Chronic Pain and Memory

This is a fas­ci­nat­ing arti­cle with excel­lent sources.

Chron­ic pain is ter­ri­ble. A new way of under­stand­ing it may help.

The past two cen­turies have pro­duced a cas­cade of life-alter­ing advances in med­i­cine, yet we have been unable to deal with one seem­ing­ly straight­for­ward con­di­tion: chron­ic pain. It affects 1 in 5 peo­ple around the world, yet in large part because of a fun­da­men­tal mis­un­der­stand­ing of its basic nature, it remains poor­ly treated.

Our fail­ure to under­stand pain is most clear­ly exem­pli­fied in the opi­oid epi­dem­ic. While opi­oid med­ica­tions are effec­tive in treat­ing patients with acute pain, such as the type one devel­ops after break­ing a limb, the cumu­la­tive evi­dence sug­gests that they are no bet­ter at help­ing patients with chron­ic pain — gen­er­al­ly defined as pain that lasts for six months or more — than safer painkillers such as ibupro­fen or acetaminophen.

Pre­scrip­tion opi­oid use sky­rock­et­ed in part because of a now-dis­cred­it­ed pub­lic health cam­paign that sought to posi­tion all pain as a pure­ly phys­i­cal sen­sa­tion, a “vital sign” sim­i­lar to one’s heart rate or blood pres­sure. Yet research stud­ies are reveal­ing that acute pain may have lit­tle in com­mon with chron­ic pain. If you study the brain using MRI scans or oth­er tech­niques, these stud­ies show, the phe­nom­e­non that chron­ic pain appears most sim­i­lar to is mem­o­ry, and the con­di­tion with the most par­al­lels to chron­ic pain is post-trau­mat­ic stress dis­or­der (PTSD).

Pain and memory
The rela­tion­ship between pain and mem­o­ry is incred­i­bly close, as many stud­ies have shown, and for good rea­son. Evo­lu­tion­ar­i­ly speak­ing, pain’s chief pur­pose is to keep us safe from harm, and to achieve that, it has evolved into an effec­tive teacher. No mat­ter how many times I warn against it, it is only after my daugh­ter touch­es the hot skil­let once that she learns to nev­er do it again.

Because humans are some of the longest-liv­ing ani­mals, we need to be able to remem­ber how we got hurt for a very long time. And because our bod­ies would much rather we be over­cau­tious, our rec­ol­lec­tions of agony are often exaggerated.

This mem­o­ry phe­nom­e­non, called the peak-end rule, says that we tend to remem­ber an expe­ri­ence through its most emo­tion­al­ly intense points and its end. When it comes to chron­ic pain, that means the more pain a per­son lives with, the more like­ly they are to mis­re­mem­ber it as being worse than it was. Even if infre­quent, pain’s worst spikes are embed­ded much more deeply than moments of rel­a­tive respite; thus our rec­ol­lec­tion is skewed negatively.

Cyn is a proud Mommy & Mémé, professional geek, avid reader, fledgling coder, enthusiastic gamer (TTRPGs), occasional singer, and devoted stitcher.
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