Wednesday, July 15, 2009


Long ago, I remember my first encounter with Harrison’s principles of internal medicine. I was in 2nd year, it was a wintry December evening and I was in the library. I opened this textbook for the first time and started reading symptomatology. I was so absorbed by the book in no time. The first chapter I read was ‘pain’. “What a beginning”! I remember thinking.

I was intrigued by pain thanks to Harrison.

A large part of pain is psychological as most of us know. Just the suggestion of pain and attention to the pain-causing stimulus adds to the agony. Come on, didn’t the dull stinging in your heel turn into a full- blown, tantrum- throwing, howling when you SAW the thorn in your heel? Yes you poor baby, I know you were in pain, but your pain increased when you paid attention to what caused it.

The concept of fear of pain was what caught my fancy the most. Sample this,MOST of the neuronal projections carrying the sensation of pain project to the areas in your brain that sub serve unpleasant emotions like suffering, crying, and the sheer dread/ fear of pain. To explain better the fear of pain- consider the Chinese water torture where the victim dreads the next drop of water falling on his forehead or worse still, the small of his back. Drops of water fall in undetermined although frequent intervals on the small of his back or his forehead. The part becomes stiff and frozen after some time. The victim is in constant fear of the next drop falling on that painful, stiff area and the drops do not fall in regular intervals. The next drop could be seconds later or minutes later or the steady dripping may resume hours later. YEAARRGH! Frustration, pain, lord! Enough to drive anyone to insanity.

Pain modulation- soldiers don’t feel pain even when they suffer major fractures, thanks to their adrenaline charged states. Remember Rudy Youngblood a.k.a.’ jaguar paw’ running miles and miles to escape being caught by his captors even after being stabbed through and through in his abdomen? On the other hand, normally, you’d grimace even before the needle pricks your precious bum. Thanks to pain modulation, it’s theoretically possible to induce pain without any external stimulus. Think voodoo! I mean just expecting pain does weird things with your brain and you appreciate the pain more.

Pain tolerance is fascinating. Some women howl and howl in labour from the very beginning, while some clench their teeth and fists and get it over with without a single cry escaping them.
What’s a mild stinging for someone is a chest crushing tractor for someone else.

Pain is also addictive, think of those getting multiple tattoos or even self- mutilating ‘cutters’. Beyond a point, nothing is painful enough for that high they get after self harm. Scary! Fact is, the body’s defense mechanism is to release endorphins after sometime of suffering pain which alleviate it a little. People strive for that endorphin rush. Endorphin is an opioid after all. Err... Like morphine and heroine.

No, I am not a masochist, thrilled and turned on by the idea of pain. I just happen to have a certain innocent fascination for it.


Keshi said...

Interesting post on Pain.

More than Physical Pain, I think we r all traumatised by Mental Pain. What say?


Keshi said...

on physical pain, I once ran ard a doctor's surgery trying to avoid a needle lol!

In so much fear of PAIN.


Chiya said...

Harrisson is giving me mental pain off late.
vomuminous! hic! voluminous it is...


freudian slip said...

mental pain is another story. :(
lol@ running from a needle. i should have put yor picture

harrison giving me mental pain too.. and stop drinking. :P hehe

shruthi said...

very interesting.... and nice pics too.... they really made me feel the pain

freudian slip said...

thanks.. :)

Arps said...

Harrison got you interested into studying something!
::thumbs up::

::awe:: ::awe::

freudian slip said...

come on! i am sure you were immersed in harrison all the way! i rem u saying your dad is a physician!

just like that said...

very interseting analysis pu.. nice observations, good visuals.. nice

just like that said...

very interseting analysis pu.. nice observations, good visuals.. nice

Anonymous said...

loved this piece, will take me to harrison to read about it. such a great blend of medical science and literature. loved it

freudian slip said...

thanks varun and anusha

Anonymous said...

Harrison gives me pain. But then most textbooks do. Methinks pain is inextricably linked to medicine. Either way, good stuff.

freudian slip said...

lol.. which year?

Anonymous said...

Still 3rd. So looooooooooooooong way to go.

aravind said...

jus discovered why pain is addictive .. :)

i think pain(i don't see physical and mental pain differently) challenges the very spirit of an individual. show him his limits and make him stretch beyond that.......... it somehow makes one feel complete??!!(cant be sure of that)
pain is precious... that one extra push up is the most difficult one but u wanna do it... so that u can enjoy that pain in the arms ...

but how do u explain the constantly pain seeking state of depression??

is it still the endorphins??

freudian slip said...

yes pain makes us complete.

yes in depression, its still the endorphins.

Ketan said...

LOL@ precious bum!

Your choice of the chapter to write on from Harrison's was really good. I'd read it from the 16th edition, and what had fascinated me the most that inflammation could sensitize C(?) fibers to make them carry pain in the GIT.

And okay, so now I know from your profile that you've read The Fountainhead! :) This is context of my response to your comment on the Obama-post.

And are you sure of the endorphins' role in clinical depression? I haven't read about the details of neurotransmitters involved, but my instincts (though not feminine, but somewhat reliable ;) ) tell me they must not be involved.

Nice effort! And please do post more often, if possible. What year are you in?


freudian slip said...

hey ketan,

yes endorphins are released after some time of pain which alleviate it, or to put it better, give a heady rush.
which is why tattoo bearers usually dont have single tattoos. the multiple ones are more to experience the rush than for fashion purposes.
had also watched this fact proved on discovery/ natgeo, don remember which.
thanks for appreciating my effort.

freudian slip said...

i am in final year by the way.