Let's say that it would take you ten minutes to solve this puzzle. How long would it take if you received constant electric shocks to your hands? Longer, right? Because the pain would distract you from the task. Well, maybe not; it depends on how you handle pain. Some people are distracted by pain. It takes them longer to complete a task, and they do it less well. Other people use tasks to distract themselves from pain, and those people actually do the task faster and better when they're in pain than when they're not. Some people can just send their mind wandering to distract themselves from pain. How can different people be subjected to the exact same painful stimulus and yet experience the pain so differently? And why does this matter? First of all, what is pain? Pain is an unpleasant sensory and emotional experience, associated with actual or potential tissue damage. Pain is something we experience, so it's best measured by what you say it is. Pain has an intensity; you can describe it on a scale from zero, no pain, to ten, the most pain imaginable. But pain also has a character, like sharp, dull, burning, or aching. What exactly creates these perceptions of pain? Well, when you get hurt, special tissue damage-sensing nerve cells, called nociceptors, fire and send signals to the spinal cord and then up to the brain. Processing work gets done by cells called neurons and glia. This is your Grey matter. And brain superhighways carry information as electrical impulses from one area to another. This is your white matter. The superhighway that carries pain information from the spinal cord to the brain is our sensing pathway that ends in the cortex, a part of the brain that decides what to do with the pain signal. Another system of interconnected brain cells called the salience network decides what to pay attention to. Since pain can have serious consequences, the pain signal immediately activates the salience network. Now, you're paying attention. The brain also responds to the pain and has to cope with these pain signals. So, motor pathways are activated to take your hand off a hot stove, for example. But modulation networks are also activated that deliver endorphins and enkephalins, chemicals released when you're in pain or during extreme exercise, creating the runner's high. These chemical systems help regulate and reduce pain. All these networks and pathways work together to create your pain experience, to prevent further tissue damage, and help you to cope with pain. This system is similar for everyone, but the sensitivity and efficacy of these brain circuits determines how much you feel and cope with pain. This is why some people have greater pain than others and why some develop chronic pain that does not respond to treatment, while others respond well. Variability in pain sensitivities is not so different than all kinds of variability in responses to other stimuli. Like how some people love roller coasters, but other people suffer from terrible motion sickness. Why does it matter that there is variability in our pain brain circuits? Well, there are many treatments for pain, targeting different systems. For mild pain, non-prescription medications can act on cells where the pain signals start. Other stronger pain medicines and anesthetics work by reducing the activity in pain-sensing circuits or boosting our coping system, or endorphins. Some people can cope with pain using methods that involve distraction, relaxation, meditation, yoga, or strategies that can be taught, like cognitive behavioral therapy. For some people who suffer from severe chronic pain, that is pain that doesn't go away months after their injury should have healed, none of the regular treatments work. Traditionally, medical science has been about testing treatments on large groups to determine what would help a majority of patients. But this has usually left out some who didn't benefit from the treatment or experienced side effects. Now, new treatments that directly stimulate or block certain pain-sensing attention or modulation networks are being developed, along with ways to tailor them to individual patients, using tools like magnetic resonance imaging to map brain pathways. Figuring out how your brain responds to pain is the key to finding the best treatment for you. That's true personalized medicine.
Recimo da će vam trebati deset minuta da rešite ovu zagonetku. Koliko bi to trajalo ako biste konstantno dobijali elektrošokove po rukama? Duže, zar ne, jer bi vam bol odvraćao pažnju sa zadatka. Pa, možda i ne; sve zavisi od toga kako se nosite sa bolom. Neke ljude bol ometa. Treba im više vremena da završe zadatak, a rade ga gore. Drugi ljudi koriste zadatke da odvrate pažnju sa bola, a oni rade na zadatku brže i bolje dok trpe bol nego kada ih ništa ne boli. Neki ljudi mogu da odlutaju mislima da bi odvratili pažnju sa bola. Kako različiti ljudi mogu da se podvrgnu potpuno istom bolnom nadražaju, a da ipak doživljavaju bol toliko drugačije i zašto je ovo važno? Kao prvo - šta je bol? Bol je neprijatno čulno i emocionalno iskustvo vezano za stvarno ili potencijalno oštećenje tkiva. Bol je nešto što doživljavamo, pa ga je najbolje meriti ga prema onome što vi kažete da jeste. Bol ima intenzitet; možete ga opisati na skali od nule - bez bola, do deset - najveća moguća bol. Bol, međutim, ima i karakter, kao što je oštar, tup, gorući ili kuckajući. Šta tačno stvara ovu percepciju bola? Pa, kada se povredite, posebne nervne ćelije koje osećaju oštećenja tkiva pod nazivom nociceptori, aktiviraju se i šalju signale u kičmenu moždinu, a zatim i u mozak. Obrađivanje podataka odrađuju ćelije pod nazivom neuroni i glije. To je vaša siva materija, a moždani putevi prenose informacije kao električne impulse iz jednog područja u drugo. To je vaša bela materija. Put koji prenosi informacije o bolu od kičmene moždine do mozga je naš senzorni put koji se završava u korteksu, delu mozga koji odlučuje šta da radi sa signalom bola. Još jedan sistem međusobno povezanih moždanih ćelija pod nazivom mreža upadljivosti, odlučuje na šta obratiti pažnju. Pošto bol može imati ozbiljne posledice, signal bola momentalno aktivira mrežu upadljivosti. Sada obraćate pažnju. Mozak takođe reaguje na bol i mora da se nosi sa signalima bola. Tako se motorni putevi aktiviraju da vam sklone ruku sa vrele ringle, na primer. Međutim, aktiviraju se i modulacione mreže koje isporučuju endorfine i enkefaline, hemikalije koje se oslobađaju kada trpite bol ili tokom zahtevnog vežbanja, stvarajući sportsku euforiju. Ovaj hemijski sistem reguliše i smanjuje bol. Sve ove mreže i putevi rade zajedno na stvaranju doživljaja bola, kako bi sprečile oštećenje tkiva i da bi vam pomogle da se nosite sa bolom. Ovaj sistem je sličan za sve, ali osetljivost i efikasnost ovih moždanih kola određuje koliko osećate i kako se nosite sa bolom. Zbog ovoga neki ljudi osećaju više bola i zašto neki razviju hroničan bol koji ne reaguje na tretman, dok drugi dobro reguju. Razlika u osećanju bola nije mnogo drugačija od drugih razlika kada se reaguje na nadražaje. Slično tome je da neki ljudi vole rolerkostere, dok drugi osećaju strašnu mučninu. Zašto je postojanje razlika u našim moždanim kolima važno? Pa, postoje mnogi tretmani za umanjivanje bola koji ciljaju različite sisteme. Za blagi bol, lekovi koji se uzimaju bez recepta mogu da deluju na ćelije gde započinju signali bola. Drugi jaki medicinski lekovi i anestetici deluju tako što smanjuju aktivnost senzornih moždanih kola za bol ili povećavaju naš odbrambeni sistem, ili endorfine. Neki ljudi se nose sa bolom kroz korišćenje metoda koje uključuju skretanje pažnje, relaksaciju, meditaciju, jogu, ili strategije koje se mogu naučiti, kao što je kognitivna bihevioristička terapija. Za neke ljude koji pate od ozbiljnog hroničnog bola, a to je bol koji ne nestaje mesecima pošto bi povreda trebalo da zaraste, a nijedno od regularnih lečenja ne pomaže. Tradicionalno, medicina se bavila testiranjem lečenja na velikim grupama kako bi odredila šta bi moglo pomoći većini pacijenata. Međutim, ovo je zapravo izostavljalo neke ljude koji nisu imali koristi od lečenja ili koji su iskusili nuspojave. Novi tretmani koji direktno stimulišu ili blokiraju neke mreže obraćanja pažnje na bol ili modulacione mreže su se razvili, zajedno sa načinima da se prilagode pojedinačnim pacijentima, koristeći sredstva kao što je vizualizacija kroz korišćenje magnetne rezonance da bi se mapirali moždani putevi. Razumevanje kako vaš mozak reaguje na bol je ključ za pronalaženje najboljeg lečenja za vas. To je prava personalizovana medicina.