a warning to help your body prevent injury or avoid further harm.

the message from your stubbed toe is forced to go through a series of checkpoints—or gates—which will either open or shut to control the intensity of pain you perceive.

When pain becomes chronic, this signaling and the gate controls go haywire. Nerves become hyper-sensitive, firing off messages to the brain even in the absence of an injury.  

Modulation of pain by estrogens

Here are 4 PubMed scientific studies exploring how estrogen affects all different aspects of pain: its sensation, its interaction with opioid receptors, and its memory. Estrogen is clearly important, but the interactions with pain sensation are very complex.

Just like with hormone replacement therapy, the effects of estrogen on pain probably differ a great deal between individuals.

Pronociceptive and Antinociceptive Effects of Estradiol through Endogenous Opioid Neurotransmission in Women – NCBI – May 2006

Prominent interindividual and sex-dependent differences have been described in responses to sustained pain and other stressful stimuli. Variations in μ-opioid receptor-mediated endogenous opioid neurotransmission may underlie some of these processes.  

Different Pain, Different Neural Circuits

Responses to External Threats and Sustained Pain Travel Via Different Neural Circuits – Practical Pain Management – By Kerri Wachter with Qiufu Ma, PhD – Jan 2019

New study outcomes in mice suggest that common pain measurement tools may be inadequate.

Different neural pathways appear to underlie

• reflexive responses to external threats and
• coping responses to sustained pain

I’m surprised this hasn’t been obvious to researchers because it’s certainly clear to pain patients. The experience of acute pain, like stubbing your toe, is wildly different than that of long-term pain, like failed back surgery, so it seems obvious to me that different aspects of our nervous system are involved. 

Enhanced Interoception Links EDS and Anxiety

How Enhanced Interoception links EDS and Anxiety  – Wikipedia

I wasn’t aware of the complexity involved in “feeling what I’m feeling”, so I’m posting relevant parts of this extensive article.

Knowing a bit about interoception is critical to understanding how a disorder of the connective tissue like EDS can result in altered emotions, mostly anxiety, through biochemical processes.

Interoception is contemporarily defined as the sense of the internal state of the body.