Category Archives: BIG PAIN [ MESSENGERS ( THE NERVOUS SYSTEM ) ]

HEADACHES ( THE BRAIN’S EQUILIBRIUM )

HEADACHES ( THE BRAIN’S EQUILIBRIUM )

HEADACHES In the waning days of the Civil War, Union general Ulysses S. Grant was suffering from a terrible headache. He stopped at a farmhouse in the rear of his army, which had been pressing the forces of Confederate general Robert E. Lee. “I spent the night in bathing my feet in hot water and mustard, and putting mustard plasters on my wrists and the back part of my neck, hoping to be cured by morning,” Grant wrote in his journal on April 9, 1865.

Shortly afterward, Grant was visited by a messenger who carried a note saying Lee, who had refused to surrender the previous day, had changed his mind and would be willing to meet to discuss a formal end of hostilities. “When the officer reached me,” Grant said, “I was still suffering from the sick headache; but the instant I saw the contents of the note I was cured.”

Red indicates pain in a map of common headache sites, none of which is in the brain itself
Red indicates pain in a map of common headache sites, none of which is in the brain itself

Grant probably suffered from a muscle-contraction, or “tension,” headache. Typically, a tension headache begins when the neck, scalp, and face muscles are tensely held stiff for a long time. The most usual source is prolonged anxiety, a debilitating form of stress. Grant needed Lee to surrender; Lee’s announcement of his plans took the worries, and the agony, away. “The pain in my head seemed to leave me the moment I got Lee’s letter,” Grant reportedly told an aide as he rode off to end the war.

HEADACHES CATEGORIES

Even as it serves as an indicator that homeostasis is being disrupted, a headache is not a disease per se. Instead, it maya symptom of some other problem. It can manifest itself in response to irritation of blood vessels in the head, or to an injury or imbalance, or to inflammation of bodily tissues, to disorders related to stress-or to a host of other possible triggers. While it may feel as if the brain screams in pain, a headache can only occur outside the brain itself, which contains no pain receptors.

Headaches come in dozens of varieties. An easy way to categorize them is by the ways they cause pain. Muscle contractions such as Grant’s are one of the most common sources, especially among those living with high levels of stress. Dilation of blood vessels is a second typical cause. When arteries expand in the head, they squeeze against surrounding tissues, producing viselike pressure and pain. Fever, migraines, drug reactions, changes in blood pressure, and carbon dioxide poisoning can provoke dilation. Internal traction an abnormal growth in the head, for example is a third trigger. When a tumor presses against other tissues, or the brain itself begins to swell, the pressure causes pain. Inflammation is a fourth common source. Allergic reactions and infections such as meningitis can irritate pain-sensitive receptors in the head. Finally, headaches can occur without an obvious physical cause. These headaches are called psychogenic, meaning they arise in the psyche. They may spring from an emotional problem, as the sufferer converts emotional pain into real, physical symptoms.

The word migraine evolved from the Greek word hemikrania, meaning “half-skull.”

HEADACHE CATEGORIES

Many of these disorders strike not next to the brain, but in the eyes, sinuses, and other facial organs and tissues. Cranial nerves intimately connect the face and neck muscles to the brain, so it is no wonder pain sensations can spread until they feel as if they overwhelm the entire head.

Treating chronic headaches requires a proper diagnosis. Given the wide range of headaches and their causes, as well as the possibility of triggers working in combination, medical treatment often relies on detective work. At least, however, the efficacy of treatment has advanced since humanity first tried to cure a headache. A thousand years ago, Arabs recommended applying hot irons to the head, while a French medical treatise written in Latin urged sufferers to mix the brain of a vulture with oil and shove it up the nose. Today, modern pharmaceuticals, relax- ation techniques, and proper diet target dilation, tension, and other causes. One of the most effective pain relievers is common aspirin.

THE NERVOUS SYSTEM [ WORKING TOGETHER/SEEING THE BALL ( WHAT IS PLEASURE? ) ]

THE NERVOUS SYSTEM [ WORKING TOGETHER/SEEING THE BALL ( WHAT IS PLEASURE? )]

WORKING TOGETHER

How do all of these systems central and peripheral, somatic and autonomic and receptors work together in the symphony of the brain? From simple actions to complex ones, these systems must work in concert.

Consider the “simple” act of catching a ball. It’s an amazingly complex process that requires some basic anatomical structures and neural circuitry before it can be attempted. Obviously, most animals cannot toss an object. Nearly all lack hands with fingers and opposable thumbs, as well as the dexterity that has developed in human beings, across millennia of evolution, through the growth of increasingly complex neural circuits in the cerebellum and cerebral cortex. Thanks to evolution providing the basic tools of manual dexterity and the expansion of specialized brain functions such as those children develop when learning how to throw a ball, adults have basic skills ready to be activated when a ball comes their way.

SEEING THE BALL

The simplified version goes like this. When someone throws you a ball, photoreceptors in your eyes register the action and send it along afferent nerve fibers to specific portions of the frontal lobes of the cerebral cortex. Parallel processing of various sensations including the motion of the pitching arm, the path of the ball as it travels through the air, and its speed occurs within milliseconds. The cortex registers the perception “The ball has been thrown” and works with the cerebellum to calculate its likely point of arrival.

WHAT IS PLEASURE?
WHAT IS PLEASURE?

“OUR ENTIRE psychical activity is bent upon procuring pleasure and avoiding pain,” Sigmund Freud said in 1920. More than a CenturyLink earlier, British philosopher Jeremy Bentham had a similar idea: What humans seek to do is maximize pleasure and minimize pain.

But what is pleasure? Bentham equated it with happiness. Freud named things (especially sex) that make us feel good. It’s not an abstract argument for neurochemists . So called recreational drugs affect the centers of the brain that register pleasure. How ironic that Freud championed cocaine as a treatment for neural disorders.

Catching a baseball requires a complex chain of actions in the sensory and skeletal muscle nerves, cerebrum, cerebellum, and basal ganglia.
Catching a baseball requires a complex chain of actions in the sensory and skeletal muscle nerves, cerebrum, cerebellum, and basal ganglia.

If it’s thrown particularly hard, say, and right at your head, the autonomic nervous system registers the action as a possible threat, sends out efferent signals that release a chemical soup of neurotransmitters, and may prompt you to duck. But if the ball arrives as an ordinary pitch you’ve experienced a thousand times, the motor areas of the cortex, which control voluntary movement, work with the cerebellum and basal ganglia to move your gloved hand to the right place for the catch.

GOOD FEELINGS / PLEASURE CENTERS [ THE NERVOUS SYSTEM ]

GOOD FEELINGS / PLEASURE CENTERS [ NERVOUS SYSTEM ]

GOOD FEELINGS

Pleasure also has its centers In the brain. A Tulane University neurologist stumbled across one such center in the 1950s when he tried to electrically stimulate the brains of schizophrenics to break them out of their passivity. His patients told him their implanted electrodes created pleasant sensations. The neurologist, Robert G. Heath, seized upon the results, focused his attention on the brain’s pleasure centers, and published the 1964 book The Role of Pleasure in Behavior.

Together with the discovery of pain centers in the brain, research on the physical causes of the sense of pleasure seemed to prove the ancient wisdom that humans seek to act in ways that bring them pleasure and reduce or avoid pain. New paths of investigation have led to innovative treatments for addiction, which is a form of behavior based on compulsive forms of pleasure seeking. PET scans reveal how drugs such as cocaine and heroin activate the brain’s pleasure centers. Cocaine, for example, blocks a neuron’s reuptake mechanism, which causes dopamine to linger in the synaptic cleft.

PLEASURE CENTERS

Joy, happiness, pleasure-what-ever you want to call the positive feelings that bring rewarding sensations and make life worth living-arise from the sensations of security, warmth, and social well-being combined with an awareness of the rightness of such feelings. A healthy brain recognizes the conditions that give rise to pleasure and responds to them appropriately. An unhealthy brain, or one that has learned negative behaviors such as addiction, can miss out on experiencing life’s joys. Both are primarily a matter of chemistry.

GOOD FEELINGS / PLEASURE CENTERS [ THE NERVOUS SYSTEM ]

The sensation of pleasure registers in several brain regions, including significant centers in the hypothalamus and nucleus accumbens , which lies below a portion of the basal ganglia linked to movement. All such pleasure centers rely on the chemical work performed by endorphins and neurotransmitters, particularly dopamine, to create and sustain a happy mood. Experiments with rats have demonstrated the key role of dopamine. In the 1950s, scientists wired rats’ brains so that when they pressed a bar, they received a mild electric shock to the hypothalamus. This stimulation registered as pleasure; the rats would rather press the bar than eat. However, in later experiments, rats wired for self-stimulation first received injections of drugs that block the receptors where dopamine normally binds, denying its pleasure-giving action. The rats no longer felt a pleasant reward from pressing a lever to stimulate their brain, and they stopped doing so. When humans take a similar dopamine-lowering medication, often in order to ward off hallucinations and other psychotic behavior, the drug’s success comes at a price. Delusions may leave, but so do joy and motivation. Conversely, drugs like amphetamines that increase the activity of dopamine in the brain lower the threshold for the perception of pleasure. Too much of a drug-induced pleasant sensation, however, can lead to addiction and manic moods.

When the skin warms, the sympathetic division of the autonomic nervous system dilates blood vessels near the surface and activates the sweat glands. When body temperature cools, the autonomic nervous system narrows surface vessels to send blood to deeper, more vital organs.

“The greatest pleasure of life is love,” said the Greek playwright Euripides nearly 2,500 years ago. Like other forms of pleasure, love is processed by brain chemistry, specifically by heightened levels of neurotransmitters in the pleasure centers. MRI scans of the brain relate the feeling of lust to estrogen and androgens; attraction-more emotional than physical-appears to be associated with serotonin and dopamine. The brain chemistry that supports long-term relationships such as lifelong commitment has been harder to pin down.

Playing key roles in the sensation of pleasure are oxytocin, endorphins, and phenylethylamine , or PEA, sometimes called the love drug. These chemicals help foster the “high” felt in the first stages of love, as well as the euphoria some-times reported by long-distance runners. Even a small pleasure, such as finding your lost car keys, begins with a tiny rise of these and similar neurotransmitters in the brain’s pleasure centers.

DEGREES OF PAIN [ THE NERVOUS SYSTEM ]

DEGREES OF PAIN [ THE NERVOUS SYSTEM ]

Similar pains don’t always register with the same intensity. Although nearly all humans-besides the very few who lack the ability to feel pain recognize extreme heat or a deep cut as painful, they can react differently. Some tolerate pain more easily, whereas others feel it more intensely. Physical, cultural, and psychological variables may also influence a person’s individual degree of pain tolerance.

Cultural and psychological influences on an individual’s tolerance of pain are more ethereal and hard to measure than physiological influences. During World War II, British soldiers injured in the brutal fighting at Anzio, Italy, in 1943 routinely refused morphine to kill their pain, while civilians who suffered far less serious wounds demanded it to ease their pain. The surgeon who noted the difference came to the conclusion that certain kinds of pain could be a matter of mind, not of the body.

Ritual mortification of the flesh at the Hindu festival of Thaipusam in Malaysia demonstrates the power of brain over pain.
Ritual mortification of the flesh at the Hindu festival of Thaipusam in Malaysia demonstrates the power of brain over pain.

Long-term, intense pain can create a different perception in the brain. This chronic sensation may confuse the central nervous system and result in hyperalgesia, or pain amplification. Such pain registers on the same kind of synaptic receptors that are activated during certain kinds of learning. Under the worst- case scenarios, the chronic pain causes the spinal cord to “learn” hyperalgesia, and pain’s sensitivity increases. Examples include the lingering pain of phantom limbs-the sensation of pain from an amputated arm or leg.

Neural networks that process stimuli from a limb remain primed to respond to signals even after it’s gone. Random signals may get misinterpreted as tingling, itching, pain, or some other sensation. Neuroscientist Vilayanur Ramachandran found he could create sensations in phantom limbs by applying pressure to various skin surfaces. His conclusion: The cerebral cortex relocated sensation pathways associated with the old limb. These pathways may always have existed in a weak state, but loss of the limb amplified them. Unfortunately, neural networks that continue to recognize “pain” signals from a missing limb become more strongly primed to repeat the mistake. Treatments for phantom pain range from drug therapy to acupuncture and deep brain stimulation. Newer treatments, using mirrors or virtual reality goggles, trick the brain into thinking it can control the amputated limb.

PATHWAYS/GRAY MATTER [ MESSENGERS ( THE NERVOUS SYSTEM ) ]

PATHWAYS / GRAY MATTER [ MESSENGERS ( THE NERVOUS SYSTEM ) ]

PATHWAYS

Pain signals take rwo tracks on their way to the brain. The express line, like a nonstop train between cities, sends signals through the spinal cord and connects directly to the thalamus. While some pain signals are diverted along the way, those that reach the thalamus are relayed to the cerebral cortex, where they quickly get analyzed.

When you cut your finger while slicing an onion, the quick pathway of pain activates the cortex to figure out how much pain you feel and where you feel it. The brain’s quick recognition of the danger may stop you from bringing down the knife blade again and slicing your finger a second time.

The other, slower pathway travels through slow, narrow nerve fibers with frequent synaptic connections, lumbering like a commuter train that stops at every little burg. These sensations register in the brain stem and hypothalamus, as well as in other deep brain regions, before a portion of them reach the thalamus. Effects include longer-lasting aches as well as emotional reactions to pain, such as the sheepishness of realizing you injured yourself through either clumsiness or negligence (or both). These slow-action pains include the unremitting discomfort of chronic diseases such as cancer.

GRAY MATTER

But not all pain sensations terminate in the thalamus. Many halt at a portion of the brain stem known as the mesencephalic central gray matter. It’s a tiny spot that is difficult to locate. But as a conver gence zone for pain impulses, this area is highly sensitive. When lab animals have their mesencephalic gray matter stimulated by electricity, they can be operated on without painkillers. Yet they maintain their sensitivity to touch, heat, and other sensations in the pain- affected body parts.

PATHWAYS / GRAY MATTER [ MESSENGERS ( THE NERVOUS SYSTEM ) ]

CAPTAIN AHAB asked his ship’s carpenter for a special bit of work in the novel Moby-Dick. Ahab, who had lost a leg to the teeth of a white whale, hoped a replacement limb might expunge the feeling of “another leg in the same identical place with … my lost leg.” “Phantom” limbs, such as Ahab’s lost leg, have been reported since ancient times. American neurologist Silas Weir Mitchell cataloged many varieties in the Civil War. About 70 percent of phantom limbs proved excrUCiatingly and chronically painful. How could a missing leg create the illusion of existence, or even pain? The answer lies in the brain.

BIG PAIN [ MESSENGERS ( THE NERVOUS SYSTEM ) ]

BIG PAIN [ MESSENGERS ( THE NERVOUS SYSTEM ) ]

It turns out, the brain has automatic defenses cued up for a quick response to more serious pain. The perception of pain warns the brain of actual or potential tissue damage. The brain’s recognition of pain sets in motion actions to reduce or remove it, and thus the threat.

Most pain receptors consist of the bare ends of sensory nerves embedded throughout all body tissues, except the brain, whose cells cannot experience sensation. These noclceptors react to any ”noxious” stimulation, anything that damages the body’s cells.

Damage makes the cells release chemicals that activate neurotransmitter receptors (substance P is the transmitter for pain) and send pain signals via the peripheral nervous system to the central nervous system, where it may take a while to be felt. Pain doesn’t reach the brain instantly because of the distance the signal must travel; in a tall man, injury to the toe may take rwo seconds to register in the brain.

In the skin, muscles, and joints, cell damage is likely to cause relatively brief and sharp pains. That’s because nerve cells in the spinal cord release natural pain suppressants known as enkephalins, which inhibit the discharge of more pain-exciting neurotransmitters and keep the sensation short. As a result, sharp pains usually fade into dull aches.

Deeper cell damage is more likely to create burns and aches that last longer. The difference lies in the kinds of nerve fibers that transmit the pain signals, and how quickly that information travels.

ASPIRIN
ASPIRIN

HIPPOCRATES, the founder of modern medicine, knew that chewing willow bark alleviated pain. Thousands of years later, scientists discovered why: The bark contains salicylic acid. When cells are damaged, they release an enzyme called cyclooxygenase-2. That chemical in turn produces prostaglan-din, which signals to the brain that part of the body is in pain. Prostaglandin also causes the injured flesh to swell and become inflamed. Salicylic acid binds to cyclooxygenase-2, blocking the creation of prostaglandin. Less prostaglandin means fewer pain signals reaching the brain, and less inflammation of the cells around the injury.


Damage to the internal organs, or viscera, usually results in dull aches, burning sensations, and gnawing pain. As the pathways for the visceral and somatic nerves of organs and body converge in the spinal cord, the brain sometimes gets confused and assigns visceral pains to other parts of the body that are not actually injured. A heart attack, for example, may seem to cause shooting arm pams.