In all of medicine there may be no bigger mystery than chronic, nonmalignant pain—especially to those of us who treat it. Pain usually serves a biological purpose, yet in chronic pain patients, pain symptoms seem to exist with little biologically useful purpose.
We know that pain can be ignored by soldiers and others in crises. We know that pain that is considered debilitating in one culture can be barely acknowledged in another culture. The same pain event that becomes resolved in one patient can turn into chronic pain in another. Chronic pain can strangely exist in limbs that are amputated or paralyzed.
These ambiguities and even paradoxes in the experience of pain strain the physician-patient relationship as both parties become frustrated at the ability of chronic pain to confound treatment.
Clearly, pain is necessary to our survival. In rare cases, humans are born without the ability to encode and process harmful stimuli in the nervous system and endure dangerous consequences. Medical textbooks tell the story of “Miss C,” a Canadian girl who was born with a congenital insensitivity to pain.
Miss C “showed no physiological changes in response to noxious stimuli. Similarly, she never sneezed or coughed, she had an extremely weak gag reflex, and she had no corneal reflex. As a child, Miss C bit off the tip of her tongue and sustained third-degree burns from her inability to sense pain.
As an adult, she developed severe erosion and infection in her knees, hip, and spine from failing to shift her weight or turn over in bed.
