The "painless woman" helps us understand how anxiety and fear fit into the general picture of pain.



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Imagine a life without pain. Not bad to the teeth. No period of pain. No arthritis.

A woman who feels no pain has recently made news, in connection with a case study published in the British Journal of Anesthesia.

Jo Cameron drew the attention of the researchers towards the end of their 60s, after undergoing normally painful arthritis surgery with only paracetamol to relieve post-recovery pain. His life was full of more or less painful wounds. Even the delivery barely disturbed her.

A life without pain can seem like a blessing. But Cameron's case – and how we understand what pain really means – is more complex than it originally appeared.



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The pain is helpful

People with rare genetic diseases can be born completely insensitive to pain. They often self-mutilate when they are young and the collective weight of injuries and microtrauma means that they rarely live up to adulthood.

This is not a surprise. Pain plays a vital protective role. It protects us from injury. This limits our movement when parts of our body are damaged. Without this integrated system, the weight of unhealed wounds can eventually overwhelm us.

Cameron presents a striking challenge from this point of view.

But detailed tests of Cameron's pain thresholds suggest that she has a perception of normal pain apart from the pain badociated with heat. She reports fractures and numerous scars, suggesting that her longevity is at least partly a matter of luck.

Childbirth was easier for her, but she received gas badgesia. She uses paracetamol, although in situations that push us most to use morphine. His perception of pain seems to be diminished in many cases (and often to his detriment) – but not absent.

The key to his unusual experience may be related to another striking fact about his experience: his lack of anxiety or fear. Even a recent car accident seems to have left it indifferent.

What contributes to the pain

So what could happen in a biological sense?

Sequencing of the Cameron genes revealed that it was deficient in the enzyme FAAH (fatty acid amide hydrolase), which breaks down the neurotransmitter anandamide.

Neurotransmitters are chemicals that have effects on signals between nerve cells, or neurons. Different drugs have different effects because they mimic different neurotransmitters: Prozac targets the neurotransmitter, seratonin, for example, while cocaine targets dopamine.

Anandamide, named after the Sanskrit word "happiness," is the best-studied neurotransmitter molecules known as cannabinoids manufactured by our body.

As its name suggests, the active ingredients of marijuana can mimic the action of cannabinoids. They also seem to have similar effects. High levels of anandamide reduce pain and anxiety in laboratory animals.

As Cameron does not break down the anandamide, it builds up in his blood. Thus, not only does she feel less pain, but she is also less anxious about the pain she feels.



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Curiously enough, what she reports is quite similar to another strange phenomenon that pain researchers have long pointed out, namely pain-free injury after a serious accident.

Many very serious injuries are initially painless. Injured soldiers and victims of a car accident often report that they feel no pain until they find safety. Patrick D Wall, a pain specialist, suggested that it was an important evolutionary adaptation.

Pain limits movements, which is serious in an emergency: a system to alleviate pain and fear until you are safe makes a lot of sense. Our integrated cannabinoid system could play a crucial role in this breaker for pain.

Certainly, there is ample evidence to support the idea that pain is not limited to tissue damage.

In one famous case, a builder came to the emergency room with unbearable pain with a 15 cm nail embedded in his boot. When the doctors removed the shoe, they found that the nail had pbaded between his toes. He was completely unscathed. the pain was completely psychological.

Anticipation and fear are important factors of pain.

Pain reflects more than just damage

The connection between Cameron's condition and the cannabinoids produced by our body is fueling a growing interest in the use of cannabis-based drugs to replace opioid drugs. Conversely, there is evidence that opioid abuse is often motivated by the ability of opiates to moderate their fear and anxiety, as well as their pain. Cannabanoids may be able to kill two birds with one stone by controlling both pain and anxiety, but without the side effects of opioids.

We are still far from that, however. Previous trials with FAAH-based drugs have shown mixed results.

Cameron herself reports "long-standing blackouts," suggesting that the cannabanoids produced in our body could have some side effects with their leisure cousins.

Researchers have already considered pain as a mere signal of bodily harm. The last 75 years of the science of pain have focused on the complexity of pain. The interaction between pain and anxiety is a crucial part of this picture.

People like Jo Cameron add another piece to a fascinating puzzle.



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