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Yes, the Pain Is All in Your Head
New study uses EEG and TMS to measure pain directly from the brain.
I’ve been thinking about Dune a lot lately. I think I might be the only person in the world who prefers the bizarre and grotesque David Lynch movie version to the elegantly crafted Villeneuve oeuvre, including David Lynch himself. We lost a real artist with his passing, and a rewatch of Twin Peaks is very much on my to do list for this winter.
But back to Dune, because one of the pivotal scenes in the novel and both movie versions is one where young Paul Atreides is tested by the Machiavellian Bene Gesserits. He has to put his hand in a box. Inside the box? Pain. Ever increasing pain. He must keep his hand in the box, despite all his instincts telling him to pull it out to prove his fundamental humanity — his ability to exercise control over his own brain.
Because, as the Reverend Mother points out after the ordeal, his hand is unharmed. The pain is a fabrication — pain by nerve induction, she says. There is no physical damage. It’s all in his mind.
And of course, that’s true of all pain isn’t it? It’s not your toe that hurts when you stub it. Signals are sent from your toe, up a nerve to your spinal cord, up another nerve to your thalamus, and then onto the cortex to give it context, emotion, intensity, reality. If that chain is broken — pain simply does not occur. It’s all in your mind.
That’s what makes pain so difficult to treat. It is fundamentally subjective. I’ve had patients with wounds that would make me scream for my mother who sat stoically silent while we worked on them. And I’ve had those who… well… seemed like they were hamming it up a bit.
But right now our best tool to get a window into someone’s level of pain is a tool like this. A pain scale. How much does it hurt?
