In one study, people who had lost a limb immediately took memantine, a drug that blocks memory-encoding receptors. Usually, more than two thirds of amputees have phantom pain, but only 20 percent of those treated with the medication developed it, says Herta Flor, professor of neuropsychology at the University of Heidelberg in Germany. But the drug doesn't have the same effect once phantom pain has set in. Other research suggests that the cough medicine dextromethorphan, a related drug, may relieve fibromyalgia pain. Don't rush out to buy a bottle just yet, as it's not a practical treatment—the high dosages used in the University of Florida study can cause hallucinations and interfere with memory.
Flor found that prosthetic limbs can help amputees unlearn their aches. People fitted with prostheses that help them walk or pick up objects have less pain than those who use purely cosmetic replacements. Imaging studies show that with a functional prosthetic, the brain begins to respond as though the replacement limb were a part of the body. This semblance of normality dampens the errant pain signals.
Being Cruel to Be Kind: Don't Indulge Your Partner's Woes
A sympathetic partner may actually be an enemy in disguise, Flor and her colleagues found. Spouses who respond to a loved one's every flinch and moan can make pain worse. Constantly asking about the pain may interfere with the sufferer's efforts to distract herself.
Also, by giving special attention to suffering, partners may unintentionally reward the patient for his aches and discourage him from pursuing other activities. This isn't to say it's bad to help someone who's hurting—but in the case of chronic pain, diversion may be better than devotion. Flor works to change the habits of pain patients and their partners so that distraction and healthy behaviors such as exercising are rewarded.
Sex Is the Opiate of the Masses
Sex is nature's own pain reliever. Orgasm doubles the pain threshold, although the effect doesn't last long enough to serve as a treatment. Exploring this effect, Barry Komisaruk, professor of psychology at Rutgers University in New Jersey, has found that for women, just a bit of pressure in the vaginal region (not the clitoris) can dampen pain perception for hours. Research with rats suggests that rectal pressure in both sexes has a similar, but less powerful effect, possibly because both vagina and rectum use the same sensory nerve. Komisaruk and his students are studying women with chronic leg and pelvic pain to see if vaginal stimulation can help.
Why Women Don't Fear Pain—and Why Frightening Pain Hurts More
The stereotype that women are more sensitive turns out to be about half true. In response to pain, women initially report stronger sensations and higher anxiety than men do. As the hours go by, though, while women still say they hurt more, their anxiety decreases, whereas men's increases.
One theory is that the sensation has different connotations for men and women. Intense suffering is often a sign of life-threatening danger. But for women, the torment of childbirth is a normal, ultimately even joyful, experience. Perhaps women's lower anxiety in response to prolonged pain is because it may have this different "meaning." There are no data to prove this theory, but other experiments do clearly indicate that discomfort associated with danger hurts more. People who had their hands dipped in uncomfortably hot water were far less bothered by it when they had received a hypnotic suggestion referring to a tropical beach than when they had been led through a more frightening scenario.
Sloan-Kettering's Pasternak describes a patient who returned to him, years after surviving breast cancer, with unbearable lower-back pain. She assumed the cancer had returned and spread. When it turned out that she had a common disc problem—and no cancer—the woman no longer wanted pain medication. Says Pasternak: "Without the anxiety and fear of a recurrence, the pain was acceptable."
Drugs Don't Stop the Pain—They Help Us Ignore It
The most potent painkillers detach us from our suffering. Opioids such as morphine and Oxycontin, which mimic the brain's natural painkillers, not only dull the perception of pain but change our interpretation of it. In the cingulate, the drugs dampen emotional distress. Patients taking opioids often say that they still hurt, but it just doesn't bother them any more.
This ability to reduce both the unpleasantness and the sensation of pain makes these drugs indispensable, says Pasternak. Despite centuries and billions of dollars spent trying, no one has yet come up with better treatments.
Don't Tough It Out
Clint Eastwood might be able to ride across the desert with a bullet lodged in his arm, but for most of us, it's best to treat pain rather than suffer through it. Toughing it out could lead to long-term problems: Because it's difficult to "unlearn," chronic pain may be easier to prevent than to reverse. The longer and more intensely pain is felt, the more likely it is to become chronic. Many people resist pain medication, says McGill's Bushnell. "They say, 'I can stand it.' But you want to treat it as quickly and as completely as possible to reduce the chances of it becoming chronic."
Opioids have a reputation for abuse, but in truth, very few people who take pills for pain become addicted. Still, some doctors may be reluctant to prescribe high doses of painkillers, so you may need to be persistent to get the treatment you need.
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