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Buddhadharma : Fall 2010
buddhadharma: the practitioner’s quarterly fall 2 0 10 36 Rick HelleR is the editor of the online magazine The New Humanism, published by the Humanist chaplaincy at Harvard University. He is also a facilitator of the Humanist contemplative Group in cambridge, Massachusetts, and has participated in practice groups at the cambridge insight Meditation center. was composed of distinct elements, including both a sensory component and an emotional one. As well, Melzack and his MIT colleague Patrick Wall proposed gate control theory, which explains how pain sensations can be amplified based on the amount of attention paid to them. Melzack gained his insight into the distinction between pain sensations and suffering by paying close attention to the words his patients used to describe their pain. He noticed that people employed words like “shooting” or “cramping” that described sensory qualities, and other words like “punishing” or “terrifying” that described their emotional reactions. From his word list, Melzack developed the widely used McGill Pain Questionnaire and the notion that pain was a multidimen- sional experience. Subsequent research verified Melzack’s hypothesis about the composite nature of pain. Modern scientists no longer refer to a “pain center” but to a “pain matrix” in the brain, reflecting the understanding that several different brain regions contribute to the experience of pain. Nerve fibers carry pain signals up the spine to a key branch- ing point in the brain called the thalamus. From there, pain signals travel along one pathway to the somatosensory cor- tex, a brain region that contains a map of the human body. It records the sensory aspects of pain, and tells us where it hurts. Another pain pathway from the thalamus leads to the cingulate cortex. This region specializes in the unpleasantness of pain—telling us that it hurts. Amazingly, people with damage to the cingulate cortex often report that pain doesn’t hurt. That is, if they choose to pay attention, they can identify sensations in the body that correspond to pain. But to them, pain lacks the urgent quality that demands attention. “They used to do limbic leucotomies for pain, which is basically zapping the anterior cingulate,” Alice Flaherty, a neurologist at Massachusetts General Hos- pital, told me. “People would say, ‘I don’t care about the pain anymore. I still feel it, but it’s not so obnoxious.’” about the approach he now teaches that he was able to free himself from pain and resume a normal life. “I totally worked myself into the syndrome despite the meditation practice,” Siegel says. “I did try meditating with the pain, but I believed that I was going to injure myself if I moved freely.” That mistaken belief was enough to maintain his pain dis- order. “That’s where the cognitive understanding is critical,” Siegel says. “It did help to have the practice once I learned what was really the matter.” It may seem strange that we can feel intense pain sensa- tions without anything major being wrong. In the West, until recently the standard view has been that physical pain is a warning sign of tissue damage, and that the greater the pain, the greater the damage. Called specificity theory, this model grew out of the ideas of French philosopher René Descartes. The theory came under challenge after World War II because of anomalies like the observation by U.S. Army doctor and Har- vard Medical School anesthesiologist Henry K. Beecher that some soldiers who were severely wounded in battle appeared to suffer surprisingly little pain from their wounds. The key figure in the modern understanding of pain was Ronald Melzack, a psychologist who did his research at McGill University in Montreal. In the 1960s, together with Kenneth Casey, Melzack proposed that the experience of pain Although we commonly experience physical pain as a single phenomenon, it is actually composed of distinct elements that include the sensation itself and an aversive element we call suffering. cindylevineteRRydoyle