The "secret world of pain"

Hot on the heels of the Pleasure and Pain documentary last week, today the BBC science documentary series Horizon discussed "The Secret World of Pain".

This show felt much more "dumbed-down" than the previous documentary, especially given the overblown hype of the introduction. Nevertheless, it was still very interesting. It also didn't discuss masochism at all, but given that it didn't promise anything about pleasure, that isn't as much of a disappointment as with the first programme.

Relevant to the topics in this programme, however, are my previous posts about pain and me. Both as a masochist, and as someone for whom pain is an important part of life, I get nervous when people talk about "curing" pain. Sometimes, yes, it is a problem (or indicative of a problem), but I would rather talk about curing the causes, rather than the pain itself.

The first two case studies mentioned in the Horizon documentary were about people who don't feel pain. These demonstrated just how important pain is as a part of everyday life. For them, a cure is not a cure for pain, but a cure for painlessness, although the researcher (geneticist Dr John Wood) spoke of the result of his research on these people as "a dream for those trying to cure pain". He was discussing the discovery that the gene SCN9A (I think this was mentioned briefly in the other programme as well) is linked to pain threshold and not to any other functions. He said that this could lead to finding something that could block its function, that would then be effectively "a painkiller without side-effects". Of course, if the drug accidentally blocked other genes' functioning as well, or had some other biochemical effects, then that wouldn't be true. I would also be very nervous about blocking it completely because even when I take painkillers I still feel enough pain to be able to know when something's wrong - I wouldn't want such a complete blocking of pain transmission except in truly drastic situations.

The next case study was presented by Professor Maria Fitzgerald, who explained for viewers about how it was believed that very early experiences can affect the development of the pain system in the brain. because a new-born child is still developing sensory perception pathways in the brain, the theory presented by Prof. Fitzgerald was that early pain experiences, if they overload the tactile nerve sensors, can have an effect on the way the brain's perception of pain is wired. The show discussed an experiment where Fitzgerald studied the difference in the brain activity between full-term babies and premature babies, given that the premature babies have to undergo necessary and painful medical procedures. This seemed to show that babies who experience a lot of pain early on develop very quickly an increased sensitivity to pain compared to those who have a relatively pain-free early existence.

Naturally, I wanted to ask whether there could be some such difference in very early life that would explain how masochism develops. Perhaps there is a combination of genetic and neurological development causes?

Interestingly, Prof. Fitzgerald went on to say that adult pain pathways are still plastic and changing. This might explain partly why it is possible to become kinky in later life, or to learn to take more pain as a masochist or bottom.

The next question discussed was that of why the amount of pain felt seems out of synch with the severity or type of injury. The case study raised here was another example of someone cutting off his own arm in order to save his life, who reported that the act had actually involved feeling not much pain at all.

The science discussed looked at the psychological impact of emotion on pain perception. Professor Irene Tracey explained her research, opening with "What I do for a living is, I burn people. Unsuspecting students, people from around the city, we inflict with all our different torture devices, various painful stimuli..."

Well, what can I say? I'm a sadist! That sort of remark is bound to get my ears pricking up! Seriously, though it was probably the most interesting part of the show for me because it was much easier to follow the science. Prof. Tracey explained much more clearly and intelligently, in terms that I could understand (not being hugely knowledgeable about science, although a little bit more so about pain), what she was doing and what she was learning from it so that you could see the links without having to take people's word for it. Or maybe I was just turned on by the study involving inflicting pain?

The experiment that we were shown looked at anxiety as an influence on pain perception. A triangle of one colour and a square of another colour are shown, the triangle followed by a low-level stimulus, the square by a higher-level stimulus. The subject only receives the high-level stimulus once. The study looked at the perceived level of the low-level stimulus when the subject experiences anxiety due to anticipating the high-level stimulus associated with the square and found that people reported that the low-level stimulus was more painful after seeing the square than after seeing the triangle. (Interestingly, I looked at the coloured shapes and I felt higher anticipation anyway associated with the square even before Tracey explained what was being done - I think I had a coded reaction to the colour. I wonder if that type of effect could skew the results, or if they controlled for that by reversing the associations for different people?) Tracey explained that they used brain scans to try to figure out where in the brain these differences were being produced by looking at which bits lit up.

Unfortunately, the programme skipped on at this point, only mentioning that Prof. Tracey also looked at the effects of high levels of sadness or happiness, but not mentioning what she found specifically for those emotions. (Would also have been nice to know if they looked at sexual arousal too! And if they checked for differences between masochists and 'nilla folks...) As mentioned previously, I did once volunteer to take part in a study of masochists' brains processing pain but the research did not go ahead.

This part of the programme also intrigued me because playing with the emotional state of a bottom in BDSM is often hugely important. Submissives in particular often report that a spanking that is delivered as a punishment is often a lot more painful and hard to bear than one that is delivered for fun. Anticipation is often a big part - either showing a bottom the next implement (or better, as with Prof. Tracey's study, showing them one thing and actually causing a different type of pain), or deliberately keeping them guessing. As the voiceover went on to say, every time a person experiences pain, it is a different experience, each pain event is unique. (The voiceover actually said "totally unique", which inflicted a form of pain on me because ONE CANNOT HAVE GRADATIONS OF UNIQUENESS - IT EITHER IS UNIQUE OR ISN'T! But anyway...) It is playing with the different ways of making it different that gives sadism and masochism such variety.

At this point, they moved on to discussing some of the practical applications of the psychological approaches to pain management and pain experience. Of course, they still talked about "curing" pain (which wasn't really what they were doing, but anyway). While the people on the programme were thinking about ways of using this research to cure unwanted pain, I was wondering if the research could be used to enhance and improve upon existing torture methods and to create new SM toys!

The first research they were discussing looked at ways of helping burn victims who suffer through rehab. The technique that they covered was basically one of distraction. Professor Hunter Hoffman explained his development of a virtual reality video game called "Snow World" which is essentially a 3d shoot-em-up using snowballs to take out penguins and snowmen who throw snowballs back. High action, attention-demanding stuff, even though the game itself is quite simple. The theory of why it works is simply that because the game is drawing on so much of the patient's attention, there isn't enough processing power left over for the brain to register the pain signals properly. It also worked by cutting down on the visual cues that increased anxiety (as discussed in Prof. Tracey's work).

This reminded me that a key component in many BDSM scenes is a demand that a bottom stay focussed on the scene, on the here-and-now, on the Top. This is often precisely to stop a bottom from distracting hirself from the sensations inflicted upon hir. Sometimes, though, the game is the opposite - the bottom is commanded to avoid letting the pain or other stimulus (e.g. handjob!) distract hir from some other task. Because the visual stimulus is still available outside of the other task, it is a lot harder than when you're wearing VR goggles!

The final case study in the programme talked about "chronic pain", which is pain that persists after the physical damage that caused it has gone. Explaining the theory and experimental treatment here were Prof. Tracey and Professor Turo Nurmikko, Prof Nurmikko being the one who was administering the treatment on the programme.

Prof. Tracey explains that sometimes the pain processing systems can be damaged, causing it to fire continuously. This causes further effects, including a decrease in the amount of grey matter in the pre-frontal cortex (which is where pain is processed normally). Tracey explains that the continuous barrage of signals causes chemical and structural changes in the brain.

Prof. Nurmikko explains that his treatment sets out to reverse these changes in the brain. At first, I was a bit alarmed at the idea of rewiring brains in that way (it made me wonder if you could rewire the brain to make people forget things, and called to mind a sci-fi scenario of governments wiping dissidents' minds!) but the explanation seemed a bit less threatening than that (although it did seem to offer the possibility of helmets that allowed someone to control the wearer by remote control). Nurmikko explained that there are several different types of changes that can happen to the brain of a person with chronic pain.

The technique is called "transcranial magnetic stimulation". In the example the programme showed, the motor cortex of a patient was believed to be changed in such a way as to cause it to amplify pain and also to change which bits of the body were wired where in the brain. They showed the magnetic stimulation causing her arm to move when they were expecting her hand to move instead. (See what I mean about creating a remote-control helmet!?) Prof. Nurmikko's treatment set out to undo the rewiring by retraining the damaged neurons by sending many magnetic pulses to stimulate them in the right way.

Nurmikko added that the motor cortex should normally provide an analgesic function as well, and when it isn't working properly this can cause chronic pain.

They showed an immediate response to the treatment in the programme, but Prof Nurmikko said that it would take many more treatments for it to have a long-term effect.

The programme ended with a summary of the subjects covered: genetics, neurology and psychology.