Let's Talk About Pain

What's phantom pain? How does chronic pain work? What determines our individual pain tolerance? Richard Holt sets out to find the answers

- By Richard Holt

Of all the sensations we can feel, pain shouts the loudest. A tender touch, a delicious taste or a beautiful sound-these are all silenced instantly by a stab of pain. It makes the most noise because it has the most urgent job to do, to protect you from harm. Without pain in our lives how would we know to pull our hand back quickly from a fire, or rest an ankle while it heals?

For the rare few born with a congenital insensitivity to pain, their lack of suffering is more than outweighed by the constant peril of injury, simply because they don't have the pain-sharpened sense to keep out of harm's way.

As a sufferer of chronic pain following a double-ankle break 14 years ago, I'm aware that pain has an important survival advantage, but only when pain is sending us signals that require action-and these signals can go wrong. Phantom limb pain is very well documented. This is when patients feel pain in amputated limbs, as their severed nerve endings continue to send distress signals to their brains.

Today, doctors have great success treating amputees with phantom pain by combining pain relief medication with more cuttingedge treatments, like electrical stimulation of the brain and spinal cord. Together this process retrains the nervous systems to stop sending unnecessary signals. Could something similar be offered to able-bodied people suffering chronic pain?

It is obviously not useful for an amputated limb to hurt, but what if your bad back, or dodgy knee is sending pain signals for an injury that no longer exists? Pain often starts with an injury, like a broken a bone or a torn ligament. But in many cases it continues long after the tissue has healed. This means a lot of us could be suffering from a form of phantom pain. And when pain is no longer useful, it is just, well, a pain.

CHRONIC HIGH