Is pain all in the mind?

Two London doctors underwent a hair-raising experiment to see if

other cultures offer something more effective than popping pills
By Esther Walker

It can be sharp or dull; it can last for a few seconds or for a

lifetime. If it's bad it can make you vomit, and we spend millions a
year trying to make it go away. Pain affects us all at some point. In the
West, the traditional treatment is a bottle of pills, in the form of
analgesics such as ibuprofen or paracetamol. But painkillers can have
unpleasant side effects, including addiction.
Is there an alternative to drugs? Two London doctors, Chris and
Alexander ("Xand") van Tulleken, who are also identical twins, set
out to investigate if we can learn anything about pain relief from other
cultures.
Both twins, 29, studied medicine at Oxford University and
trained at the city's Radcliffe Camera Hospital. They believe that
Western medicine is missing a trick, so they teamed up with Channel
4 to do a series about alternatives to Western medicine, called
Medicine Men; the second episode in the series examines pain.
"We heard about a Hindu festival in Malaysia, where people
pierce themselves and claim to feel no pain," says Xand. "We wanted
to learn whether there are ways of controlling extreme pain just with
your mind."
So they decided to perform an experiment: they'd both get
pierced at the festival, but one of them would prepare for it and the
other wouldn't. Because Chris and Xand are identical twins, they are
ideal subjects: one can be a control, the other a variable.
"I prepared according to the Hindu priests," says Xand, "while
Chris just rolled up on the day. I also spent a lot of time talking to
people who had done it before. The man who was going to pierce me
said, 'Don't worry, I'll put you in a trance', and I genuinely thought he
would just do something to me on the day."
Chris was more sceptical. "I turned up with a hangover and I'd
been doing all the things you're not supposed to. I've never been able
to be hypnotised, and I was certain that it was going to hurt. We were
dressed up in sort of Aladdin trousers, covered in beads and had

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turmeric in our hair. We felt pretty stupid until we got to the area
where people were being pierced and it was quite a sombre
atmosphere.
"Xand was pierced before me and it was quite a violent process.
The spikes are sharp, but not that sharp, so they had to force them
through. I saw Xand's arms come up from his sides to stop the guy
from piercing his tongue, but someone held his arms back."
After an hour, the spikes were removed. Chris, who had done no
preparation for the event, recovered quickly, whereas Xand didn't find
it so easy.
"I really felt like I'd been assaulted," he says. "I was really quite
upset and choked up at the end – and was also in a lot of pain."
Chris says: "The others were simply acting like it was
Christmas," says Chris. "It wasn't bullshit and it wasn't just painful
devotion – they were really entering some kind of trance state. We
came away pretty convinced that it is a phenomenon."
Britons spend £300m a year on over-the-counter pain relief, and
10 million of us suffer from chronic pain. The most common cause is
arthritis, followed by back pain. "All pain is in the brain," says Xand.
"The pain pathways to the brain have been so reinforced that even if
the thing that's making it hurt is taken away, the brain still feels the
pain."
It is also subjective, adds Chris. "I have seen patients with
sprained ankles vomiting and white as a sheet: they can't cope at all.
But then someone will come in having lost all the skin off one finger
and be quite relaxed."
Another dimension is placebos. "The fact is that they work – and
they work best when both the patient and the doctor believe that they
will work," says Chris.
The modern understanding of the placebo effect is in part down
to Dr Harry Beecher, an Army medic. Dr Beecher ran out of morphine
while treating casualties in Italy. He gave them saline solution instead,
telling them that it was morphine – and found that in 40 per cent of
cases their pain was relieved anyway.
Doctors are increasingly prescribing cognitive behavioural
therapy (CBT) for chronic pain, which can potentially "break" pain
pathways to the brain. Dr Joan Hester, a consultant at King's College
Hospital in London and president of the British Pain Society, believes

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attitudes are changing. "The use of painkillers long-term certainly has
problems," she says. "They can work if used properly, but there is
evidence that taking painkillers for headaches can make them worse.
Chronic pain is made worse by the anxieties about the pain itself,
which can be treated simply by allaying the patient's fears. CBT can
be very effective, but there is a shortage of practising psychologists –
and pain can be very disabling if it is left untreated."
There has also been a resurgence in the number of surgeries
being performed under hypnosis, rather than general anaesthetic.
Hypnosis is thought to reduce both blood loss during the operation
and recovery time. In 2006, a hernia operation was successfully
performed on a hypnotised patient live on the More4 television
channel.
"In a search to be so rational and scientific, Western science has
cut itself off completely from a form of healing that falls under the
umbrella term of the placebo effect," says Xand. "After what we saw
in making the programme, we feel that's a mistake."

What pain is, and how to stop it

* When part of the body is injured, nerve endings transmit pain
signals to the brain via the spinal cord.
* However, the degree to which the pain is felt may depend on
other factors such as degree of fear and the general health of the
injured person. Hence, dental pain, for example, may be felt more
severely than the treatment causing it would suggest.
* Most over-the-counter painkillers work by blocking the body's
production of prostaglandins, one of the chemicals that produce the
sensation of pain. Narcotic painkillers such as morphine work by
blocking the chemical messengers that carry the pain signal to the
brain.
* Pain is exacerbated by tension, so many relaxation techniques
can ease it. No one knows for sure why it works, but acupuncture is
particularly helpful for musculo-skeletal pain. It is available on the
NHS, but access is limited and many doctors dispute its effectiveness.
* The most painful diseases are thought to be necrotising
fasciitis (flesh-eating disease), trigeminal neuralgia (a nervous
disorder causing pain in the nose, eyes, lips and jaws – labelled the

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"suicide disease"), gout, kidney stones, gall stones and cluster
headaches.

Glossary

Medical semiotics/ sem(e)iology/ symptomatology

In English the art of interpreting clinical signs was originally called
semiotics, a term now used for the study of sign communication in
general. Semiotics, then written semeiotics, was first used in English in
1670 by Henry Stubbe (1631–1676), to denote the branch of medical
science relating to the interpretation of signs. Since then the study of
clinical signs has been the key to diagnosis in medicine.
Medical semiotics is part of general semiotics, which means the study
of signs within society.
Medical semiology comprises the study of symptoms, somatic signs
and laboratory signs, history taking and physical examination (in
English-speaking countries is known as Bedside diagnostic
examination or Physical diagnosis).
Symptomatology (also called semiology) is a branch of medicine
dealing with symptoms, signs as indicators of disease.
In Medicine, signs are objective manifestations of disease, as opposed
to the subjective nature of symptoms.

Allopathic medicine = a system in which medical doctors and other

healthcare professionals (such as nurses, pharmacists, and therapists)
treat symptoms and diseases using drugs, radiation, or surgery. Also
called biomedicine, conventional medicine, mainstream medicine,
orthodox medicine, and Western medicine.

 Allopathic [æləˈpæθɪk] = adjective form of allopathy

 Allopathy [əˈlɒpəθi] a system of medical practice that aims to
combat disease by use of remedies (as drugs or surgery)
producing effects different from or incompatible with those
produced by the disease being treated.

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Alternative medicine = any of a range of medical therapies that are
not regarded as orthodox by the medical profession, such as
herbalism, naturopathy, and crystal healing.

 Naturopathy [ˌneɪtʃəˈrɒpəθi] = a system of alternative medicine

based on the theory that diseases can be successfully treated or
prevented without the use of drugs, by techniques such as
control of diet, exercise, and massage.

Complementary medicine any of a range of medical therapies that

fall beyond the scope of conventional medicine but may be used
alongside it in the treatment of disease and ill health. Examples
include acupuncture and osteopathy.

 Osteopathy [ˌɒstɪˈɒpəθi] = a system of complementary medicine

involving the treatment of medical disorders through the physical
manipulation of the body muscle tissue and bones.

 Analgesics [ˌæn(ə)lˈdʒiːzɪks]

 Ibuprofen [aɪbjuːˈprəʊfen]

 Paracetamol [pærəˈsetəmɒl]

 Malaysia [məˈleɪʒə]

Identical twins / monozygotic twins [ˌmɒnə(ʊ)zʌɪˈɡɒtɪk] = twins

resulting from one zygote that at an early stage of development
separated into independently growing cell aggregations giving rise to
two individuals of the same sex and identical genetic constitution.

 Zygote [ˈzʌɪɡəʊt] = a fertilized ovum

Control and variable groups

A simple experiment may be used to determine whether or not plants
need to be watered to live. The control group would be plants that are
not watered. The variable/experimental group would consist of plants

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that receive water. A clever scientist would wonder whether too much
watering might kill the plants and would set up several experimental
groups, each receiving a different amount of water.

Turmeric [ˈtəːmərɪk] is a spice that comes from the turmeric plant. It

is commonly used in Asian food. It has a warm, bitter taste and is
frequently used to flavor or color curry powders, mustards, butters,
and cheeses. But the root of turmeric is also used widely to make
medicine. Turmeric is commonly used for conditions involving pain
and inflammation, such as osteoarthritis. It is also used for hay fever,
depression, high cholesterol, a type of liver disease, and itching.

Placebo [pləˈsiːbəʊ]

 A substance that has positive effects as a result of a patient's

perception that it is beneficial rather than as a result of a
causative ingredient.
 An inactive substance or preparation used as a control in an
experiment or test to determine the effectiveness of a medicinal
drug.

Cognitive behavioral therapy (CBT) is a therapy that is often used

to help people think in a healthy way. It focuses on thought (cognitive)
and action (behavioral). CBT can help you notice the discouraging
thoughts that make you feel bad. These thoughts are sometimes called
irrational or automatic thoughts.
Using CBT, you can learn to stop these thoughts and replace them
with helpful thoughts. This kind of thinking also involves calming
your mind and body. You can use one or more techniques. These may
include meditation, yoga, muscle relaxation, or guided imagery.
Cognitive-behavioral skills can change the way your mind influences
your body. When you shift your thinking away from the pain and
change your focus to more positive aspects of your life, you change
the way your body responds to the anticipated pain and stress.

 Guided imagery involves using a series of multi-sensory images

designed to trigger specific changes in physiology, emotions, or

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 mental state for the purpose of increasing healing response or
unconscious changes.

The NHS stands for the National Health Service. It refers to the
Government-funded medical and health care services that everyone
living in the UK can use without being asked to pay the full cost of the
service.

Necrotizing fasciitis [ˈnekrəˌtaɪzɪŋ ˌfæʃiˈaɪtɪs]: Severe bacterial

infection of the fascia, that causes extensive tissue death. Necrotizing
fasciitis can be caused by several different types of bacteria,
particularly by virulent strains of streptococcus and staphylococcus.

 Necrosis [neˈkrəʊsɪs] = the death of most or all of the cells in an

organ or tissue due to disease, injury, or failure of the blood
supply.
 Fascia [ˈfeɪ.ʃə] = a layer of strong, stretchy tissue that covers,
separates, or holds together different organs, muscles, blood
vessels, and nerves.
 Streptococcus [ˌstrep.təˈkɒk.əs]
 Staphylococcus [ˌstæf.ɪl.əˈkɒk.əs]
 Strain = a genetic variant, a subtype or a culture within a
biological species.

Trigeminal neuralgia[traɪˌdʒem.ɪ.nəl njʊəˈræl.dʒə] = a disorder of

the trigeminal nerve that causes sudden short periods of severe pain in
the face along the nerve and most commonly affects the right side of
the face.

Gout [ɡaʊt] = Gout is a form of acute arthritis that causes severe pain
and swelling in the joints. It most commonly affects the big toe, but
may also affect the heel, ankle, hand, wrist, or elbow. It affects the
spine often enough to be a factor in back pain.

 Arthritis [ɑːˈθrʌɪtɪs]

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Cluster headaches = is a neurological disorder characterized by
recurrent severe headaches on one side of the head, typically around
the eye. The pain lasts for one to two hours on average and may recur
several times in a day.