Tuesday, March 22, 2016

Pain, Nitrous Oxide, And The Interpretation Of Sensation

I don't know if you've ever encountered that idea that pain wouldn't be so bad if you could just relax and enjoy it. OK -- maybe you not "enjoy" it, but you see the basic idea: it's not that pain is essentially bad, it's more that the way you respond to the pain that's bad. 

When I first encountered an idea sort of along these lines (I think it was here), I thought, "WTF"? It seemed to me obviously false. What was pain if not something bad? If you weren't feeling something bad, I thought, you'd hardly classify the sensation as "pain." You'd call it something else. A "funny feeling." Something "strange." How could it be pain if it wasn't bad?

Then I had to have a bunch of dental work. It's always been true of me that I don't respond much to novocaine and those other things that are supposed to produce a numbing sensation. There were times years ago I'd have to get shot after shot after shot .. and still it wouldn't work great. It's no wonder I developed a lot of anxiety about dental work.

The dentist I've seen now for the last ten years or so -- well, his office is set up for nitrous. The "magic nose," as he's used to saying - to his patients who are literal children instead of metaphorical ones.

As we've discussed before on this blog, I learned that nitrous and I were made for each other. The last bunch of times I had to have serious dental work, I had nitrous, and not only does it make me feel awesome and happy, it also takes away the pain. One shot of novocaine -- and I'm totally good. I mean, with nitrous, I'm not only pain-free -- I'm having a good time.

Anyway, after a few uneventful sessions fixing various things with "the magic nose," I got talking about nitrous with my dentist, and he said that nitrous is not actually a pain reliever -- it doesn't work that way. It's not obvious why it works, exactly. He thought that maybe the nitrous relaxes you and that's what makes a difference, either because a very tense person's body breaks down things like novocaine too efficiently, or maybe -- and this the crucial bit -- because a tense person experiences pain differently from a relaxed one. Hm, is it possible that nitrous just allowed me to "relax and enjoy it"? 

At the end of that conversation he said to me nervously that he hoped our conversation wouldn't undermine the nitrous effect for me. Maybe if I thought it wasn't a pain-killer, it wouldn't work as a pain-killer. We all know in these murky domains, subjectivity transcends theory and becomes a real thing. But nothing like that ever happened. Nitrous continued to work for me just as perfectly as it ever did.

That conversation was about four years ago, and for all that time, I'd been wondering if I had to revisit my resistance to the idea that pain was bad because of the way we interpret it. Maybe I could feel the drill touch my teeth and expected pain. Maybe I imagined something harmful happening, so my brain interpreted the pain as something bad. Maybe that's why it hurt. Maybe what the nitrous did was change my attitude: "Oh, ha ha, a little drilling never hurt anyone!"

Then about a year ago, I had an experience that took the whole thing to the next level, because I had to have a root canal. And the endodontist I was going to see? He didn't use nitrous.

I was a little freaked out about it. I told him about my typical situation with novocaine, and he said not to worry, there'd be no problem. He said he was an expert number, knowing exactly how to get the novocaine into the right spot so it would work. He said if I wasn't totally numb, we wouldn't do it. No worries.

So I settled in and we started with the shots. And they didn't work, and we did more shots. And they didn't work, and there were more shots. And more. And eventually we got to the point where the endodontist said that we were maxing out: it wasn't safe to have too much more, so if the next one didn't work, we have to cancel the whole thing and regroup for another day. Fortunately, the next one worked!

Here's the thing, though. To see if the shots had "worked," the endodontist did a special test. He had a special tool with a soft tip that was super cold. I had to close my eyes, and he would ever so gently touch the tip to my tooth. If I could feel it, the shots hadn't worked. Not only could I feel it -- I just about jumped out of my chair every goddamn time.

The whole point of the exercise, of course, was that the test was about what experience you're having when you don't know what is happening. So at least we can say one thing: whatever my dental pain is, it is not contextual. That is, it's not because I'm primed for pain, ready for pain, expecting something bad is happening, that the pain happens. And it is not only because nitrous changes my outlook or interpretation of my sensation that it takes away the problem. There has to be some other mechanism involved.

This doesn't settle the matter, obviously. I mean, no one in an endodontist's chair is in a mood to "relax and enjoy it." And maybe there are other ways to experience pain and not have it be bad. Who knows? But it certainly made me think that nitrous doesn't work by changing how I interpret my sensations. It works by actually making me feel less pain.

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