The Frontal Cortex

Sin Dolor

The New Yorker recently had a cool short story by T.C. Boyle about a boy who couldn’t experience pain. The story is told from the perspective of a doctor who has trouble believing that the symptoms of the child are real. The mother pleads:

“He’s not normal, doctor. He doesn’t feel pain the way others do. Look here”–and she lifted the child’s right leg as if it weren’t even attached to him, rolling up his miniature trousers to show me a dark raised scar the size of an adult’s spread hand–“do you see this? This is where that filthy pit bull Isabel BriceƱo keeps came through the fence and bit him, and we’ve gone to the lawyer over it, too, believe me, but he never cried out or said a word. The dog had him down in the dirt, chewing on him like he was a bone, and if my husband hadn’t gone out into the yard to throw his shaving water on the rosebushes I think he would have been torn to pieces.”

[snip]

“We call him Sin Dolor, doctor. That’s his nickname. That’s what his father calls him when he misbehaves, because no amount of spanking or pinching or twisting his arm will even begin to touch him. Sin Dolor, doctor. The Painless One.”

From the perspective of the brain, there are two distinct types of pain. The first type of pain is sensory. When we stub our toe, pain receptors in the foot instantly react to the injury, and send an angry message to the somatosensory cortex, the part of the brain that deals with the body. The hurt has a clear bodily cause: if you inject an anesthetic (like novocaine) into the stubbed toe, the pain will quickly disappear. Rare genetic conditions can leave people unable to experience any pain at all. Like the boy in the short story, they are at constant risk of injury.

The second pain pathway is a much more recent scientific discovery. It runs parallel to the sensory pathway, but isn’t necessarily rooted in signals from the body. The breakthrough came when neurologists discovered a group of people who, after a brain injury, were no longer bothered by pain. They still felt the pain, and could accurately describe its location and intensity, but didn’t seem to mind it at all. The agony wasn’t agonizing.

This strange condition – it’s known as pain asymbolia – results from damage to a specific subset of brain areas, like the amygdala, insula and anterior cingulate cortex, that are involved in the processing of emotions. As a result, these people are missing the negative feelings that normally accompany our painful sensations. Their muted response to bodily injury demonstrates that it is our feelings about pain – and not the pain sensation itself – that make the experience of pain so awful. Take away the emotion and a stubbed toe isn’t so bad.

It’s never quite clear what causes the boy’s disease of painlessness in the short story – a “mutation” is vaguely referenced – but such diseases are all too real.

Update: Check out p-ter’s post on this short story. T.C. Boyle, it turns out, reads Nature.

Comments

  1. #1 Anne-Marie
    October 20, 2007

    Do you know if much research has been done on the second pathway of pain (the one processed in the amygdala, etc) on other animals? One of the topics of controversy in lab research is to what degree different animals can feel pain, and from my observations working at a vet clinic there is no doubt that animals *feel* pain, but I think that the *suffering* part (depending on your definition of the word) often comes into play when emotions are involved. I don’t doubt that animals lack the capacity to suffer, at least mammals/birds, but it would be interesting to see some scientific literature on the concept.

  2. #2 mark brady
    October 20, 2007

    Paul Brand in *The Gift of Pain* interestingly identifies leprosy as a disease that is primarily the inability to feel pain. People’s fingers and toes, hands and feet suffer serious injury that they remain oblivious to, which subsequently become seriously infected resulting in necessary amputation. So the common notion that leprosy causes parts to fall off is a grave misconception.

  3. #3 amybuilds
    October 20, 2007

    I have a daughter that doesn’t sense pain the same way as other children do. She will come home with bruises and scraps and have no memory of getting them. From the time she was a small child she would watch the needle go into her arm for her immunizations without a word. She now has a more learned response from watching her brothers but her reaction is strangely out of sync and looks manufactured. She is very coordinated and seems to naturally avoid injury which is a blessing. The dog next door has never decided to chomp down on her leg so we don’t know the extent of her uniqueness. On an odd side note she is not ticklish either.

  4. #4 p-ter
    October 20, 2007

    It’s never quite clear what causes the boy’s disease of painlessness in the short story – a “mutation” is vaguely referenced – but such diseases are all too real.

    indeed. this story was ripped from the pages of Nature

  5. #5 wonderfulforhisage
    October 21, 2007

    I had a heart attack six years ago and very painful it was too, that is until, the ambulance men gave me nitrous oxide gas. Then I became aware of a very strange sensation – the pain was very much still there but I didn’t care.

    It’s a memory now and although I remember the experience in words I have no subjective experiential memory of it. I can remember the original pain subjectively but don’t remember subjectively the experience of having the pain and not caring.

  6. #6 Jonathan
    October 21, 2007

    Infinite pain tolerance is strongly associated with ASPD. Considering sociopath’s frequent lack of affect, could it be merely damage to the brain stem that causes sociopathy?

  7. #7 wheelchairmafia
    November 15, 2007

    Some people react to pain in a laugh, cry, yell, etc. possibly out of fear, emotional response, or auditory stress relief? But has anyone ever experienced pain so intense you had no external verbal/physical response? Someone accidentally closed the door in my finger and I couldn’t get the words out to signal for help. It wasn’t shock but just because I didn’t react does not mean I didn’t feel or internalize it. Maybe the child protected himself from worse injury by not showing vocal vulnerability?

    To react to pain could be fight/flight genetics but is it more desirable to let the body react the way it wants…retrograde amnesia happens in instances when we shouldn’t remember or feel pain. What about the Gait Theory? Can distraction or chemical endorphins be that powerful?

  8. #8 Madhanagopal
    September 10, 2008

    Is there any explanations to the fact that people who are (apparently) normal, feel pain but don’t seem to care too much in certain circumstances?

    For example, when in a fight (especially when one knows that he/she has a upper hand!).

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