3 ms·

Pain is information. Instead of trying to manipulate the brain into not feeling it, we need to be figuring out the cause and fixing that. These ooh, shiny med

Pain is information. Instead of trying to manipulate the brain into not feeling it, we need to be figuring out the cause and fixing that. These ooh, shiny med tech solutions are likely on such shakey ground in part because the mindset that says "Hey, what can we build and sell to make the pain go away?" (instead of wondering what causes the pain and fixing that) is exactly the kind of thought process that turns a blind eye to the big picture and the long term. Such a mindset is not really good for genuinely addressing health issues. In response to the dead reply to me (that I don't plan to vouch for): No, I don't assume all med tech is made in bad faith.

CatWChainsaw 4y ago
The information that pain conveys is: something is wrong and the nervous system will fire until it is fixed. I do some work with animals, and in training the primary edict is to minimize pain.
footlose_3815 4y ago
I'd expect a comment like this on Facebook, not here. Yours is a "Natural human" take that assumes every piece of medical tech was made in bad faith. How sad and cynical and absolutely untrue. >Pain is information. It can be NULL information, too. or WRONG information. Dude was having cluster headaches for 8 hours a day. Do you have a cure for cluster headaches? Are you able to interpret this "Information"? How arrogant! If they had a cure or a magic wand it would have been done by now.
- jamiek88 4y ago
  Yes pain can indeed be an incorrect signal. Phantom limb pain is one example that comes to mind.
  - DoreenMichele 4y ago
    I've had phantom pain. I no longer do. It's still telling you something is wrong, though perhaps a different something.
    - jamiek88 4y ago
      You’ve had a limb removed and recovered from phantom pains? How interesting! Did you do mirror therapy or anything like that?
    - zx8080 4y ago
      Sounds interesting. Do you mind sharing how was that cured?
ShroudedNight 4y ago
How does this reconcile with scenarios where there is no discernible physiological explanation for the pain experienced by a patient?
- DoreenMichele 4y ago
  There's a lot we still don't know about the human body. Our current inability to establish cause may be a defect in our knowledge base, not evidence that "there's nothing actually wrong."
  - frosted-flakes 4y ago
    OK, that is obvious, but knowing it doesn't make the pain go away. Instead, we should attack the problem from both sides.
Nevermark 4y ago
You are arguing for cruelty with a false dilemma. The symptoms are the problem. The suffering and loss of function are the problem. Sure, total causal knowledge and a perfect treatment would be nice. But until we have that, ignoring partial solutions in the name of medical research purity would be deeply irresponsible.
- DoreenMichele 4y ago
  Sure, total causal knowledge and a perfect treatment would be nice. We won't get it if we never bother to look for it. I'm not arguing for cruelty. These articles make the front page of HN precisely because our current approach is so broken that people find the results horrifying.
  - czx4f4bd 4y ago
    Why do you think no one is bothering to look for it? I can go on Google Scholar right now and find thousands of articles exploring the causes of cluster headaches or anything else mentioned in the article.
  - Nevermark 4y ago
    You seem to frame efforts to treat patients as being competitive with further research. But active diagnoses, treatment attempts, and tracking of patient responsiveness, are indispensable to medical research. And it took less than a minute to Google up an overview of recent research progress along many avenues for cluster headaches, as an example: https://www.bmj.com/content/376/bmj-2020-059577.long https://www.bmj.com/content/376/bmj-2020-059577.long I think you can stop worrying that medicine has to make dire choices between best treatment efforts today vs. finding better treatments for tomorrow.
at_a_remove 4y ago
You are correct in that pain is a kind of information. I am going to be quite cross with you: you lack both medical experience and, well, imagination to understand why that information might be blocked by its recipient, why not all information is valuable. You have traded empathy for the quasi-magic Star Trek fix, so far in the future. You have forgotten the short-term in your look ahead to the long-term. Pain can be brief, pain can be long, pain can come in waves. I have a lot of experience with it. Right now, for me, here is the valuable information: You are dying slowly of a very rare, incurable metabolic disorder. Sometimes I wake up in the middle of the night because you are dying slowly of a very rare, incurable metabolic disorder. I might struggle to keep a grimace from my face at Thanksgiving dinner at a sudden stab, or in a meeting because you are dying slowly of a very rare, incurable metabolic disorder. A rare moment of levity is spoiled because you are dying slowly of a very rare, incurable metabolic disorder. At times the message becomes constant and disruptive not merely to a good mood, but competent thought, or even much thought at all. It can be so loud and wearying that, lacking medication, I will tumble to the ground and injure myself; even as I cradle my knee, I am also told you are dying slowly of a very rare, incurable metabolic disorder. Now, I no longer have sessions where I am shrieking into a pillow and the ER visits are few and far between because I have been managing this for a long, long time. I avoid triggers and maintain a frankly bizarre "diet" which is hurting me in other ways because I am tiptoeing around a very rare, incurable metabolic disorder that is demanding and fussy as an infant with colic, if there was also some kind of sound-activated device which hurt you every time the baby cried. Even the most rigid avoidance of triggers and the greatest compliance will still not bring it to heel. Originally, the information was new and fresh, and caused me to do a lot of research and homework, but there's nothing more informative about you are dying slowly of a very rare, incurable metabolic disorder as it stands today. The science to deal with this was science fiction when I got it, and is decades away now. But still ... you are dying slowly of a very rare, incurable metabolic disorder. I have been receiving this message for more than thirty years. Tonight, the message you are dying slowly of a very rare, incurable metabolic disorder is repeated and loud and I will have to sort through nasty Schedule II drugs, estimating what I can get away with until my next refill (and they seem to happen more frequently) to see if I can't turn down the volume on this information. Soon I will "graduate" to something like dilaudid, which is more potent, needed because you are dying slowly of a very rare, incurable metabolic disorder is just a little louder, a little more urgent, every month. I can still see the unhappy microexpressions crossing my physician's face when I suggested he begin to look into a celiac plexus block, which essentially "burns out" some nerves temporarily, at some great costs, for when I need it in a few years, after the much-lamented fentanyl patches will not be enough to cover you are dying slowly of a very rare, incurable metabolic disorder. It's a risky and unattractive procedure, with a ton of side effects, but it does keep down the screaming. Not all information is that great. I am dying slowly of a very rare, incurable metabolic disorder.

CatWChainsaw 4y ago

The information that pain conveys is: something is wrong and the nervous system will fire until it is fixed. I do some work with animals, and in training the primary edict is to minimize pain.

footlose_3815 4y ago

I'd expect a comment like this on Facebook, not here. Yours is a "Natural human" take that assumes every piece of medical tech was made in bad faith. How sad and cynical and absolutely untrue. >Pain is information. It can be NULL information, too. or WRONG information. Dude was having cluster headaches for 8 hours a day. Do you have a cure for cluster headaches? Are you able to interpret this "Information"? How arrogant! If they had a cure or a magic wand it would have been done by now.

jamiek88 4y ago
Yes pain can indeed be an incorrect signal. Phantom limb pain is one example that comes to mind.
- DoreenMichele 4y ago
  I've had phantom pain. I no longer do. It's still telling you something is wrong, though perhaps a different something.
  - jamiek88 4y ago
    You’ve had a limb removed and recovered from phantom pains? How interesting! Did you do mirror therapy or anything like that?
  - zx8080 4y ago
    Sounds interesting. Do you mind sharing how was that cured?

ShroudedNight 4y ago

How does this reconcile with scenarios where there is no discernible physiological explanation for the pain experienced by a patient?

DoreenMichele 4y ago
There's a lot we still don't know about the human body. Our current inability to establish cause may be a defect in our knowledge base, not evidence that "there's nothing actually wrong."
- frosted-flakes 4y ago
  OK, that is obvious, but knowing it doesn't make the pain go away. Instead, we should attack the problem from both sides.

Nevermark 4y ago

You are arguing for cruelty with a false dilemma. The symptoms are the problem. The suffering and loss of function are the problem. Sure, total causal knowledge and a perfect treatment would be nice. But until we have that, ignoring partial solutions in the name of medical research purity would be deeply irresponsible.

DoreenMichele 4y ago
Sure, total causal knowledge and a perfect treatment would be nice. We won't get it if we never bother to look for it. I'm not arguing for cruelty. These articles make the front page of HN precisely because our current approach is so broken that people find the results horrifying.
- czx4f4bd 4y ago
  Why do you think no one is bothering to look for it? I can go on Google Scholar right now and find thousands of articles exploring the causes of cluster headaches or anything else mentioned in the article.
- Nevermark 4y ago
  You seem to frame efforts to treat patients as being competitive with further research. But active diagnoses, treatment attempts, and tracking of patient responsiveness, are indispensable to medical research. And it took less than a minute to Google up an overview of recent research progress along many avenues for cluster headaches, as an example: https://www.bmj.com/content/376/bmj-2020-059577.long https://www.bmj.com/content/376/bmj-2020-059577.long I think you can stop worrying that medicine has to make dire choices between best treatment efforts today vs. finding better treatments for tomorrow.

at_a_remove 4y ago

You are correct in that pain is a kind of information. I am going to be quite cross with you: you lack both medical experience and, well, imagination to understand why that information might be blocked by its recipient, why not all information is valuable. You have traded empathy for the quasi-magic Star Trek fix, so far in the future. You have forgotten the short-term in your look ahead to the long-term. Pain can be brief, pain can be long, pain can come in waves. I have a lot of experience with it. Right now, for me, here is the valuable information: You are dying slowly of a very rare, incurable metabolic disorder. Sometimes I wake up in the middle of the night because you are dying slowly of a very rare, incurable metabolic disorder. I might struggle to keep a grimace from my face at Thanksgiving dinner at a sudden stab, or in a meeting because you are dying slowly of a very rare, incurable metabolic disorder. A rare moment of levity is spoiled because you are dying slowly of a very rare, incurable metabolic disorder. At times the message becomes constant and disruptive not merely to a good mood, but competent thought, or even much thought at all. It can be so loud and wearying that, lacking medication, I will tumble to the ground and injure myself; even as I cradle my knee, I am also told you are dying slowly of a very rare, incurable metabolic disorder. Now, I no longer have sessions where I am shrieking into a pillow and the ER visits are few and far between because I have been managing this for a long, long time. I avoid triggers and maintain a frankly bizarre "diet" which is hurting me in other ways because I am tiptoeing around a very rare, incurable metabolic disorder that is demanding and fussy as an infant with colic, if there was also some kind of sound-activated device which hurt you every time the baby cried. Even the most rigid avoidance of triggers and the greatest compliance will still not bring it to heel. Originally, the information was new and fresh, and caused me to do a lot of research and homework, but there's nothing more informative about you are dying slowly of a very rare, incurable metabolic disorder as it stands today. The science to deal with this was science fiction when I got it, and is decades away now. But still ... you are dying slowly of a very rare, incurable metabolic disorder. I have been receiving this message for more than thirty years. Tonight, the message you are dying slowly of a very rare, incurable metabolic disorder is repeated and loud and I will have to sort through nasty Schedule II drugs, estimating what I can get away with until my next refill (and they seem to happen more frequently) to see if I can't turn down the volume on this information. Soon I will "graduate" to something like dilaudid, which is more potent, needed because you are dying slowly of a very rare, incurable metabolic disorder is just a little louder, a little more urgent, every month. I can still see the unhappy microexpressions crossing my physician's face when I suggested he begin to look into a celiac plexus block, which essentially "burns out" some nerves temporarily, at some great costs, for when I need it in a few years, after the much-lamented fentanyl patches will not be enough to cover you are dying slowly of a very rare, incurable metabolic disorder. It's a risky and unattractive procedure, with a ton of side effects, but it does keep down the screaming. Not all information is that great. I am dying slowly of a very rare, incurable metabolic disorder.