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Can you forget pain?

PainSci » bibliography » Choi et al 2007
updated
Tags: chronic pain, odd, case, pain problems

Two articles on PainSci cite Choi 2007: 1. Pain is Weird2. Chronic Pain as a Conditioned Behaviour

PainSci commentary on Choi 2007: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

“Forgetting pain” would be an amazing and profound phenomenon… if it actually happens.

Back in 2007, Choi et al. reported two cases of amnesia (different causes) preceding relief from severe chronic pain and the end of any need for opioid management. The implication is that amnesia relieved the pain. 😮

Unfortunately, these stories may not be what they seem. The disappearance of pain after amnesia could definitely be correlation, not causation. Both of these cases were extremely complex, humans in severe distress, with many potential confounding factors. They are also the only case reports of their kind that I can find. And two messy, lonely data points just aren’t enough to blow my mind.

Still… while correlation doesn’t equal causation, “it sure is a hint” (Tufte). So what if amnesia actually gave them relief?

That would imply that chronic pain can be strongly dependent on the contents of the mind — pain as a function of identity, of what we think we know about ourselves. No pain without context and meaning!

If so, that would not imply that we “control” pain, of course. It would not mean that we can either create or relieve pain with our thoughts, because our “thoughts” are only a small part of what goes on between our ears. We have no more control over what we remember and what it means to us than we have over a phobia or flinching away from a flame.

Hat tip to Christine Sutherland for helping me decide how seriously to take these case studies — not super seriously. My enthusiasm was curbed. (To learn more about Christine’s related expertise, see Chronic Pain as a Conditioned Behaviour: If pain can be learned, can it be unlearned?)

But they are certainly interesting to think about, and I will not forget the possibility that some kinds of pain can be forgotten.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Nociceptive pain and its emotional component can result in the development of a "chronic pain memory". This report describes two patients who had long histories of chronic pain and opioid dependence. Both patients experienced sudden memory loss that was followed by significant pain reduction and an eradication of their need for opioid management. Neural centers involved in sensory pain, its affective component, opioid dependence, and memory overlap in the brain and share common pathways. The anterior cingulate cortex, the insular cortex, and the amygdala are examples of regions implicated in both pain and memory. One of the patients in the report experienced multiple seizure episodes, which may have contributed to memory loss and pain relief. The role of electroconvulsive therapy as it relates to amnesia and pain is reviewed. Questions are raised regarding whether therapies that address the memory component of pain may have a role in the treatment of long-term chronic pain patients.

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