I read somewhere a long time ago by an author that I do not remember who said "Without emotion there is no pain". I have seen this in thousands of patients but only recently, because of the experience of someone very near and dear to me, I have realized the extreme impact of central pain on post operative pain.
The part of our brain which controls our emotions is known medically as the limbic system. The limbic system is responsible for threat assessment, reward, bonding and all other motivational drives. It gives us the emotions and instincts that are so important for our individual survival and survival of our species. It is the most primitive part of the brain. It is exceedingly fast, efficient and accurate. It serves us well but can get it wrong such as in addiction, chronic pain and PTSD.
It has been shown experimentally in humans and laboratory animals that stimulation of the paraventricular grey, part of the limbic system, turns off the perception of pain like a light switch.
An example of normal function of the limbic system in threat assessment is accidental injury. When you accidentally break a bone most of us do not immediately feel pain. We feel pain when the threat is over. Our limbic system makes a threat assessment and does not want to distract us from ongoing threat that we have to deal with to survive.
Examples of dysfunctional limbic system response to pain are cancer pain and osteo-arthritic chronic pain. This pain tells us that something has to be done to alleviate the pain. But as individuals there is nothing that we can do. Can we stop walking? Can we claw our cancer out? Before modern medicine anyone with these types of pain did not have long to live. Evolution does not care about your pain if you do not have long to live. So why do we have chronic pain and central pain? I do not know. But there must be a good reason.
So what is the best cure for these types of chronic pain? Remove the primary cause! Cure the cancer. Replace the joint. Unfortunately removing the primary cause does not cure all patients. Chronic pain persists because of central pain. 30% of patients have persistent pain after total knee replacement. After hernia mesh removal for pain 25% of patients are not relieved.
I believe the cure for chronic pain after removal of the primary cause is treatment of central pain. All chronic pain patients have central pain. Fortunately this reverses naturally in most patients after removal of the primary cause. There are some things which can be done to help it reverse.
For my mesh pain recovery patients I have a recovery protocol. The most important part of this protocol is to follow my instructions. They are on this website and have been for 7 years. I have advised patients of this for years before I put it on the internet. Most of the patients who fail recovery do not follow my instructions. I thank my former patient Paul for making me learn this. I wish him recovery. He posts his story all over the internet. I could not cure him and I am sorry. But nobody could. I tried. There are others who I tried to help but failed. Most recognise that no other surgeon tried and I did. It is not a cure but my number one patient tells me that the most important thing that I do is to validation her pain. I think it is to show compassion. Maybe it is the same thing. Validation is an act of compassion. Compassion soothes the limbic system. We are social creatures. Social isolation is very painful for us. In the penal system we that have the most powerful punishment that exists is social isolation. Solitary confinement is more severe than execution. Chronic pain patients complain of isolation and lack of validation.
Chronic exposure to nociceptive pain signals from the peripheral nervous system causes anatomical changes in the central nervous system everywhere between and involving the spinal cord and the somatosensory cortex which results in central pain. These changes are observed in pathological examinations of laboratory animal who recieve painful stimuli and then are sacraficed and examined. In humans central pain is identified by the observation of symptoms of allodynia, hyperalgesia and widening of the pain field.
The emotional part of our brain, the limbic system playes a very large role in modulating our perception of pain. It can literally create the perception of pain when there is no nociceptive pain stimulation, phantom pain.
This is why I advise patients to avoid litigation until they are fully recovered and not to blame anyone for their pain. The surgeon followed the standard of care. The standard of care is wrong. But some doctors should know better. History of emotional trauma or abuse also will promote central pain and psycological treatment of these conditions can help chronic pain patients. There are some new drugs recently released by the FDA to the market which are promising such as Tanezumab and Esketamine.
"Milan—Chronic groin pain after hernia surgery is now considered the most important issue facing inguinal hernia surgeons and their patients. Yet, there is still much uncertainty surrounding what causes the pain and how to prevent it." - Victoria Stern, General Surgery News