I recently encountered something perhaps as frightening as mortality: chronic pain.
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A routine dental procedure transmuted into facial neuralgia. Without qualms, I have undergone shoulder arthroscopy, two ear stapedectomies, the setting of broken fingers, several root canals, tooth extractions. With relative equanimity, I have watched my once-perfect eyesight fade, my hearing fail in one ear. But the effect of long-term nerve pain cannot be adequately described. It crushes your spirit, pulverizes your morale and takes you over like the larvae in the Alien films. When a paroxysm occurs, thoughts and emotions collapse into a black hole of animal fear. Peeople with chronic neuralgia lose jobs and partners, go mad, kill themselves. Yet the condition is invisible to any medical test yet devised.
This affliction, which is still plaguing me and may or may not get cured, gave me a tremendous amount of admiration (and visceral understanding) for those who deal with chronic disease: the diabetics who must endlessly prick themselves and measure each bite they consume, the sufferers of MS and ALS who slowly but inexorably lose control of their limbs. It also brought home the realization that, our accumulating wisdom and experience notwithstanding, we are still biologically wired to expire in our thirties, as soon as we’re past our reproductive peak. Lingering beyond that ushers in the lengthening list of deficits that make us increasingly uncomfortable squatters in our own bodies.
The ordeal also made me aware how crude our tools still are for managing neuropathic pain. The drugs used to ameliorate it have such disturbing side effects that I have repeatedly considered going the cold turkey route. Like chemotherapy reagents, they are blunt hammers: they affect all nerve functions, from the sublime (the ability to concentrate) to the mundane (random aches and itches). The only other path to therapy, if it can be called that, is surgical or chemical deadening of the affected nerve, which is not guaranteed to stop the pain – but which leaves the nerve’s territory irreversibly numb.
The enthusiasm for neural interfaces is a staple of the transhumanist community and of science fiction. Our current knowledge of the crucial details of the central nervous system leaves us far short of such a goal. It is true that today’s neuroprosthetics and retinal and cochlear implants allow some semblance of function – but the emphasis must be laid on “semblance”. Virtually helpless against the relatively pedestrian and common phenomenon of chronic neuropathic pain, we are a long way from Johnny Mnemonic’s augmented hippocampal capacity, let alone the seamless integration with either computer circuits or starship control consoles so beloved of cyberpunk.
Chronic pain, unlike its acute counterpart, has no protective function. It is truly an aberration, a system error. I’m trying to figure out how to turn my own intruder into a guest, however unwelcome. If I can learn to live with it, I may be able to tuck the rest of my life around it until it disappears from view, like the irritating grain in an oyster that eventually creates a pearl.
Athena Andreadis is Associate Professor of Cell Biology in the
Shriver Center for Mental Retardation at University of Massachusetts Medical School, and the author of
To Seek Out New Life: The Biology of Star Trek.
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