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Pain: it’s in the brain

May 8th, 2004 · 11 Comments

In addition to writing about subjective time, at Marginal Revolution this week, Tyler Cowen has also described controlling pain through biofeedback while Alex Tabarrok mentioned fighting fatigue by changing mental and emotional expectations (“central governor” theory). I wonder how these theories would apply in particular to the pain of childbirth and what neural processes are working. When I was in school, I enjoyed neurology: the brain is mysterious and amazing. How we perceive time, pain and memory (see later in this post) fascinates me.

I think that for many women, labor is difficult because it is different from what the mind expected. Fatigue leads moms-to-be to believe that they can’t continue. I believe that some of the medical intervention that happens in childbirth may become necessary when the woman feels too exhausted and other processes within her react to these feelings. I’ve seen this effect in myself. Any way to help women in labor learn how to re-set their mental expectations or tap into their energy reserves – whether it be childbirth class training or athletic training prior to pregnancy – would be valuable.

The biofeedback idea intrigues me. Years ago I was told that learning biofeedback would help me learn to keep my fingers and toes warmer(they can turn purple with cold!). I never did learn biofeedback techniques, settling instead for a husband: that’s why I got Ted, as he makes such a handy foot and hand warmer 🙂

I’m trying to imagine showing a woman in labor a computer screen or maybe a PDA that could help her regulate her pain and emotions during childbirth. Getting someone who is suffering intensely to look at anything could be difficult, but if it worked, what incentive! If more women were able to have less medical intervention, that would be an economic advantage in dollars and cents. I think that teaching a woman how to control her own pain would be very powerful. Some believe the birth process in a hospital feels more like a factory or a system of oppression at an institution. Giving women happier birth experiences with less pain and more control would be a wonderful gift of life.

As I was preparing to post this piece, I saw that Dean Esmay today linked to this study

Scientists at The Hospital for Sick Children (Sick Kids) and UCLA have pinpointed for the first time a region of the brain responsible for storing and retrieving distant memories.[…] We were able to determine that it is the anterior cingulate cortex where older, or lifelong, memories are stored and recalled

The anterior cingulate cortex is also the area of the brain used in the biofeedback studies mentioned above

The eight volunteers saw the activity of a pain-control region called the rostral anterior cingulate cortex represented on a screen either as a flame that varied in size, or as a simple scrolling bar graph. This brain region is known to modulate both the intensity and the emotional impact of pain.

Another blogger (I found via Google) has made a list of the functions of the anterior cingulate cortex. It seems this part of the brain may be involved in emotions, pain, resolving conflict between two choices as well as opiate production/drug addiction. I don’t know much – seems I’ve forgotten what I learned in my neurology classes – but I wouldn’t be surprised to find long-term memory was stored together with pain and emotion. Fascinating.

Tags: news

11 responses so far ↓

  • 1 Dean Esmay // May 8, 2004 at 3:58 pm

    I at times wonder also if we don’t do at least some damage to first-time expectant mothers in the way we discuss labor pains. Of course I’m not sure what could be done better, because obviously it’s painful and you don’t want to lie about that, but….

    Well, here are a few things I know. Obviously as a man I can’t speak from direct experience, but I do notice that a lot of young women are terrified of having kids because they’ve been told over and over that it’s the most unimaginably horribly painful experience you can possibly go through. For some women, I guess that’s true, but I’ve talked to a good number of women for whom that wasn’t true, and I wonder if there are times when by teaching them to anticipate simply unimaginably horrible pain we aren’t in some ways creating self-ofulfilling prophecies.

    I’ve spoken to women who’ve had experiences they’ve said were as painful or more painful than giving birth. Heart attacks, torn ligaments, stuff like that. My ex-wife once had gas pains so severe she had to be taken to an emergency room, and she said it was as bad or worse than giving birth (and don’t laugh, some forms of gas pain are so acute they can be as bad as a heart attack or similar things).

    And there are other women I’ve known who said, of labor, “Yes it hurt but I knew I would be okay and I got through it and it wasn’t the most horrible thing ever. I wish they hadn’t scared me so much.”

    I dunno, since it’s not something I’ll ever do my opinion is limited but I do think it’s probably the case that this is a worse experience for some women than others, and I do wonder at times if by scaring young women so much over this we aren’t making the problem worse sometimes.

  • 2 Dean's World // May 8, 2004 at 11:01 pm

    Pain, Labor & Otherwise

    Interesting discussion of mental regulation of pain, labor, and related things over at Julie Leung’s….

  • 3 Julie // May 9, 2004 at 4:15 pm

    Thanks, Dean, for your perspective. Frightening people is not what I want to do at all. As a midwife-wanna-be (I’d love to teach childbirth classes) and a woman who’s seen many friends have unhappy or difficult labors (so much so that they’ve only had one child), I think about what could be done to improve the experience for the mother and family. I want to do anything I can to encourage moms. But if the way I am exploring these ideas or writing about labor is scaring women then I will stop. I will think a lot more about what I write. Thanks for letting me know.

  • 4 Beth Donovan // May 9, 2004 at 4:23 pm

    Please, don’t stop writing about something because a few souls might be scared of pregnancy – believe me, you can’t make it any scarier for them than their mothers, mothers-in-law, girlfriends and sisters.

    Through the years, I have had many friends and acquaintances who were absolutely petrified of childbirth because all their friends and relatives told them how awful it would be.

    I was lucky. I was adopted, and my mom had never experienced childbirth, so I didn’t get the lifelong stories of how awful it was that so many other women get.

    I was even luckier, because though childbirth is a very intense experience – more intense than anything else I’ve experienced (though not the most painful – an ear infection that punctured my eardrum was way more painful), I didn’t go through hour upon hour of hard labor – it was only tough for the last 45 minutes – up until then, I was walking around.

    I make it a point to tell pregnant friends that it isn’t really as bad as people make it out to be. And several have thanked me for doing so.

  • 5 Dean Esmay // May 9, 2004 at 11:21 pm

    Oh, I certainly didn’t mean to imply that you are frightening people, Julie. Indeed I applaud you for discussing ways to address the issue.

    I am merely pointing out that socially/societally, particularly since the 1980s I think, it has become very in vogue and trendy, and the source of endless comedy skits, to emphasize how horribly and unimaginably painful childbirth is. It’s usually done as a way to belittle and demean men, in the “you can’t possibly understand how horrible it is” vein, but one of the upshots of that is that young women who’ve never gone through it also get the crap scared out of them. Or so I’ve observed.

    And I do wonder if constantly drumming that message into young women’s heads doesn’t get them pumped up and emotional when the time comes and make it seem all the more dreadful when it finally does come.

    Mind you I’m not saying to lie. Obviously, it’s painful, and for some will be more painful than things they’ve borne before. But I do have a notion that we should stop with all the joking and the war stories and whatnot and focus more on emphasizing certain basic points: women have been going through this through time immemorial, almost everyone who goes through it says they’re glad, most women do it more than once, it’s not like a heart attack or a broken bone because you know the pain will be gone in a while and you’ll have something special at the end of it, there are drugs and things to help, and so on.

    I’m merely commenting that in general we should stop scaring the crap out of girls on this thing. I wouldn’t, frankly, mind if we stopped belittling men too, although I know that’s usually done just in fun. But regardless, the point is, I do think that if you constantly tell someone “this pain will be excruciating, worse than you could possibly imagine,” well gee, how do you expect them to react?

  • 6 Julie Leung: Seedlings & Sprouts // May 10, 2004 at 12:43 am

    P.S. – postscripts to yesterday’s posts

    Anita Rowland posted some links describing “the intersection of real brain science and fantasy in the movie Eternal Sunshine”. I wonder how this storage(erasure?!) of emotional memories in the brain fits with some of the studies I linked in…

  • 7 Metamanda's Weblog // May 10, 2004 at 5:37 am

    anterior cingulate cortex, childbirth, and expectations

    Julie Leung found me thru google and trackbacked to my anterior cingulate cortex entry… it seems she has found out even more cool stuff about it….

  • 8 Katherine // May 10, 2004 at 2:51 pm

    Then of course there are those of us who just had epidurals and were in heavenly peace for the remainder of the labor, and delivered very happily. I think you, Julie, go for the most natural birth process possible (laudable), but I am on the other side in my own approach – go for the most comfortable – and I practically swear by epidurals. I’ve actually had three, one with each delivery and one with knee surgery. They all took all the pain away. A bit of a sore back afterwards, but definitely worth it for me. I personally offer that as a good fallback option for moms afraid of labor/delivery/birth. But I also have heard people say it didn’t work for them for some reason.

  • 9 Julie // May 11, 2004 at 4:20 pm

    Dean: thanks, I agree!

    Katherine: Ah, but what if you didn’t need an epidural – if you could control pain without it! 🙂

  • 10 The Corpus Callosum // May 12, 2004 at 12:09 am

    fMRI in the News

    …Well, not exactly. CNS Spectrums is not what you would call a leading news outlet. Still, it devoted an entire issue to the subject; I just got it today. Functional Magnetic Resonance Imaging of the human brain is one of those obscure things th…

  • 11 Julie Leung: Seedlings & Sprouts // May 14, 2004 at 12:40 am

    Maybe men should birth babies

    I mean it in a good way. Let me explain……