Recovering from chronic pain

March 2, 2022|Chronic Pain

By Anita Schnee, GCFP CM

Imagine body, mind, and soul in a healthy, vibrant biome, each element at home in its fitting habitat. Then imagine a biome desiccated by old anguish, every green thing devoured by battalions of locusts. This is the chronic pain biome at its worst. An injury is no longer acute but the pain grinds on. Its triggers are unknown or only vaguely identifiable. Sufferers feel desperate or in despair. Bystanders are baffled or hostile or both. Pain is misdiagnosed, mistreated, or merely masked by medication.

In the last two decades, though, thanks to technological advances in brain imaging, a new narrative is emerging. That narrative reveals the role of the glial nervous system. Glial “white matter” underpins the more familiar “gray matter” neuronal systems.

In chronic physical pain, recent research posits that the glial system gets “stuck” in over-stimulating the neurons.

GLIAL CELLS

In an interview with Dr. Ginger Campbell on her Brain Science podcast, groundbreaking neuroscientist Douglas Fields says:

“Pain has more to do than with just nerve endings. . . . [I]t turns out that the glia in the spinal cord . . . are monitoring the pain information – the neural activity in pain fibers. And [the glia] respond to . . . initial injury [by releasing] substances that are important in the healing process, but they intensify the pain by exciting neurons. Now, that’s fine right after an injury . . . It makes you leave this injury alone, so it will heal. But that needs to subside with time. And if these glia don’t stop releasing these substances that excite pain neurons, then you will continue to feel excruciating pain after the injury has healed.”

Where there is no other convincing explanation for the pain, then, the glia appear to have commandeered the chronic pain situation. We sufferers need to learn how to persuade them to change course.

ALGEBRA ACCORDING TO THE GLIA

The nervous system depends on its ability to manage split second coordination of nerve impulses from various sources in the brain and body, so the impulses can wire together and fire together. Specialized glial cells pick and choose which messages to favor. They pull off this feat by myelination.

Myelin is insulation that grows around the spidery legs of nerve cells, the axons. The more myelin, the more insulation. The more insulation, the faster nerve impulses can travel along the axons. To orchestrate a coherent signal, timing is everything. Sometimes speed is called for; sometimes not so much. Glia juggle it all, in an intricate biological story problem.

Suppose two nerve-impulse friends want to rendezvous simultaneously in New York City. One friend lives in Chicago, the other in Boston. Both depart for New York at the same time. How fast must the Chicago friend travel, to meet the Boston friend on time in New York?

The glia perform that calculation (somehow) and then they myelinate accordingly. Less myelin is deposited along the Boston pathway; more along the Chicago pathway. Voltage leaks out of the Boston-NYC pathway and the Boston friend ambles. More voltage is packed in along the Chicago path and the Chicago friend hustles. Thanks to glia’s exquisitely precise myelin orchestration, the two friends fist-bump on the dot under the Grand Central clock.

So if the glia can do all that, what could be stopping them from reorganizing, to coordinate neuronal output into a more kindly message than chronic pain?

THE GRIEF-PAIN CONNECTION

The answer might lie in the close similarity I see between chronic physical pain and the very particular emotional condition of chronic grief. The physical pain can be thought of as a more concrete expression of more amorphous and elusive chronic grief.

Social scientist Pauline Boss describes chronic grief as “ambiguous loss.” It’s also been called “frozen” or “complicated” or “disenfranchised” grief. This grief is felt in trauma as it is experienced by the individual who suffers it over the arc of time. Boss says that “no single narrative can explain a deprivation; subjectivity colors our perception of loss.”

There is a very particular feeling of haphazardness that seems to trigger episodes of chronic pain. Joan Didion described the lead-up to her regular migraines:

“It never comes when I am in real trouble . . . . It comes instead when I am fighting not an open but a guerilla war with my own life, during weeks of small household confusions, lost laundry, unhappy help, canceled appointments, on days when the telephone rings too much and I get no work done and the wind is coming up.”

IMAGINE ANOTHER TRUTH

On the emotional side, a new narrative must replace the old story. Apparently it needs only to be good enough in order to serve as a plausible means to lay to rest the old alarms and sorrows. Pauline Boss suggests that some losses have no concrete solutions. Boss says that the process happens through “listening to one’s emotions and responding to intuition. [One needs] . . . to imagine what the truth might be.”

The key seems to be to turn away from unanswerable questions where no satisfactory explanation can be found. Those kinds of questions build glial loops resulting in frustration or unhappiness. Rather, a more constructive question might instead be: “Where can I look for truth within myself?”

That is not a simple enterprise. It’s important to cultivate and nourish each of the elements so the body may grow out of dysfunctional habitual patterns, the mind may find rest, and the soul may be nourished. Each element may then coexist with the others in an organized, cooperative relationship.

If “stuck” glia do contribute to sustaining both physical and psychic pain, the way to move is to invite them into new paradigms in both realms, physical and emotional.

List of references:

“The Quiet Scientific Revolution That May Solve Chronic Pain”

https://www.nytimes.com/2021/11/09/well/mind/glial-cells-chronic-pain-treatment.html

Brain Science podcast with Dr. Ginger Campbell and Dr. Douglas Fields, episode 169

https://brainsciencepodcast.squarespace.com/bsp/2020/169-fields-glialcells

“On Being” podcast with Pauline Boss and Krista Tippett

https://onbeing.org/programs/pauline-boss-navigating-loss-without-closure/

Joan Didion, “In Bed,” from The White Album

Les Fehmi, “Open Focus,” https://openfocus.com/