Pain And Emotion

Although mainly about the effects of emotion on reason, ‘Descartes’ Error‘ by Antonio Damasio contains a few fascinating nuggets on pain. He distinguishes 2 components to pain:

• Sensory perception from skin, mucosa, muscle, organ, etc. – the nerve endings stimulated in an area of the body lead to a ‘pain image’, a temporary representation  of body change in the brain. This is no different from any other kind of body perception and if it were all, we would not be inconvenienced.
• Emotion and feeling – it’s from these body-state changes that the unpleasant feeling of suffering is formed. “Suffering puts us on notice and offers us the best protection for survival, since it increases the probability that individuals will heed pain signals and act to avert their source or correct their consequences.“

Damasio’s views on emotion/feeling and pain are probably the result of his experience with the eminent Portuguese neurosurgeon Almeida Lima. Lima worked closely with Portuguese neurologist Egas Moniz. Together they developed prefrontal leucotomies, later known as lobotomies, during the 1930s. In 1949 Moniz received the Nobel Prize in medicine for his work. Damasio recalls following Lima on a pre-operative visit of a patient with trigeminal neuralgia, a condition that causes severe facial pain. “He was crouched in profound suffering, almost immobile, afraid of triggering further pain. Two days after the operation, when Lima and I visited on rounds, he was a different person. He looked relaxed, like anyone else, and was happily absorbed in a game of cards with a companion in his hospital room. Lima asked him about the pain. The man looked up and said cheerfully “Oh, the pains are the same, but I feel fine now, thank you.” Clearly, what the operation seemed to have done, then, was abolish the emotional reaction that is part of what we call pain. It had ended the man’s suffering.”

Obviously, lobotomies are extreme measures and they can cause serious side effects. This is certainly the reason fewer and fewer operations are being performed. Nowadays these operations are called psychosurgery and they have become much more precise. The important point is Damasio’s view on the link between pain and emotion. It corroborates a lot of the research being done on chronic pain. Hence, the importance of addressing the emotional part. Fortunately, there are now safer more humane ways of doing it, like relaxation, meditation, cognitive behavioural therapy, neuro-linguistic programming and hypnosis.