Some say life is pain. But they are optimists. In fact, life is not pain, it is pain, in the plural: toothache, back pain, pain of separation, pain of loss, pain of not meeting expectations, pain in the stomach and tonsillitis, pain of fatigue and deprivation of limbs - thousands of different manifestations of this condition, which each person experiences to some extent before (most likely, painful) death. But what kind of pain - if we talk about physical pain - “hurts” the most? Let's turn to the professionals who research pain: doctors.
Most excruciating pain: trigeminal neuralgia
David Yeomans, an anesthesiologist at Stanford University, believes that people consider trigeminal neuralgia the worst pain.
The trigeminal nerve transmits all information about head and face pain. If you have a toothache, part of your face, eyes, whatever, it all goes through the trigeminal nerve. In some people, it happens that a blood vessel expands or hypertrophies and presses on the trigeminal nerve. Often, patients describe this pain as if lightning strikes part of the face. The attack does not last long - up to two minutes - but can occur up to a hundred times a day, caused by very mild stimulation, such as a gust of cold wind, brushing teeth, or shaving. Many people with trigeminal neuralgia stop brushing their teeth for this reason. Dental problems occur.
Pain specialists use what is known as a digital pain scale to assess patients' pain. The scale goes from 0 to 10, and nearly everyone with trigeminal neuralgia rates their pain at 10 - the worst pain imaginable.
This is treatable to some extent. There are drugs created for epileptics that help people at least at first. But there are also side effects: the medications seem to dull you.
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Ultimately, people agree to have surgery. One surgery is to open the skull and place a small pad between the nerve and the blood vessel. The relief is almost instantaneous, but every second needs a second operation. Or patients are exposed to focused ionizing radiation directed to the area that is in the problem area, and the system is baked, as it were. This usually helps too.
Many mothers will say that childbirth is the worst pain they have ever experienced, and it really is. But those who have had labor and then trigeminal neuralgia will tell you that neuralgia is much worse.
Chronic pain
Theodore Price, principal investigator at the PAIN Neurobiology Research Group, believes that the worst physical pain is one that cannot be controlled. This is a huge problem for people with overwhelming chronic pain. This happens in people with pain, which was originally the result of a trauma that healed long ago, but has persisted and is not going to go away.
One of the common ways this chronic pain occurs is when someone gets into a car accident and breaks a limb. Trauma can destroy a nerve, and a destroyed nerve causes neuropathic pain that does not go away.
Another, increasingly common example is cancer chemotherapy. The patient receives chemotherapy and it kills the cancer, but the toxicity of the procedure is neuropathy, which does not go away after the chemotherapy is stopped. The patient gets rid of the cancer, but for many years after, he feels burning pain in the arms and legs.
This type of pain destroys quality of life and basic functions. Few people realize that 7-10% of the population suffers from chronic pain of this type, with a high level of impact on daily life. Unfortunately, this type of pain is also extremely difficult to treat.
Fibromyalgia
Mohab Ibrahim, an assistant professor in the Department of Anesthesiology and Pharmacology at the University of Arizona, says many people who meet certain criteria and whose pain doctors cannot cope with fall into the fibromyalgia category. Fibromyalgia is difficult to treat. Difficult, but amenable. Symptoms can vary from person to person - diffuse pain and depression, for the most part.
But from a physical point of view, the worst pain is most likely pain without a known diagnosis - when you pass all the tests and they are all negative. Psychology plays an important role in this kind of pain - and psychological problems can often manifest as pain. One treatment is to make patients understand that their pain may come from another, non-physical source. Another way is to involve psychiatrists in treatment. But it's hard to cure something when you don't know what to cure.
Oftentimes, when people think of the worst kind of pain, they expect to hear something like “needles being pushed under their nails” - something traumatic. These things can certainly be very painful, but they don't last very long, and we measure pain in terms of both intensity and duration. It's hard for us to say that the pain of short-term torture is stronger than chronic lower back pain, for example.
But trying to define the worst kind of pain also depends on what we think of as pain and what we consider its purpose.
The task of pain is to warn us about what threatens our body: nerve cells are stimulated, which warn us that there is a threat, then the spinal cord turns on, then the brain interprets the signal against the background of the context.
A few years ago there was an incident in Australia. One of the navy divers was making a practical dive in Sydney harbor when he suddenly felt a piece of wood poke in his side and leg. He brushed aside the chip, but then realized that he could not move his hand. Looks like these aren't driftwood, he thought. Then he looked down and saw that his entire leg was in the shark's mouth. And the hand was in the mouth of the shark. And seeing this, he said, he experienced the most intense pain imaginable.
His nerve endings were screaming danger to his brain, but he still had no idea that he had been bitten by a shark. This tells us a little about pain: it has to do not only with how your body feels, but also with how the brain processes the signal. If it treats the signal as very dangerous, it will determine the appropriate level of pain that you will experience.
Most people think that pain speaks about what is happening in our body - for example, people with back pain may think that their discs are shifting or vertebrae are breaking. But in reality, the pain they are experiencing suggests that they do not feel safe. And often it's the thoughts that make the pain worse. This is where the phenomenon of pain is born, which people feel for a long time after it should have disappeared: the point is not that the body is in danger, but that the brain has changed the way it processes information.
Ilya Khel
