July 21, 2014

Study: Fascinating Way to Beat Pain



By Crabby McSlacker

OK, maybe no one else would be quite as intrigued by this study as I was.  It still leaves many questions, and it's a bit impractical in its current form. It isn't a magic pill that the pharmaceutical companies can exploit. So who knows if anyone but avid Do it Yourselfers will take advantage of it?

But it's the implications of this study that got my overthinky brain churning away.

And, unfortunately for you guys, these implications led me to much speculation and theorizing about pain and personality and neuropsychology! Even more ominously, it got me thinking again about the whole Subjective versus Objective reality question.

Be very afraid.



So What Did The Damn Pain Study Say, Already?


Basically, this clever Pavlovian pain reduction study demonstrates that you can train your brain to reduce pain sensations whenever you hear a particular auditory stimulus--in this case, a "beep tone."

The pain reduction wasn't just by self-report. It showed up in EMG recordings of facial muscles, as well as something called the "nocifensive RIII flexion reflex." (And I have no idea what the hell that is. But I do know that if you arrived at Cranky Fitness googling THAT, you are probably far too smart to be reading this silliness. But please hang around anyway, okay? We love smartypants science geeks here!)

So anyway, this sounds really good, doesn't it?

Let's say you're going to the dentist, or getting your nether regions waxed, or attending your six year old nephew's clarinet recital. Wouldn't it be nice to take along an mp3 player, and know that whenever you felt any pain, you could beep-tone it down a few notches?

Well, the bad news is the methodology you have to use in order to train your brain to do that.

Meet Your New Friend: Heterotopic Noxious Counter-Stimulation (HNCS)!


OK, HNCS is not a friend you're going to want to hang around with for long.  HNCS is basically a new distracting pain that your body attends to instead of the old pain.

In this case, study participants were trained to reduce the pain of nasty electrical shocks to the foot--by additionally sticking their hands in a bucket of ice water while the tone was playing. 

Fun times!

(And yeah, if you learn nothing else from this blog post, I hope you at least take away: Do Not Sign Up for Pain Studies Unless They are Paying a Huge Crapload of Money!)

photo: wikipedia

As it turns out, HNCS is a well-known pain reduction phenomenon.  But it's not very practical. Switching the kind of pain you are experiencing to a different kind doesn't really buy you all that much if you are still miserable.

However, the cool thing is: once the subjects were trained, the experimenters took away the ice bucket, perhaps to mix themselves very large cocktails.

But the beep-tones that had been paired with the ice acquired the power to reduce pain from the electrical shocks all by themselves!

Why I Love This Study


What a simple and elegant design! And a hopeful conclusion: You can learn to use an arbitrary sound to alter your physiological and psychological response to pain.

I get really excited by any kind of scientific validation that the brain can be trained to do useful shit like this. I would even consider doing some experimentation with an ice bucket and an mp3 player the next time I have any predictable repetitive painful experiences coming my way.  

Questions and Hypothetical Musings:


But, as the experimenters say in their conclusion: "future research will have to investigate the persistence of these effects."

In other words, they don't know how long the tones would keep reducing pain, once they stopped being paired with the "real" pain killer, the HNCS.

Because I'm thinking if it doesn't last very long, and is such a painful hassle to set up, it's not very practical, right?

So here's where I go off the deep end with my speculations, and indulge in some flagrant oversimplification and generalization.

Who Might Best Be Able to Erase Their Pain With Magical Beeps?


My guess is: for some people, this phenomenon could work pretty much forever.

I'm thinking specifically of folks with cheerful optimistic, wishful-thinking worldviews who keep their positive thoughts pumping regardless of the evidence.

Let's call them the Smiley People.



The first few times the beep tones would work like they're supposed to--and these people would go: Great, this is awesome!  And from then on, they would expect their pain to go down, and they would harness the placebo effect and ride the hell out of it. And so then it would work again and they'd go: see? This is the best thing ever! And their enthusiasm might even help them see it as working even better each time than they remembered it working before.

And even if somehow it didn't work quite as well one time? A Smiley Person would assume it was a temporary glitch due to some external variable, and still go in the next time with high expectations. This cycle could constantly fuel the connection between the arbitrary tones and the magical pain reduction and they'd have a handy new tool for life!

In contrast: others folks would get no use out of this at all. Let's call them the Frowny People.


The Frownies would be skeptical from the very beginning.  They would expect the pairing not to work, and if it did help a little, they wouldn't expect it to last.  They would be hypervigilant for the very first signs that it was all a bogus mind-trick.

And sure enough, any variability would be the evidence they needed to conclude that it wasn't working so well anymore.  It would be yet another example of how things never are as good as they're hyped to be, and how they are never the lucky people who things work for.

The Frownie People might even castigate themselves for any faint hopes they may have had that anything as dumb as listening to beep tones would be useful to fight pain. The Frownies would remember next time someone talks about pain relief to go in with even lower expectations.

Mr. Frownie? Meet Miss Smiley!

UPDATE: OK, after I spent all this time theorizing, I realized it would be totally embarrassing if the placebo/personality connection had been researched already and that I was totally full of it thinking there was a connection.  But voila!  There has indeed been research suggesting that the placebo effect works better for optimists.

From Ice Buckets to the Sneaky Secret of Happiness


Regular readers have probably picked up the fact that I'm a Frownie Person who is trying to change in into more of a Smiley person.  I would really like to become someone who could stick my hand in a bucket of ice a few times, and have a lifetime of pain relief because I would keep reinforcing my belief that it works! Or I'd like to be a person who could hypnotize herself into becoming more confident or successful, or impervious to the temptation to eat 74,000 calories worth of trail mix in one sitting if any happened to be in the house.

Despite pissy examples like last weeks blog grouchfest, I'm making pretty good progress on the whole positive attitude adjustment project.

If you can imagine such a thing, I used to be way more of a curmudgeonly party pooper than I am now. But I'm still not as sunny and suggestible as a natural-born Smiley Person in the way I perceive and think about things.  

I believe I've written about this before, and no doubt will again with more specifics, but one big trick I'm working on in improving my world view has been to become a lot more selective about when I even care about "objective reality."

Sure, if I'm contemplating an expensive purchase, then yeah, bring on the skepticism and screw wishful thinking.  I want all the data I can find and want to muster critical thinking skills. I do not want to end up paying a fortune for some shoddy piece of crap just because I'd love to believe some nice salesman's earnest self-serving testimonial.  

But when it comes to matters where a positive attitude might serve me better, regardless of evidence? Matters like physical health, and confidence and tranquility and follow-through and potential blissfulness? Well, bring on the beep tones, baby, and let me hop on the Placebo Train with all the happy Smileys.  I suspect that the more I believe I can rewire my brain to do what I want it to, the better the chances are that I can do exactly that.

The tough question is: how do you rewire a skeptical mind to start believing things that are useful, regardless of objective "truth?" Well, as you may have feared, I've been playing around with that and have some thoughts! Perhaps for a future "Mindf--ck Monday" blog post.

How about you guys, do you have any pain reduction tricks or thoughts about personality or whatever? Or heck, how was your weekend?

(I'm off for another medical appointment and long-ass drive this morning but will return later in the day to check back in. Oh, and my grouchy mood seems to have passed even if the circumstances that led to it have not yet abated--yay! And thanks for your patience!)

31 comments:

  1. This isn't pain, but in a quasi-related matter I've used hypnosis to ease my gag reflex for dental procedures. I suggested to me that when I grasp my left wrist with my right hand I'd relax. It worked very well. It's been more than 15 years since I planted the suggestion and it works to this day.
    As to rewiring a mind, I have no clue. Maybe approach it as a science experiment and see what happens?

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    1. Leah, thank you, what a great idea! I have a very rambunctious gag reflex myself and this sounds like a great self-hypnosis project if I can ever get myself suggestible enough.

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    2. My oldest son kept gagging at the dentist (grated on my last nerve but....) - after about 4-5 unsuccessful visits over the course of a couple years, the hygienist finally tried salt. She tole him that a little salt on his tongue would take the gag away - worked like a charm and he hasn't had a problem since!!!

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  2. I have used a back scratcher when I had menstrual cramps that pain killers wouldn't work on. I have a big need for control so I would concentrate on the scratching feeling to distract me from the cramps. The cramps would drive me crazy because I had no control and I didn't know how long they would last or if they would get worse. The scratching I could control. No I didn't scratch myself hard! Just enough to feel it. I find a good scalp massage and scratching works for me on headaches, but I am not one of those people that get a lot of migraines.

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    1. Cindy, that's another great distraction idea! And your point about control is well-taken, it's a big part of what makes pain so hard to take. Having a distraction you can control might really help!

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    2. Similar to Cindy's method, I used to walk in circles during painful menstrual cramps as a teen. Our living/dining room attached to the kitchen on one side and the hallway on the other and I would just pace in circles through the rooms and entrances until the ache went away. No wonder I was skinny then. I found myself falling back into that old pattern when in labour each time. .. except then, it was up and down the hospital hallways.

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  3. The whole placebo thing fascinates me. Especially the nocebo effect! If possible, I think we should use a placebo for everything!

    Look into PEMS (Percutanious electro magnetic stimulation).

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    1. OK at first I thought you wrote PMS and was gonna say BEEN THERE DONE THAT but PEMS sounds much more intriguing!

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  4. Pain is literally all in our heads...as is everything else. It's all perception. Every aspect of how we experience reality is based on our perception which is informed by our expectations, past experiences (which influence neural pathways), our neural network, our genetics, our beliefs, our thoughts, our emotions and feelings...all of which are founded on our perceived experiences which are interpreted by our neural network which is dictated by our experiences. You literally turn around in circles. Is there an objective reality and does one exist without someone there to observe it? By observing do we change reality? Waves and particles, electrons popping into existence when we expect to see them? Our brain filling in the actual blind spots in our vision with what we "expect" to be there.

    Conscious thought and subconscious thought? Which one is really in control? Do you really want to be "happy" all the time? I have heard (and read) that meditation seems to be helpful. There is such a thing as neural plasticity....we can change the way our neurons fire but we do have to practice "thinking differently". And it's a lot of work for those of us predisposed to being well, cranky and critical.

    http://online.wsj.com/news/articles/SB10001424052748704893604576200471545379388

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    1. Thanks Tiffany! You touch on some of the weird questions that come up when we start really looking at perception vs "reality" and how intertwined and confusing it all is philosophically, and really, what a magnificent way to get one's head all twisted if you really start to think about it. When physics goes quantum my mind starts to get blown!

      As to that happiness article, I thought it was interesting in distinguishing hedonic vs eudaimonic but screw it, I want BOTH kinds! :)

      The rewiring IS a huge pain in the ass, but since I find that working at it does seem to pay off, I'm going to keep at it, even if the cranky neurons are still not quieting down completely yet.

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    2. Interesting - I've always sort of thought the same thing but then when pain hits I decide it is real:)

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    3. There are some Eastern Philosophies that would say (I think) that it's the "wanting" that is the real problem and makes you "unhappy". I actually taught a course for the Psychology department called "In Pursuit of Happiness" and we discussed the historical, biological, societal, etc... aspects of our obsession with happiness. It was really a great course and all the faculty in the department walked around amazed that "I" was the one teaching it given my general disposition. But we didn't search for it, we deconstructed the concept and in reality, contentment is much better because happiness is an emotion and is fleeting.

      Still, none of it is real! You know that great quote from Morpheus to Neo in The Matrix: "What is real? How do you define 'real'? If you're talking about what you can feel, what you can smell, what you can taste and see, then 'real' is simply electrical signals interpreted by your brain."
      And of course the famous there is no spoon quote:
      Potential "Do not try and bend the spoon. That's impossible. Instead... only try to realize the truth.
      Neo: What truth?
      Potential: There is no spoon.
      Neo: There is no spoon?
      Potential: Then you'll see, that it is not the spoon that bends, it is only yourself.

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    4. my favorite Matrix quote is from Morpheus "There is a difference between knowing the path and following the path." I think of this quote often when I'm trying to make healthy choices. (what that has to do with pain relief, I don't know.)

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    5. That's a great one too Ben, not just for health choices but life! That's why that movie is so awesome! I mean I read a lot about this stuff....all this positive psychology, quantum physics, etc....so I "know" a lot...now "living" it is entirely different.

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  5. Death Ride GrandmaJuly 21, 2014 at 1:42 PM

    I think there's a perception that placebo effects require an almost religious belief to work, and from much that I have heard and seen, that's not necessarily true. We once met a guy, a fisherman, who spent his weekends out on the Pacific, that badly named ocean, in rough conditions without ever feeling a twinge of motion sickness. One day, he went out as usual and was sick all day. But when he got home, he was still sick. Motion sickness pretty much disappears as soon as you get your feet back on the dock, so he knew he must have had a stomach bug or food poisoning. The weird part? From then on, he was prone to motion-sickness. In other words, a guy who knew he didn't have that issue, who knew that was not what he had experienced, had nonetheless managed to flip some sort of switch in his brain that he was unable to switch back.

    The point of this is that I suspect that even we skeptical types can be effectively served by these things that we believe to be sort of fuzzy and suspicious. Our understanding of the brain is so primitive right now - we are only beginning to see how much there is yet to be learned, and I think this area is going to be a very cool one.

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    1. Funny DRG, a similar thing happened to me as to your fisherman friend--I got nauseated in the car once after no history of it, and then became car-sickness prone for like a year afterwards, as though my body had learned how to be car sick! Thats NOT the kinda rewiring I wanna do! :) I think you have a great point that even skeptical folks can be influenced by mind/body dynamics.

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    2. Yikes!! Sadly, I think there is a lot of truth to this - my youngest son did fine in Colorado many times and then one time he was sick - now he is convinced he will always have altitude sickness!
      I think our mind is a powerful thing and we are very susceptible to the power of suggestion!!

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  6. Yes, it's all experienced in our heads, as is everything, but Labor Pain Still Hurts!

    Anyway, yes, there are ways to experience things differently, and i'm working on them. Keep sharing these studies, they encourage me to continue trying.

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    1. Oh my goodness messymimi, I can't imagine what sort of HNCS could possibly distract from labor pains! Short of maybe an axe to the head, which would be a bit counterproductive.

      But then... I know there are people who can use hypnosis to go through major surgeries without anaesthesia, so I guess the mind is a powerful thing!

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  7. Two anecdotes for your reading pleasure...

    1 - My husband would always say "Pain is a state of mind! You can ignore it!' And then he would be in pain and I would repeat that back to him and he was not so impressed. He doesn't really say that any more.

    2 - I broke a tooth and had to get it fixed. I am terrified of dental work. I don't even like getting my teeth cleaned. I don't know why, but I suspect it has something to do with feeling helpless. Anyway, the dentist gave me a prescription for Ativan to keep me all calm and uncaring during the procedure. I believed that it would work, because they told me it would...Until I spent the first half of the procedure bawling. Not because it hurt; it's a panic reaction.

    My husband on the other hand is terrified of needles. They gave him Ativan for a medical test involving lots of needles, and even knowing that it did nothing for me, it worked for him.

    I'd like to draw some profound conclusion from this, but mostly I just think sometimes things work, and sometimes they don't. I like to think of myself as a realist. :)

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    1. I think "sometimes things work, and sometimes they don't" is as sensible a conclusion as anyone could draw, JavaChick! And I love your anecdotes--I'm guessing this why clinical testing of drugs always give such confusing results. Does Ativan work? Sounds like yes! And no! :)

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  8. This entire study is interesting - I would love to avoid pain all the time!!!
    I think that a form of this has been around for a long time - I remember hurting myself when I was young and my dad saying he would punch me in the gut so that I would forget about the other pain - lots of truth in that kind of thing!!!

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    1. Wow. I'm just hoping your dad (a) was making an obvious joke knowing you'd understand he wasn't serious and (b) followed that offer up up with a more compassionate response? Know you are a brave one, but sheesh, tough crowd!

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  9. If re-wiring the brain were easy, we'd do it more often! I'm generally a Smiley Person, but my long experience of medical treatments that Don't Work makes me doubt my placebo reaction.

    Also, on the motion-sickness examples: I started getting car-sick in my teens, and eventually noticed that it was only when my mother was smoking with the windows closed. The next time, some years later, that my allergies were tested I showed allergy to tobacco smoke.

    Mary Anne in Kentucky

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    1. That would be an interesting study Mary Anne--whether even sunny people with chronic health problems are as able as healthy folks to harness the placebo effect.

      And as a kid I was also subjected to the car-smoke torture, and even though i didn't develop allergies I'm still pissed about it! We KNEW it was bad for us even then and I'm sure my parents did too.

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  10. Wow, I didn't have time to read this post this morning when there were only 4 comments. But now I'm glad I waited. I got to read all the interesting comments and replies, plus LOL Crabby, your posts are so funny. My daughter told me to be quiet!

    The brain is fascinating. If you think you can or if you think you can't, you are right.

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    1. Aw, thanks Bob Ben!! And yeah, I love the great comments, I always learn so much down here!

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  11. As you might know, I'm one of those naturally positive people! (so how can I suffer life-long from depression? -it is NOT YOUR MOOD!) I swear I read this article and could imagine those beepy noises working for me!

    My dentist explained this is also why they wiggle your cheek as they give you a numbing shot! Distraction!

    The spouser is a pessimist (he claims realist).. and I have yet figure out a way for him to sense things as better. Good luck with that!

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    1. I always concentrate on wiggling my toes when I'm in an uncomfortable moment in the dentist's chair. It helps me to sit still and get through it. Wiggling helps me sit still. Doesn't make sense but it works for me. I don't recall if it blocks pain. Next time I'll pay attention to that aspect.

      A smoke alarm has been beeping for last 3 nights. Made me crazy at first! 2nd night not as bad. Last night I hardly noticed it. Of course, it stopped during the day, so I could forget to fix. Finally got a ladder and had my kids fix it today. Very high ceiling in that room naturally.

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  12. Congratulations on getting the nod from Hilary as one of her long time bloggers....

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