Please Explain: Pain

Friday, June 14, 2013

This week we’ll explore how the body perceives pain—what causes it, how it affects us, and how to treat it. We're joined by Dr. Denise Chou, Assistant Professor of Neurology, Columbia University Headache and Facial Pain Center; and Dr. Jing Wang, Assistant Professor of Anesthesiology, NYU School of Medicine, and director of research and education at NYU Langone’s Center for the Study and Treatment of Pain.

Ask a question: Call us at 212-433-9692 or leave a comment below.


Dr. Denise Chou and Dr. Jing Wang

Comments [35]

dave from nyc

Dr Wang- there are no known causes of neuropathic pain, pain from osteoarthritis and migraine pain- 85% of low back pain is also considered of unknown origin. Biomedicine has failed to fight diagnostic or prognostic markers for most pain conditions. Perhaps medicine should try substantially new approaches to pain.

Sep. 12 2013 02:10 PM
Ed from Larchmont

Leonard Lopate asks a sensible question - how can severe pain be an evolutionary advantage? Pain yes, which warns of damage, but why such severe pain?

It's an indication that evolution isn't the whole story. In Catholic thinking suffering was not part of God's plan, our senses were made exquisitely sensitive so we could enjoy things, sense things. When we sinned and brought death and suffering into the world, it is these same senses that feel the pain.

Jun. 28 2013 05:59 AM
Amy from Manhattan

T&B, thanks, but for me, at least, the kind of pain I'm talking about is very specific to dental disorders or procedures. Pain elsewhere in the head is nothing like it & easier to tolerate.

Jun. 16 2013 11:05 PM
Noah from Portland, OR

It would have been good to hear more about painkillers. Maybe you could do another show on that.

Jun. 16 2013 01:43 PM
Ed from Larchmont

Actually, research into fetal pain is a current topic of research. Conclusions so far are that by 20 weeks the fetus can certainly feel pain, perhaps by 8-10 weeks. The other note is that the endorphin pain-dampening system doesn't develop until after birth, so the fetus feels pure pain, feels more pain than we would feel with a similar injury. Scary.

Jun. 15 2013 05:39 AM
Truth & Beauty from Brooklyn

For migraine sufferers:

1. For women, they are often associated with menstrual cycles; men usually get cluster headaches rather than migraines.

2. For pain and nausea, try one ice pack on the head where the pain is and one on the back of the neck.

For Anonymous:

You have changed your physiology with all the medication. Maybe you can switch to methadone, which is used as a heroin substitute; it accesses the same receptors but does not inhibit brain function.


That is simple behavior modification (read Skinner). Once pain is associated with pleasure, one seeks more and more pain to get more and more pleasure. It does not, however, work for everyone. For some people, the pain/pleasure association is weak or non-existent.

Amy from Manhattan:

Some people are more sensitive to pain in any part of their head because they are in less control of it. When your head hurts, you can't think as well about what to do about it, and that includes dental work, headache, earache, etc. When another part of your body hurts, you feel more in control and because it is not your head, you can concentrate on taking measures to alleviate the pain.


You were in shock. It's the body's way of letting you get on about your business before you start feeling the pain and having to treat it. If you've injured yourself and don't feel it, take advantage of the time to take a pain killer because it will be working for you when the pain kicks in and it won't be so severe. One key to pain management is to treat it early. It is easier and more effect to treat less severe pain than more severe pain.

Medha from Edison, NJ:

Pain of any sort indicates some kind of problem, be it physical or psychological, but most pain is not immediately fatal. Ongoing pain should be checked out carefully because it is often "referred pain" that may be something you don't suspect.

Pain management is VERY important because constant pain can cause depression. The best thing to do is have your pain diagnosed and take steps to alleviate it as quickly as possible. Depending on the cause of the pain, treatment options rain from pharmaceutical to surgical to acupuncture and everything along the way. Whatever works for you, provided it is not addictive, will help relieve your depression.

By the way, chocolate stimulates endorphin production, so aside from tasting good, it helps relieve pain and depression. :-)

Re Back Pain:

If you haven't actually broken any vertebrae or damaged any nerves, the most common source of back pain is muscle spasm. This is best treated with heat (heating pad, hot shower, hot tub) and gentle massage, along with muscle relaxants when necessary. As the muscles begin to relax, gentle exercise to stretch them helps - even in the shower or bathtub with hot (not scalding) water. Sudden exposure to cold makes the muscles contract and spasm, so be certain to wear appropriate attire when going out in cold weather. Acupuncture can also be helpful.

Jun. 14 2013 02:22 PM
Louise Mowder from North Brunswick NJ

I represent a patient advocacy group for sufferers of Central Pain Syndrome. This is a neuropathic pain disorder caused by injury to the Central Nervous System (the brain, brain stem, and spinal cord.) The sufferer perceives it as every pain that can be experienced, at maximum intensity, all at once.Once you acquire it, it is lifelong; it may grow worse and spread, but it *never* spontaneously improves. At this time, it is incurable. Unfortunately, many doctors are not familiar with it and have no idea about how to treat it.

Mike and the caller with pain from spinal surgery - you might want to visit the page of the Central Pain Syndrome Foundation and look at some of the materials there. Right now, Brain CPS is somewhat treatable with anti-convulsants and other neurotransmitter-affecting drugs. The really bad news is that Spinal CPS patients will really get little relief from these drugs, because the pain neurotransmitter in the spine has no pharmacological treatment.

CPS is an umbrella term for pain such as MS pain, epileptic pain, pain from strokes, spinal cord injuries, closed head injuries, tumors, infection, birth defects, and anything else that can injure your Central Nervous System. I encourage anyone suffering from pain that feels like the fires of Hell, combined with being stranded on an ice floe, while being electrocuted and crushed between heavy objects, to investigate Central Pain Syndrome as a diagnosis. There are online patient groups (CPS_Alliance@yahoogroups, the CPS FB page) where you can find understanding and advice.

You are not alone.

Jun. 14 2013 02:20 PM

Is dopamine related to pain? Could it somehow be encouraged to be produced when one is in pain?

Jun. 14 2013 01:56 PM
Kathy from Mendham, NJ

Monosodium glutamate always gives me a headache. There is so much hidden MSG in food these days, I wonder if people who have a headache problem don't realize what they are eating. Food companies usually use yeast extract or hydrolyzed vegetable protein instead of stating MSG on the label.

Jun. 14 2013 01:54 PM
Ricardo from Brooklyn

Who has greater tolerance to pain? Men or women?

Jun. 14 2013 01:54 PM
TessaM from Brooklyn

I just started reading a book: Healing Back Pain, John E. Sarno. He says that chronic back pain and sciatica is caused by a spasmin the muscle, but is actually because of emotional stress. It is a way of our body distracting us from feeling anxiety or anger for example. It has been very interesting and helpful for me.

Jun. 14 2013 01:54 PM

Now I'm using heroin because it makes me feel normal and can't stop...

Jun. 14 2013 01:51 PM
Medha from Edison, NJ

1. Does pain besides a heart attack, ever lead to fatality ?
2. What can one do to take care of depression due to pain ?

Jun. 14 2013 01:51 PM
Anne from NYC

Sarah from Paris -- You should definitely consult a migraine specialist. There's a headache unit at St. Luke's/Roosevelt and several others around the city. The vomiting is a response to hormonal changes and often women get menstrual migraines with vomiting for this reason. You must be feeling terrible and desperate -- so sorry. Can you take any anti-nausea medication, for example, Compazine, non-orally? Hope they address your question.

Jun. 14 2013 01:50 PM
MikeInBrklyn from Clinton Hill

It is not uncommon during a bicycle race for cyclists to crash, yet get up and continue the race even though they have suffered considerable bruising to thighs, arms or back. Cycling develop substantial lactic acid threasholds, does this have somthing to do with them being able to continue?

Jun. 14 2013 01:49 PM

I was on massive doses pain meds for 5 years; fentynal patch & lollipop, morphine, Oxycontin, etc. I stopped when I rehabbed and didn't need it anymore but my body never went back to normal. Chronic trouble sleeping, diarrhea, restless leg, concentration & anxiety all became problems. I had dental work done and a prescription of Vicodin made all the problems go away. Now I'm using Heroin because it makes me feel normal.

Jun. 14 2013 01:46 PM
Dan from brooklyn

I fell 10ft. out of a tree when I was 12 years old. I landed flat on my back. I have the stiffest back that hurts when i run and when I sit for too long.

I'm a 33 year old male.

What's the problem?

Thank you

Jun. 14 2013 01:46 PM
Brogan from Brooklyn

I work with Urban Zen in Beth Israel hospital to help patients reduce anxiety, insomnia, nausea and pain. We use Yoga Therapy, Breath Awareness, Reiki and Aromatherapy. We chart symptoms and by in large pain levels are reduced after a treatment quite substantially.

Jun. 14 2013 01:44 PM
Debra from Montclair

Are there any additional/alternate ways to deal with postherpatic neuralgia after a shingles episode? Does acupuncture really help - especially with with facial pain?

Jun. 14 2013 01:43 PM
John A

Fresh Air guest Barry Meier on the overuse of painkillers. Makes for interesting study, esp. for people now using them. 29 May episode.

Jun. 14 2013 01:41 PM
Steve from Queens

What is the definition of chronic pain. Because after my hip operation there was no pain for years in my hip. But now as I get older; the same side of my body my left knee, and left shoulder is in constant pain some days especially when it rains. Since I also have lower back pain. How do I know what or where the pain is originating from.

Jun. 14 2013 01:40 PM
Amy from Manhattan

Why & how is dental pain different from other kinds? I have no (well, not much) trouble w/needles inserted through alcohol-based sterilization, but I can't take even dental procedures that dentists tell me they often do w/no local anesthesia unless I do get a novocaine shot (although the shot itself doesn't bother me).

Also, at the beginning of the program Dr. Chou called pain an "abnormal" sensation. Isn't it normal to feel pain when you're injured?

Jun. 14 2013 01:38 PM

When someone becomes dependant on pain killers, and they need to take more and more as their body becomes immune to them, how does this process occur?

Jun. 14 2013 01:37 PM

Lenny, can you inquire as to whether your guests are familiar with a Hurtz Donut?

Jun. 14 2013 01:36 PM
rose from brooklyn

What are the new methods to treat pain from RSD- reflex sympathic distrophy? My husband suffers from this and it's just a horrible disorder.

Jun. 14 2013 01:32 PM
Miscellaneous from Brooklyn


You are too much! Trying to manipulate the subject to your Catholic anti-abortion stance. Far too transparent.

Anyway, the same way we will never have any report from deceased Muslims re the 72 virgins, we will never have any report from deceased fetuses about their abortion experience.

Whether they feel pain would be dependent upon how developed their nervous systems are at the time, and whether they are cognizant of the feeling of pain, which would mean that their brains would be developed enough for cognition and whether that cognition recognizes an experience they have not yet had and can distinguish that experience from any other.

Next time, try sticking to the subject at hand.

Jun. 14 2013 01:32 PM

How does pain change to pleasure in an s & m encounter

Jun. 14 2013 01:29 PM
Jeff from NYC

Lower back pain upon rising — barely able to walk — but once upright with moving and walking pain subsides considerably.


Jun. 14 2013 01:28 PM

I hope one of the doctors mentions the pioneering work of Dr. John Sarno, MD, which is the only thing that has truly helped me in a 3 year battle with a 24/7 chronic daily headache and TMJ dysfunction. In his over 40 year career at the Rusk Institute at NYU, Dr. Sarno treated thousands of chronic pain patients successfully because he made the right diagnosis: most chronic pain is the result of unconscious emotions. His clinical success led him to publish 4 best selling books. With chronic pain, the mind is attempting to distract you with very real and painful physical symptoms, in an attempt to have you focus on the pain,and not on the more difficult unconscious emotions.

Unfortunately, many doctors of physical medicine have largely ignored Dr. Sarno's work, as the unconscious mind cannot be mapped by x-rays or MRIs, and their own training in physical medicine frequently biases them-- preventing them from seeing the widely accepted connection between the mind and the body. Many doctors will admit emotions can contribute to chronic pain, but in fact it IS the problem. Still many more doctors will not be honest with their patients in telling them that the pain is based in their emotions. And many more patients refuse to accept the emotional basis for their pain and so they continue with physical treatments. And so America's pain problem continues.

Jun. 14 2013 01:27 PM
Truth & Beauty from Brooklyn

I understand that bones have no nerves. This being the case, why does it hurt so much when one is broken?

Jun. 14 2013 01:25 PM
sarah from paris france from paris france

Migraine headaches--why so mysterious? Why connection to vomiting in some? Having horrid ones during 2nd trimester of pregnancy, with terrible vomiting--why don't endorphins or something kick in, to relieve? Any advice to help with the next episode?

Jun. 14 2013 01:25 PM
tom LI

Please ask about pain management, alternative therapies - chiropractic, etc -

Also foot pain caused by nerve impingement. Bottoms of my feet have recently begun to hurt, and a nerve induction test showed nerve issues in both legs. BTW - I'm a very fit and active 50 yo male.

Jun. 14 2013 12:57 PM

Any new research on CPS - Central Pain Syndrome - which is a perceived pain with no physical cause? My wife has it due to trauma caused by a stroke near her thalamus.

Unlike motor neurons which stop sending signals when cut, pain neurons increase their perception of pain when the message doesn't get through. The result is excruciating and continual pain. Her only relief is massive doses (3+ grams per day) of gabapentin. And all that does is bring the shout down to bearable level. It never ends.

Stroke victims, MS sufferers, closed-head and other TBI victims, athletes, shingles...All of these can suffer from CPS. How common 1 in 10? 1 in 100? 1 in 1,000? is this malady. Is there any good research going on?

Jun. 14 2013 12:08 PM

I tripped and fell during a run and landed on my hands and knees. The skin under my knee was torn to shreds, pieces of gravel stuck in the wound, but I had no pain. I was stunned and embarrassed, but no pain. It was almost an out of body experience, when I looked at the wound, I thought that should hurt, but it didn't. The pain didn't start until I got home to clean it. I always wondered what was going on. Thanks,

Jun. 14 2013 12:07 PM
Ed from Larchmont

Please comment on the unborn and pain, thanks.

Jun. 14 2013 05:51 AM

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