The Pain of Painlessness

September 23, 2015

The Signs of PainNow that Pain Awareness Month is in full swing, we at Migraine Treatment Centers of America thought it would be nice to take a look outside the mainstream issues to the shadowy borderlands of pain. Lets look at cases, diagnoses, missing diagnoses, and other strange phenomena that are both perplexing and potentially invaluable to the science of pain alleviation and management.

 Of the 50 million plus Americans that suffer from chronic pain, the cases that follow represent a tiny, tiny fraction. And yet, as we will see, these rare manifestations of pain or painlessness may have huge implications for the vast majority of the 50 million.

We’ll start with the Painless Ones.

Pain Un-Awareness, or Painlessness

 For the chronically pained, the thought of feeling no pain must be wonderful. In fact, it was the ancient Greek philosopher Epicurus who quipped that pleasure is the absence of pain.

In order to test his theory, let’s take a look at those few people in the world who have a genetic inability to feel pain. Perhaps you have heard or read of some of these cases – one was covered in Dr. Robert Marion’s book, The Boy Who Felt No Pain1 and Ashlyn Blocker, perhaps the world’s most well-known painless patient, has been written about and covered by everyone from Geraldo Rivera to The New York Times.2

The basic condition that Ashlyn and a few others suffer from is this: they feel things, like textures, even temperatures, but they do not feel pain. They can be scalded by boiling water or walk barefoot through the Alaskan tundra and feel like they’re taking a tepid shower or walking through a park on a spring day. In a particularly gruesome example, Ashlyn’s father summarized her condition by saying if her hand were cut off by an axe, she would feel fear at the sight of the blood and her disembodied hand, but she would not feel any terrible physical sensation.

In a very sad story recounted in a New York Times article, an Indian boy with this rare condition used it to entertain his friends: on his birthday, he displayed his “superpower” by jumping off a one-story roof. He died the next day of internal injuries, but he still felt no pain. It turns out Epicurus is wrong: far from being pleasurable, this condition is extremely dangerous.

Pain is a Gift

 Those rare people who feel no pain are typically marked by scars from injuries they did not know they sustained. Just because you can’t feel pain does not mean you don’t have to worry about, say, blood loss!

In this way, the condition is similar to what happens when a diabetic develops neuropathy of the foot. In diabetic neuropathy, the nerves that service the foot are compromised, which can lead to numbness. While numbness in itself may not be a bad thing, the risk of sustaining—and failing to treat—an injury results in wounds that turn into ulcers that turn into thousands of amputations every year. This is not good.

In order to survive a painless childhood (as Ashlyn has), a major support system must be erected. In Ashlyn’s case, teachers and students at her school know that they must watch out for her. If she takes a fall, for example, she must be reminded to look for scrapes so they she can treat them before they become infected.

How Does This Happen?

 This condition of painlessness is either so rare or so under-reported that medical science only recently began to take it seriously. Inspired by Ashlyn and a handful of other cases, geneticists went to work and have successfully isolated a range of genetic abnormalities that the painless ones tend to share.

It seems that because these patients can experience physical sensation but not pain there is something fundamentally unique about how neurons pick up on and communicate the sensation of pain to the brain. So where is the disconnect? It is in the nerves themselves, or is it in the brain? Could it happen in between, say in the spinal column?

The answer to this question is not completely known, but the very fact the science has zeroed in on some particular genes should be a cause of great excitement, not only for sufferers of painlessness, but also for those who suffer too much pain, especially pain that is unexplained.

How Can This Research Impact Your Pain?

 Is it possible that the genetic abnormality that robs a person of her ability to experience pain can work in the other direction – by causing a person to feel too much pain? That theory takes this rare case of painlessness into potentially widespread applicability for the 50 million of us who live with chronic pain.3 Researchers are invigorated by the possibility of developing interventions—like drugs—that can target these “pain” genes and bring them into an acceptable range: sensitive enough to be safe, but not so overreactive as to cause debilitating pain.

The Takeaway

Greater communication and technological innovation in the modern era has led medical researchers to make some unlikely—and previously impossible—links. In this strange case of painlessness, it started with a few families with afflicted children seeking medical answers. Researchers were then able to hear those disparate and isolated voices and were than able to test them and arrive at some startling and promising findings.

No one knows what will happen next, or when. But a breakthrough in the understanding of pain could be around the corner, and that could benefit all of us.

 

  1. Marion R. The boy who felt no pain. Addison-Wesley; September 1990.
  2. Heckert J. The hazards of growing up painlessly. The New York November 15, 2012.
  3. News Medical. New NIH study shows nearly 50 million U.S. adults experience chronic or severe pain. August 20, 2015. http://www.news-medical.net/news/20150820/New-NIH-study-shows-nearly-50-million-US-adults-experience-chronic-pain-or-severe-pain.aspx

 

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