Is your memory just too good?
I’m not talking about recalling what you ate for breakfast six Sundays ago or always knowing where you dropped your car keys. I’m referring to the body’s ability to remember everything that happened to it — for your entire life.
We hear terms like “muscle memory,” but most of us have no reason to contemplate what that means. Well, let me enlighten you. Muscles remember a strength training routine far easier the second time around; say you start training, have a few weeks of vacation, and then start again because your clothes don’t fit after the annual Holiday Food Gauntlet. It is far easier to get back on the saddle the second time, and it takes less time to reach the same goals.
This idea of the body remembering things has always stuck with me. Let’s say I took a tire iron to your knees on Thanksgiving, Nancy Kerrigan-style (stay with me). Once you get over the initial shock, pain, casts, surgery, rehab, soft casts, physical therapy, aqua therapy, and more — let’s say that now we’re about a year past the tire iron incident, and understandably you are wary at the next Thanksgiving dinner — it’s possible that your knees will remember that injury and keep reacting as if it’s acute.
In reality, we know so little about the human body. We know more than we did when people thought ice pick lobotomies were the greatest thing ever, and we know more than we did when we thought schizophrenics were actually witches. Really, though, we don’t understand pain.
Side note: I went to Ohio University for my undergraduate degree. Athens, Ohio is famous for its ghost stories, one of which discusses the Ridges — a haunted mental institution set on a hill above campus. Dr. Walter Freeman was one of the doctors on staff, and he would drive around performing ice pick lobotomies; he eventually dubbed his car the “loboto-mobile.” He was even the one who performed the botched lobotomy on Rosemary Kennedy, which was a significant factor in JFK shutting down state mental institutions. The more you know!
My spine surgeon told me that even if you fix a structural abnormality, the nerves might nevertheless keep gliding across that same recognized pain path; for example, a bulging disc can be removed and the pinched nerve relieved, but the pain continues regardless. Basically, if your nerves learn to do things one way, they sure as hell don’t have a reason to do it another way.
This concept intrigues me. You can remove an obstacle, and the pain keeps coming anyway. It learned to do it, somehow, like a rerouted river. These “learned pain pathways” make sense when you visit a doctor and the two of you sit before your radiology report, stumped.
“Your pain doesn’t make sense with such a slight structural abnormality,” your doctor says.
“That’s great,” you reply. “I didn’t realize until just now that the human body is only made up of bones. Thanks!”
There is so much more to our bodies than our respective skeletons. There are muscles, tendons, connective tissue (or fascia), organs, etc. All of these are affected by an injury. Even if you remove part of the spinal column, the stuff remaining in the area (the blast radius, if you will… and you will) can stay angry.
This goes far beyond today’s treatment of intractable pain. Hell, if I’d been alive in 1970, there’s a good chance that doctors might have insisted on a cordotomy — cutting through the front half of the spinal cord, or if that wasn’t an option, then a frontal lobe lobotomization — to treat my chronic pain. What would that have done? Oh, I dunno, taken away 100 percent of my orgasms, to start. That’d be fun. That’d be just dandy. After a cordotomy, 1 out of 10 patients becomes paralyzed on one side of the body; loses bladder and/or bowel control; and/or develops a new, worse pain than what was there in the first place. That’s a 130 percent complication rate. Bravo, ladies and gentlemen! Bravo.
Patton Oswalt once said that even if a parent reads literally everything available in relation to child-rearing, 40 years from now he will learn that, despite his herculean efforts, he totally screwed up. I’m sure it’ll be the same for doctors. Hell, it is the same for doctors. Cordotomies probably sound so quaint now! Not as quaint as bloodletting, though, or wearing plague masks. Those totally worked.
My point is that even if a bone is removed, the nerves might not get wind of that development. These pain reactions have to be relearned, in a sense, like training yourself to use your non-dominant hand. If I knew how to achieve that in terms of pain control, we wouldn’t be having this discussion right now.
Either way, the result remains the same: The sooner doctors realize that chronic pain is more than what can be revealed in an X-Ray or MRI, the sooner patients can start making headway in terms of recovery.