Tag: pain

Posted in Life & Happiness

Disconnect

Posted on by Jinavie

One of the greatest types of non-physical pain is the feeling of being disconnected. This may be due to being physically separated from someone, such as when a friend moves overseas or when a loved one passes away, or emotionally distanced, such as when when someone stops talking to you for some reason or a partner acts uninterested in you.

As social animals, we have a strong desire to feel connected to others. In fact, it is one of the greatest sources of happiness for us. Connection gives us a safe space for us to express ourselves and feel accepted for who we are. It gives us room for emotional growth as we not only share our inner thoughts and feelings with another person, but also teaches us empathy as the other person tells us more about themselves. Lastly, it gives us a sense of belonging and feeling wanted and needed. Therefore, becoming disconnected from someone can feel as hurtful as if a part of you has been cut away.

The pain of disconnection can be so powerful that it is a common cause of affairs (particularly emotional affairs) in relationships. As a relationship matures and we grow older, people may prioritise other aspects of their life more, become stressed by work or grapple with their insecurities and anxieties. This may result in people becoming more withdrawn as they sink into themselves, becoming more distanced from their loved ones. If the reason for this is not communicated, the partner may easily think that the cause of disconnection is because they are no longer wanted or loved, and they may look for intimacy and closeness elsewhere.

So how do we remedy the pain of disconnection? The obvious answer is connection.

Firstly, we can restore the connection with the person we have been disconnected from. This may include more frequent calls and video chats with a friend who lives overseas, or communicating honestly with a partner to tell them that we are hurting and to explore why the disconnection happened in the first place. Without communication, we resort to assumptions based on our fears and insecurities, which can cause even more damage.

Secondly, we can seek different kinds of connections (but not having an affair). For example, developing deeper connections with other people such as friends, old and new, or finding people to enjoy a hobby or passion with together. The reason for feeling disconnected may be a temporary stress for the other person not involving you, so giving them space while distracting yourself is not a bad idea.

Lastly, if there is true disconnection because of a falling out where even communication cannot repair it, then we must accept the disconnection as a loss, grieve it, process it and move on. People come and go in life and unfortunately, we must accept that even relationships are impermanent.

The reason why disconnection causes so much suffering is because connection lets us be so much more than just ourselves, creating the magical equation of 1 + 1 = 3.

In other words, the feeling of disconnection teaches us to value and be grateful for the connections that we have in life and to encourage us to make more effort to maintain and foster those connections.

Posted in Psychology & Medicine

Analgesic Ladder

Posted on by Jinavie

Quite possibly the most common condition that a physician needs to treat is pain. Being the main way for the body to communicate that there is something wrong, pain can take various forms to make us suffer physically. The best way to make this pain go away is to treat the underlying cause, but often the cause is unclear and we need to manage the symptoms first.

Just as there are many kinds of pain, there are numerous different types of analgesics, or painkillers. Doctors and nurses take into account various factors to decide which analgesia to use, how much to give and how often to give it. For example, opioids (e.g. morphine) are one of the most effective pain-reliefs, but it comes with many adverse effects such as vomiting, constipation, drowsiness, slowing of breathing and potentially death. To facilitate this, the World Health Organisation created the concept of the “Analgesic Ladder”, establishing some simple rules to guide appropriate analgesia administration.

The ladder has been adapted to accommodate for new research and advancing pain-relief methods, but the general principle remains the same.

First, simple non-opioid medications should be given orally and regularly. Almost always, the first-line analgesia is paracetamol (acetaminophen in USA). It is an effective pain-relief, especially when it is taken regularly four times a day, while being extremely safe as long as it is not taken above the maximum dosage (4 grams/day). As effective as it is, people often neglect to take it regularly as directed, or take it too late when the pain has progressed to a severe level, hence the common misunderstanding that it is weak.

The next step of non-opioid medications are non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen or diclofenac. These medications work particularly well for musculoskeletal pain, muscle aches from viral illnesses and simple headaches. However, they are prone to causing stomach upsets, ulcers and kidney dysfunction. They can also exacerbate asthma in some patients. It should be taken in conjunction with paracetamol as they have a synergistic effect. Because of its gastrointestinal side effects, it is recommended to be taken after meals.

When paracetamol and NSAIDs are ineffective at easing the pain, a weak, oral opioid such as codeine or tramadol is added in. These medications are powerful, but often have undesirable side effects such as nausea and vomiting, constipation, confusion and agitation.

As we step up the ladder, we introduce stronger opioids. This includes oral options such as sevredol and oxycodone, to intravenous options such as IV morphine and fentanyl. As effective as these medicines are, they must be used with caution given the significant adverse effects such as opioid narcosis, where a patient can stop breathing or enter a coma.

Other than opioids, there are various other options of pain relief that may be explored as adjuncts. Neuropathic pain from nerve damage is notorious for being opioid-resistant, so medications such as gabapentin or tricyclic acids (traditionally an antidepressant) may be used. Ketamine is sometimes used as it has analgesic properties. A PCA (patient-controlled analgesia) pump with morphine or fentanyl may be more effective to optimise the timing of doses. Long-acting opioids such as methadone may be considered. Lastly, nerve blocks with local anaesthesia, such as epidurals, are often used in conjunction to reduce the need for opioids.

Pain is an extremely useful evolutionary tool as it allows as us to avoid harm, but it can create just as many problems. The analgesic ladder helps health professionals better manage pain so that patients do not have to suffer as much while they are being investigated and treated.

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Posted in Life & Happiness

Exoskeleton

Posted on by Jinavie

If you look at a crustacean, such as a crab or lobster, you will notice that they have a very tough exoskeleton. Unlike us, they have their skeleton on the outside to act as armour to protect their weak, soft insides. This allows for great protection against injuries and when battling.

But if they are contained in a rigid shell, how do these animals grow? The answer is that they moult. As they grow, crustaceans will periodically shed their armour, so that the growing inner tissues can create a larger exoskeleton to hold their body in. This is a critical period as the animal is most vulnerable, as the new exoskeleton is still soft and does not offer much protection.

Even though human bodies contain skeletons on the inside, we could consider our hearts as having an exoskeleton. Like all animals, we want to avoid pain – both physical and emotional. So as we grow up, we put up resilient walls to try to protect our weak psyche and ego, to prevent being hurt by others. But a heart with a rigid, hard shell cannot grow. Only when we lower our guard, climb out of our shells and allow ourselves to be vulnerable can we grow and mature.

Life is full of suffering and hardship. We all have our scars and traumas, but at the end of the day, we survived. If we decide to shut ourselves in to avoid connection and refuse to open up to others, we may protect ourselves from some pain. But these are the moments – when we feel like all is lost, when we feel so weak and helpless, when we are anguishing – that we are growing as a person.

Don’t be afraid of feeling weak and vulnerable – it is a necessary step for your heart to grow.

Posted in Philosophy

Skeleton

Posted on by Jinavie

Is it better to have a skeleton inside the body, or on the surface?

In the case of insects, the skeleton is on the surface and takes the form of a shell that protects them from external damage. The flesh is protected by this shell and becomes soft until it becomes fluid-form. Therefore, when something sharp penetrates the armour, it causes critical, irreversible damage.

If the skeleton is inside the body, it takes the form of thin, hard bones. The soft flesh on the outside is exposed to harm. This leads to endless number of wounds. However, the weakness of being exposed leads to the muscles becoming harder with more resistant muscle fibres. The flesh evolves.

I have met many people who wear an intellectual shell made from remarkable knowledge and intellect, protecting themselves from attacks made by people with different ideas. They appeared much more robust than normal people. They would laugh at everything else, saying “I don’t care”. But when a different opinion would penetrate the hard exterior of their mind, the blow to their ego was indescribable.

I have also met people who would be hurt by even the smallest, insignificant confrontations or dissonance. However, they were sensitive because their minds were open and they learnt something from whatever attack they received.

(from The Encyclopaedia of Relative and Absolute Knowledge by Bernard Werber)

Werber spoke of the “skeleton” of the body and mind, but human beings have one other thing that needs a sturdy skeleton – the heart. Many people protect their heart from being broken with hard armour. They do not open up themselves easily and always give an image of strength and stability. But there is no such thing as a life without pain. People who put a skeleton on the outside of their heart tend to be those who have been hurt badly before and trying to protect themselves from being hurt again. This may be effective to some degree, but if you close off your heart, you cannot heal your wounds and you also shut off the happiness of connection. If they suffer pain greater than their armour can withstand, their heart is shattered and they fall into a pit of despair, unable to recover.

On the contrary, some people open up easily to others, exposing themselves to frequent pains from social interactions. These people are sensitive to pain and heartbreak. Hence, the world considers them frail and weak. But as these people have a strong skeleton inside their hearts, they can recover from any wound and they become stronger like well-developed muscle. They grow through pain and their heart – like a warrior who has fought countless battles – becomes strong and resilient against the pains of the world.

We mustn’t avoid suffering and pain and instead try to overcome it. Through this we learn how to bounce back and through experience, we develop ourselves. Suffering is hard, but it is a catalyst that helps us grow into a strong, resilient person.

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Posted in Philosophy

Epicureanism

Posted on by Jinavie

What is the greatest good in life? A school of thought called Epicureanism, founded by Epicurus of ancient Greece, believed that the greatest good is pleasure. Epicurus and his followers believed that life is about achieving the greatest amount of pleasure possible. However, this has been mistranslated throughout time and people misused its name to promote the seeking of physical pleasures such as sex, decadence and partying (which is essentially hedonism). What Epicurus meant by “pleasure” was the combination of two states: a state of tranquillity and a state of no fear or bodily pain. A combination of the two states (ataraxia and aponia) constitute happiness in its highest form. Contrary to what the layperson thinks of Epicureanism, he taught people to live modestly and moderately, avoiding the suffering caused by overindulging. Ergo, an Epicurean life is not that filled with pleasures of the body, but with pleasures of the mind. To quote Epicurus: “with whom a person eats is of greater importance than what is eaten”.

To attain this simple life, Epicurus came up with the tetrapharmakos, or “four-part cure” – a guide to how to live the happiest life possible. It states:

Don’t fear god,
Don’t worry about death;
What is good is easy to get, and
What is terrible is easy to endure.

Epicureanism also promotes gaining knowledge of the workings of the world and the limits of one’s desires. For example, knowing more about the world will reduce your fear of gods and your worries about dying. Perhaps the act of discovering new things and quenching your curiosity brings about simple pleasures of the mind for you. Essentially, every action and way of life in Epicureanism is driven by the principle of minimising pain and maximising happiness.

However, the flip side to this is that if something does not result in happiness, it is deemed counter-productive  For example, it advises against culture and politics as it can potentially create pain and unhappiness (although it is more complicated than such a sweeping statement). Even the morality and ethics of the thought is questionable, as it says that altruism and good morality is essentially driven by how it can benefit you. Epicurus believed that people should abide by the law and act morally as it will lead to less guilt and shame, and being nice to another person will make them trust you more and minimise pain. Ultimately, it is based on a social contract driven by mutual agreement rather than trust and goodwill. Although this may be effective and results in a “model citizen”, the motives may be deemed impure.

Even though it is a rather extreme example of how to live life, the thought of living for the sake of happiness is a nice one to go by.
If it does not harm you or others, then do whatever the hell makes you happy.

Posted in Psychology & Medicine

Pain

Posted on by Jinavie

Perspective is everything. By changing your perspective, you may discover an innovative solution to a problem, or understand the actions of someone else. But more importantly, your perspectives have direct implications in your life and health.

For example, let us consider pain. Pain is a sensation – an electrical signal in response to a noxious stimuli that is causing damage to your body. It is a warning system that screams to the brain that something is wrong. To boil down the complex physiology of neurotransmission, essentially imagine the system as an electrical circuit. If something damages tissue, like a knife slicing through flesh or a clot blocking off oxygen supply to the heart, the pain “switch” is activated, a signal is sent to the brain, and it is interpreted and “felt” by the brain as pain. Because your brain needs to interpret the signal, pain is essentially subjective. If you are distracted or in a good mood, you will feel less pain compared to when you are distressed and focussing on it. The same stimuli can be handled completely different by every person, making pain extremely complicated and difficult to assess in a medical setting. Pain scales may be used to try objectify the level of pain, but this is still very crude.

UCEM Pain Scale

One way or another, pain is technically all in your head. That is not to say that pain is not real – that would be an insult to sufferers of chronic pain. But your perspective, way of thinking and frame of mind can make a significant difference to the amount of suffering the pain causes. This is not just an overly-optimistic view of the world that everything can be fixed with optimism. There are real physiological systems in place to alleviate pain when you are happy. These chemicals are called endorphins – so named because they are so potent that they match the effect of morphine (endo(inside) + morphine). This natural painkiller is released in response to pain, but can also be stimulated by having fun and being happy. Laughter is literally medicine.

Not only that, but by being in a good mood, you become more resilient and “distracted from the pain”, allowing you to bear the pain more easily. A woman going through childbirth suffers quite possibly the most extreme level of pain a human being can experience, but the prospect of seeing their newborn child (and probably finally ending their pregnancy) and the loving support of their spouse, family and friends keep them pushing onwards. Even though the noxious stimuli of stretching is real, the brain can choose to downplay how much pain it thinks it should feel with these positive factors.

Although it may not be able to make your pain magically disappear, never underestimate the power of positivity, laughter and happiness. Perhaps that is why the emotion of happiness was evolved – to alleviate the misery and pains of living in this world. To survive.

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Posted in History & Literature

Surgeon

Posted on by Jinavie

In many cultures (especially in Asian countries), the public conception of doctors has changed where surgeons are considered the “real doctors”. This is particularly evident in Asian dramas where main characters tend to be surgeons, saving the patient’s life with dramatic operations and charisma. The idea that surgeons are superior to physicians may go as far as some adults advising medical students to become surgeons for a higher status (again, more evident in Asia). However, as the root of surgery is completely different from that of medicine, technically it is a misnomer to call a surgeon a “doctor”.

This is reflected in the relatively unknown fact that a fully-trained surgeon is referred to as “mister”, not “doctor”. To understand why surgeons call themselves Mr., we must look into the origin of the surgical discipline.

In ancient times, surgery was limited to treating flesh wounds and setting bones (with some exceptions such as trepanation), such as those sustained during battles. Other than the odd few cases of specialised surgeons such as Galen of ancient Greece and Hua Tuo of ancient China, it is hard to find records of doctors employing surgery as a form of treatment. This was mainly due to two reasons: that surgery was considered a “dirty, unrefined” form of treatment, and that surgery was too risky.

For a long time, especially in the Western world, surgery was considered to be of a lower status compared to medicine. It was considered more of a craft tradition – something which physicians believed was beneath them. Because of this, surgeries were mainly performed by barbers in medieval Europe. One can still find evidence of a barber’s alternative historical role on the barber’s pole, which has white, red and blue stripes. The white stripe symbolises bandages, the red symbolises arterial blood and the blue symbolises venous blood. This originates from the practice of bloodletting, where white bandages wrapped around a pole would get dyed red from the blood, giving the appearance of the barber’s pole. The profession of “surgeon” did not formally appear until around the 18th century when a Guild of Surgeons was formed in England. However, physicians refused to accept surgeons as equals for a further century. When they did come to accept that surgery was a legitimate form of medical treatment, the surgeons decided that they did not want to be assimilated as doctors, so they chose to keep their title of “mister” to distinguish themselves from physicians.

The reason why surgery was considered an unrefined art in the past mainly focuses on three issues: bleeding, pain and infections. Before modern surgical developments, uncontrolled bleeding was a real issue in surgery. This not only made surgeries extremely messy, but it was also dangerous for the patient as patients would often die from shock (dangerously low blood pressure). On top of this, anaesthetics was only introduced in the late 19th century, meaning before that, patients had to suffer the pain of their flesh being cut and stitched with no relief. Of course, this meant that surgeries were almost always a brutal scene, with the agonising screams of the patients filling the room, while they sprayed blood everywhere. Lastly, even if the patient somehow survived the surgery without bleeding out or dying from the stress and pain, there still remained a high risk of post-operative infection. Thus, surgeries were most often unsuccessful and were considered a barbaric form of treatment with no promise.

Thanks to medical advancements, surgery has become an important aspect of medicine, where one cannot live without the other. However, the tension still remains between physicians and surgeons, with each profession jokingly mocking the other whenever a chance arises.

Posted in History & Literature

Zodiac: Sagittarius

Posted on by Jinavie

Sagittarius is the Zodiac sign for those born between November 22 and December 21. The symbol for Sagittarius is centaur (half-man, half-horse) with a bow and arrow.

The model for Sagittarius is the wisest and most intelligent centaur, Chiron. Although most centaurs are known to be aggressive beasts only interested in women and alcohol, Chiron was different in that he was culture and civilised. He was interested in gathering knowledge and learning philosophy, especially medical knowledge. Chiron is also famous for being the teacher and master of many famous heroes and gods. Among his students are: the god of medicine, Asclepius; the Trojan War hero, Achilles; leader of the Argonauts, Jason; and the famous hero, Hercules. One day, Hercules ended up in a fight with some centaurs, which resulted in a bloody battle. Hercules used arrows coated with the poison of the Hydra (which he obtained during his twelve labours), swiftly killing many centaurs. Chiron saw this battle and galloped there to try and stop everyone from hurting each other. But Hercules did not see his master and accidentally shot him with a poison arrow. Although Chiron was given the gift of immortality by the gods, the Hydra’s poison still caused excruciating pain. Even though he was one of the best medical professions of his time, he could not alleviate the pain and begged Zeus to put him out of his misery. Zeus accepted this and raised him into the heavens to become a constellation as a sign of respect.

(Part of the Zodiac series: https://jineralknowledge.com/tag/zodiacs/?order=asc)

Posted in History & Literature

Torture

Posted on by Jinavie

Travelling is fun. But strangely, the etymology of the word travel is the Latin word tripalium, which means “torture instrument”. This is most likely because in the old days before airplanes and trains were invented, travelling was often long, arduous and painful. Travelling is probably the least terrifying form of torture. Let us explore the various methods of torture used throughout human history. There are many types of tortures, but they can be largely divided into physical and psychological torture. The main goal of torture is to induce maximum pain to extract information from, punish or to execute a person.

Physical torture is very simple: inflict as much pain as you can. For example, you can simply tie the person to a chair and beat them senselessly, or apply pressure to a wound to cause intense pain. A useful tip for beating someone is to place a phonebook on their stomach or hand and hitting the book, which transfers pains while not leaving a bruise or any marks. A simple way to cause extreme pain is the use of fingers. Finger tips are extremely sensitive and contain many nerve endings, meaning sticking needles under the nail bed or ripping the fingernails off causes extreme pain. Like this, medical knowledge has often been used to develop new ways to torture people. For instance, heating the sole of the feet with fire causes severe pain, electricity used in the right amount can keep the person alive while causing pain and seizures, and if you lie a person flat and on a slight decline (so the head is lower than the body), put a cloth over their face and pour over it, you can induce a sensation of drowning (this is called waterboarding and is used by the CIA). Another simple, effective torture method is the joori-teulgi(주리 틀기) from Korea, where a person is tied to a chair with the feet bound, with two long sticks inserted between the thighs, crossed, then pulled down to streth the thighs apart. This causes extreme pain and suffering.

As mentioned above, torture can be used to kill a person too. The famous hanged, drawn and quartered torture was used in the Middle Ages to punish treasonists. The convict was drawn behind a horse for a while and then hanged until just before death, when they were disembowelled, beheaded and quartered. Another strange, complicated method of torture can be found in China, where slow slicing was used. Slow slicing involves tying a convict to a post and cutting slices of flesh off him until he dies. Executioners often had an art of slicing in such a way to prolong the suffering for as long as possible without killing the person. Another execution method found in both Western and Eastern history is dismemberment by horses, where the person’s four limbs and head are tied to individual horses (or cows), which are then made to run in different directions to violently rip the person up.

Animals were used in various forms of torture throughout history around the world. Tying the prisoner to an elephant’s feet to crush them to death, putting a rat on the person’s stomach then putting a pot over it and heating it with fire to make the rat burrow into the person’s guts, feeding them to lions or vicious dogs, coating them in honey and leaving them in the path of fire ants to make them get slowly eaten… Out of all of these, the most bizarre method is the goat torture used in ancient Rome. This torture involved tying the prisoner to a chair and securing their feet, which were coated with salt water. Next, goats were released around the prisoner. The goats would lick the sole of the feet to cause tickling, which over a prolonged period is interpreted as pain by the body. This eventually drives the person insane from pain.

Unlike physical torture, psychological torture induces shame and fear rather than pain. Threatening, solitary confinement, sleep deprivation, rape and sexual torture, sensory deprivation, exploitation of phobias, loud noises (such as banging on a door constantly), blindfolding the person and rubbing a balloon on their cheeks, placing foreign objects or snakes in the anus or vagina, leaving them in a container full of insects… Psychological torture has just as much a variety as physical torture and can have longer lasting effects on the person. Furthermore, as it leaves no external marks, it is still frequently used in the modern day.

No matter what the method, inducing extreme pain to control people, extract information and cause suffering is an inhumane act that cannot be tolerated. If mankind had focussed their creativity and effort into more constructive and altruistic things rather than discovering various ways to cause pain, we would probably be living in a much better world.

Posted in Science & Nature

Chalkboard

Posted on by Jinavie

The sound of fingernails scratching a chalkboard is one of the most difficult sounds to listen to. This “screech” sound gives the sensation of your soul being ripped to shreds and invokes great discomfort. Why is this?

Professor Randolph Blake of Vanderbilt Center, USA, observed that this sound is very similar to the scream chimpanzees and macaque monkeys make when they see a predator. According to other researches on this phenomenon, many species of monkeys also hate this sound greatly. Blake used these facts to hypothesise that as our primitive ancestors used this sound to alert an enemy approaching, it has been programmed into our primitive brain to trigger a negative response. Also, physically this sound amplifies in our ears at a certain frequency to cause intense pain. The pain and our basic instincts combine to generate such an unpleasant feeling.