Many have heard the story of the hapless soldier who falls into enemy hands, being in the wrong wrong place lands him in a world of trouble becoming a prisoner of war to the enemy he or she was supposed to be killing. During his or her captivity, he or she is the recipient of brutal torture and inhumane treatment, this not as often an occurrence as it was previously as many of the prisoners of war tend to end up decapitated. The unfortunate individual we speak of is encouraged to reveal important secrets and so forth in order for the horrible treatment to cease, yet does nothing and maintains his or her detachment from the situation until he or she is rescued. On the other end of the spectrum, our subject is just an average human, who is chronically fatigued and suffers from widespread pain in his or her muscles, tendons and ligaments. The latter is characterized as having a debilitating disease known as fibromyaglia. What causes both of our subjects to react to their environments as the do, the first having harsh surroundings where a great deal of physical pain is being inflicted but does not seem to be effected by it, and the second has no apparent physical pain being inflicted but cannot find anything to remedy the fact that his or her brain insistently tells him or her that the pain is incredibly intense. Pain is an incredible phenomenon, beyond merely an occurrence being experienced by every single person but also, “According to the National Institutes of Health, pain costs the U.S. economy more than $100 billion annually in health care and lost productivity.”(Kossoff) In this paper, we shall discuss what would cause the differences between our two subjects' differing recognition of their respective pain.

One of the debates argues whether pain is a perception or a sensation; if it were a sensation, then it would occur in all people in the same manner, and conversely, if we were merely perceiving it, then how it would be felt by us would be wholly dependent on the chemical makeup of our brains. The argument we find most convincing is that of the phantom limb. The concept of the phantom limb comes from when a person has a an extremity amputated and after which, the individual can still “feel” the amputated part. If pain were a sensation, then after having the limb removed, the subject would feel nothing coming from the appendage as all nerve connections would have been cut therefore no sensation would occur. On the other hand, perception deals with changing chemicals in one's brain which may still be present despite our amputee's lost part. Is this an isolated incident, or does it occur often, one may wonder. According to Ronald Melzack's article “Pain: Past, Present and Future”, “An excellent series of studies found that 72% of amputees had phantom limb pain a week after amputation and that 60% continued to suffer phantom limb pain, which means that only about 1-12% of amputees obtain pain relief.” This seems to be a rather remarkable number of those who continue to feel limbs which are no longer attached to them, and therefore, strongly suggests that one perceives and does not actually sense pain.

Since we have established that pain is largely perception as opposed to sensation, we shall now analyze differences in the perception of pain. As we mentioned initially, the way any single person may experience any bout with the ubiquitous idea known as pain. According to Dr. Ranney, there two classifications of pain, “Nociceptive pain is pain in which normal nerves transmit information to the central nervous system about trauma to tissues (nocere = to injure, Latin). Neuropathic pain is pain in which there are structural and/or functional nervous system adaptations secondary to injury, that take place either centrally or peripherally. Much of what has previously been considered psychogenic pain is now better understood as neuropathic pain of central origin. The IASP defines central pain as pain initiated or caused by a primary lesion or dysfunction in the central nervous system. Neuropathic should not be confused with neurogenic, a term used to describe pain resulting from injury to a peripheral nerve but without necessarily implying any neuropathy.” (Ranney 1) This is an important distinction because our second subject may very well fit into the neuropathic category, they previously and still by some are considered to have neurogenic pain, but are widely being understood to have neuropathic pain (where there is a disease of the nervous system). As mentioned in the previous quotation, there are two main types of pain origins; peripheral pain, which begins in muscles and tendons, and central pain, which arises from central nervous system pathology. It is a possibility that some this may arise from maladaptive though processes as in fibromyalgia. Most, however, is caused by structural changes in the central nervous system itself, such as a spinal cord injury, multiple sclerosis, stroke or epilepsy. (Ranney 1) With regard to our individuals suffering from chronic pain, a theory called central sensitization appears to be characteristic. “With long continued stimulation, there are physiological changes.But many are structural in nature. For example, changes in expression of genes (e.g.,c-fos and c-jun) occurs within the secondary (e.g., spinothalamic or spinoreticular) neurons that arise in the dorsal horn. These genetic changes affect the volume and type of enzymes and neuropeptides produced. Thereby they induce long term changes in these post-synaptic cells.” (Ranney 2)

One may wonder what the subject of pain has to do with the author's own experience. Besides being a basic human occurrence, the author's mother has battled with fibromyalgia for quite a long time. He has seen her treated by many doctors who have prescribed innumerable medications to attempt to alleviate the pain experienced. It is an extreme event to watch someone struggle with such amazing pain, and be able to do nothing about it, and have doctors who know little about what causes it and even less about how to terminate it.

Works Cited

Melzack, Ronald. "Pain: Past, Present and Future." Canadian Journal of Experimental Psychology (1993) 47:4 615-629.

Ranney, Don. Anatomy of Pain. Ontario Inter-Urban Pain Conference. Waterloo. 29 Nov. 1996. http://www.ahs.uwaterloo.ca/~ranney/painanat.html.