Biobehavioral Approaches to Pain Rhonda J. Moore Editor Biobehavioral Approaches to Pain Foreword by Judith A. Paice 13 Editor Rhonda J. Moore Bethesda, MD USA [email protected] ISBN: 978-0-387-78322-2 e-ISBN: 978-0-387-78323-9 DOI 10.1007/978-0-387-78323-9 Library of Congress Control Number: 2008939896 # Springer ScienceþBusiness Media, LLC 2009 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer ScienceþBusiness Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper springer.com It has been said that a person reaches in three directions: Inward, to oneself, up to G-d, and out to others. The miracle of life is that in truly reaching in any one direction, one embraces all three. (Rebbe Nachman of Breslov) This book is dedicated first and foremost to G-d, the most high for his love, guidance, and many blessings. It is also dedicated to the memory of my father, friend and colleague R. Calvin Wilson (11/26/1926–06/10/ 2006). He was a man that had a profound and positive impact on my life, my thinking, and on my desire to embrace this miracle called life. I will love and miss you always. Know you are never forgotten, and may you rest in peace. Preface Who except the Gods can live time through forever without any pain. Aeschylus (BC 525–456) Hunger, love, pain, fear are some of the inner forces which rule the individual’s instinct for self-preservation. Albert Einstein (1879–1955) Two thousand years ago St. Paul called his painful affliction ‘‘the thorn in the flesh’’ and a ‘‘messenger from Satan’’ which only God could remove. St. Augus- tine echoed this sentiment stating, ‘‘the greatest evil is physical pain.’’ The concept of pain as punishment for one’s sins lasted for centuries and evolved into a ‘‘warning’’ of impending doom. Historically, attempts at defining and quantifying pain have been akin to trying to control and corral a herd of feral housecats. The current definition of pain by the International Association for the Study of Pain (IASP) as, ‘‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’’ is certainly inadequate. Advances in neuroscientific and biobehavioral aspects of pain, as demonstrated in this volume, promise to help clarify the multifaceted phenomenon of pain as more than simply an unpleasant sensory assault. This will afford a more comprehensive definition. We now know that the velocity of neuronal transmission leading to the perception of nociceptive stimuli through supraspinal brain centers may be inconstant. Variations in nerve conductivity, that was once thought to be relatively fixed, along with synaptic neurochemical alterations may lead to a delayed or altered recognition of pain. Responses to painful stimuli, at times reflexive though primarily subjective, are the most difficult to predict and especially to measure. Emblematic of this is The Facial Action Coding System (FACS), based on pain reactions such as grimacing, nasolabial fold deepening, and brow furrowing.. FACS is one of several schemes attempting to measure degrees of pain. Psychometric and psychosocial evaluations are also used, with varying degrees of success, in identifying the ramifications of an individual’s unique responses to pain. vii viii Preface Because of the Gestalt of cultural, behavioral, emotional, and spiritual components in painful ideation, the best portrayals of pain, for millennia, have been through poetry, philosophy, art, and music. Individual examination of each of the integral entities within neuroscience, though exciting and promis- ing, cannot alone explain the wondrous complexity and plasticity of the human nervous system and man’s ‘‘experience’’ with pain. The microanatomy of pain mechanisms, once thought to be fully elucidated, is in a constant state of flux. The immune–glial cell contribution to neuropathic pain is one of a constellation of continually evolving discoveries in neu- roscience. Gene research and therapies have opened a vast frontier for under- standing how the nervous system works. Consider the discovery of the gene responsible for the neurochemical defect in patients with Congenital Insensi- tivity to Pain. Advances in PET and SPECT scanning, fMRI, Electroencepha- lography, Deep Brain Stimulation, and MR spectroscopy, along with technical advances in neurochemistry and molecular neurobiology, should expand our ability to correlate biobehavioral aspects of pain to the hard neurosciences exponentially. In this volume, Dr Rhonda Moore has established a holistic template for understanding the complex nature of pain. The neuroanatomy and neurophy- siology of nociceptive reception and perception are fundamental and evolving. Along with this, crucial biobehavioral elements responsible for an individual’s response to pain must be integrated in any reasonable definition. These include, but are not limited to, gender, cultural, emotional, genetic, societal and spiritual factors. To honestly evaluate an individual’s painful experience, inclusive of neuroscience, one must consider it a ‘‘perfect storm’’ of all that is implicit in understanding human behavior. In the selection of the contributors’ and subject matter for this book, Dr. Moore has accomplished this. This multidimensional approach in defining pain in all of its ramifications will have a profound impact in clinical medicine and beyond. Houston, TX Richard M. Hirshberg Forward Pain finds its way everywhere, into my vision, my feelings, my sense of judgment; it’s an infiltration... Alphonse Daudet, In the Land of Pain, 1840–1897 Pain is all encompassing. To the person suffering from it, pain infiltrates all aspects of the individual’s life. Pain is indiscriminate; it affects everyone at some time during their life, regardless of age, gender, race, or geography. For those unfortunate individuals who experience chronic, persistent pain, their lives are forever changed. There is much that we can do to address the needs of those in pain. To do so effectively, scientists, clinicians, and policy experts must be informed regarding a wide range of topics. In the past decades, this has become incredibly over- whelming. The scope of our knowledge base in pain has exploded, ranging from understanding the basic mechanisms of pain at a molecular level to discerning the larger role of biological, environmental, emotional and psychosocial pro- cesses that affect the individual, and beyond, to realizing the societal implica- tions of pain and its treatment. Because the scope is so broad, multidisciplinary perspectives are critical. This is true in the treatment of pain, as well as in our understanding of this complex phenomenon. This comprehensive text addresses the rapidly expanding scope of the field of pain by providing a forum for experts from many disciplines to share their wisdom on a variety of topics. From addressing the larger impact of pain, to describing specific syndromes and special populations, this text takes a multi- disciplinary and biobehavioral approach throughout each chapter. The authors are internationally recognized experts representing an authoritative and global viewpoint. Furthermore, the authors embody many specialties, from the basic sciences to psychology, medicine, philosophy, ethics and public policy, provid- ing the reader a deeper understanding of the many facets of pain. Biobehavioral Approaches to Pain has been expertly edited by Rhonda J. Moore, PhD, who as a medical anthropologist, is uniquely qualified to explore this topic from a universal perspective. Specialists in pain will find this rich perspective refreshing. Those new to the field will discover an extraordinary synopsis of the complexity of this fascinating syndrome. Ultimately, the field will benefit from this text as scientists, policy analysts, and clinicians use this ix x Forward information to further enrich our understanding as we explore new mechanisms and treatments. Finally, patients will benefit as this new information is trans- lated into safe and effective therapies provided by multidisciplinary teams of informed clinicians. Chicago, IL Judith A. Paice Acknowledgements If you concentrate on finding whatever is good in every situation, you will discover that your life will suddenly be filled with gratitude, a feeling that nurtures the soul. Rabbi Harold Kushner ‘‘No duty is more urgent than that of returning thanks.’’ Unknown The beginning and completion of an edited volume is never an individual endeavor. Others always assist along the way. At this time I thank those individuals who were supportive of this edited volume. I begin by thanking my collaborators for their enthusiasm, commitment and support of this project. I could not have completed this volume without your fine insight and the wisdom of your words. I thank Bill Tucker, Khristine Queja, James Russo of the New York editorial offices of the Springer Publishing house and Sharmila