Thursday, July 31, 2008

Unknown Pain Facts: Dukkha

Pain The International Association for the Study of Pain (IASP) Committee for Taxonomy defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage...pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life" (Merskey, 1994).
Pain forces an estimated 36 million U.S. residents to miss work every year and results in roughly 70 million doctor visits. Studies find that exercise is in many cases one of the best remedies for chronic pain.
5 Painful Facts You Need to Know
By Robert Roy Britt (LiveScience, July 25, 2008)

First off, let's set the record straight: Pain is normal. About 75 million U.S. residents endure chronic or recurrent pain. Migraines plague 25 million of us. One in six suffer arthritis.

The global pain industry peddles more than $50 billion in drugs a year. Yet for chronic pain sufferers, over-the-counter pills are typically little help, while morphine and other narcotics can be addictive sedatives.

An overview study published last month in the Journal of General Internal Medicine looked at multiple studies of pain and found "researchers don't yet know how to determine which [treatment] is best for individual patients." From studies of drugs to surgeries and alternative medicines, "We have found that there are huge gaps in our knowledge base," said Dr. Matthew J. Bair, assistant professor of medicine at the Indiana University School of Medicine.

So what is pain and why do so many suffer so long?
Pain is felt when electrical signals are sent from nerve endings to your brain, which in turn can release painkillers called endorphins and generate reactions that range from instant and physical to long-term and emotional. Beyond that, scientific understanding gets painfully fuzzy. Here's what's known:

1. Scientist don't understand pain
When you're in pain, you know it. But if scientists could fully grasp how pain works and why, they might be able to help you more. The American Academy of Pain Medicine defines pain as "an unpleasant sensation and emotional response to that sensation." Some pain is the result of an obvious injury. Other times, it is caused by damaged nerves that are not so easy to pinpoint. "Pain is complex and defies our ability to establish a clear definition," says Kathryn Weiner, director of the American Academy of Pain Management. "Pain is far more than neural transmission and sensory transduction. Pain is a complex mixture of emotions, culture, experience, spirit and sensation."

2. Chronic pain shrinks brains
If you have chronic pain, you know how demoralizing and debilitating it can be, physically and mentally. It can prevent you from doing things and make you irritable for reasons nobody else understands. But that's only half the story. People with chronic backaches have brains as much as 11 percent smaller than those of non-sufferers, scientists reported in 2004. They don't know why. "It is possible it's just the stress of having to live with the condition," said study leader A. Vania Apkarian of Northwestern University. "The neurons become overactive or tired of the activity."

3. Migraines and sex go together
It may not eliminate the phrase "Not tonight, honey ..." but a 2006 study found that migraine sufferers had levels of sexual desire 20 percent higher than those suffering from tension headaches. The finding suggests sexual desire and migraines might be influenced by the same brain chemical, and getting a better handle on the link could lead to better treatments, at least for the pain portion of the equation.

4. Women feel more pain
Any man who has watched a woman having a baby without using drugs would swear that women can tolerate anything. But the truth is, guys, it hurts more than you can imagine. Women have more nerve receptors than men. As an example, women have 34 nerve fibers per square centimeter of facial skin, while men average just 17. And in a 2005 study, women were found to report more pain throughout their lifetimes and, compared to men, they feel pain in more areas of their body and for longer durations.

5. Some animals don't feel our pain
Animal research could offer clues to eventually relieve human suffering. Take the naked mole rat, a hairless and nearly blind subterranean creature. A study this year found it feels neither the pain of acid nor the sting of chili peppers. If researchers can figure out why, they might be on the road to new sorts of painkilling therapies for humans. In 2006, scientists found a pathway for the transmission of chronic pain in rats that they hope will translate into better understanding of human chronic pain. Lobsters feel no pain, even when boiled, scientists said in a 2005 report that is just one more salvo in a long-running debate.

Video-link. Kishore took part in a meditation/anxiety study in February. The study focused on emotion processing and anxiety and how these might change with mindfulness-based stress reduction or cognitive-behavioral therapy (i.e., how meditation affects anxiety). The process was similar to the one shown in this video (courtesy Science Friday)
What you can do
Meanwhile, exercise is a useful remedy for many types of chronic pain. In an Italian study detailed in the May issue of the journal Cephalalgia, office workers did relaxation and posture exercises every two to three hours. Over an eight-month period, they kept diaries, which were then compared to those of a control group that did not change habits. In the end, the group that exercised reported that headaches and neck and shoulder pain decreased by more than 40 per cent, and their use of painkillers was cut in half.

"Physical activity is actually a natural pain reliever for most people suffering from arthritis," concludes another study published in the Arthritis Care and Research journal in April. "Even minor lifestyle changes like taking a 10-minute walk three times a day can reduce the impact of arthritis on a person's daily activities and help to prevent developing more painful arthritis," said Dr. Patience White, chief public health officer of the Arthritis Foundation. "Physical activity can actually reduce pain naturally and decrease dependence on pain medications."
A Buddhist Point of View
Dukkha (the range of pain) definition: dukkhatā (abstract noun from dukkha): "the state of suffering," painfulness, unpleasantness, the unsatisfactoriness of existence. "There are three kinds of suffering:
  • (1) suffering as pain (dukkha-dukkhatā),
  • (2) the suffering inherent in the formations (saṅkhāra-dukkhatā),
  • (3) the suffering in change (vipariṇāma-dukkhatā)" (S. XLV, 165; D. 33).

(1) is the bodily or mental feeling of pain as actual]y felt.

(2) refers to the oppressive nature of all formations of existence (i.e., all conditioned phenomena), due to their continual arising and passing away; this includes also experiences associated with neutral feeling.

(3) refers to bodily and mental pleasant feelings, "because they are the cause for the arising of pain when they change" (Path of Purification XIV, 34f).

Nirvana: (verb) the end of all suffering; lit. "to blow out," "extinction" [of suffering] (nir + √vā, to cease blowing, to become extinguished); according to the commentaries, "freedom from desire (nir + vana). Nirvana constitutes the highest and ultimate goal of all Buddhist aspirations...the ultimate and absolute deliverance from all future rebirth, old age, disease, and death, from all suffering and misery.

Abhidharma (Buddhist Psychology)
"Feeling" is one of the five basic supports for the continued existence of a being. Through watching various aspects of it, a relationship can be seen between the sense pentad and the Factors of Absorption (jhananga). Through the analysis of this relationship, it can be seen how watching "feeling" may lead to the development of one's being and understanding.

The basis of being
Two parallel processes -- nama (mentality) and rupa (materiality) support each other continuously in existence. When an active regenerative energy from an action is carried over as vinnana (consciousness) and contacts a material group ready for support, rebirth occurs. This can be the rebirth of a human being, a deva, a habit, a process, or a conscious experience.

The material process manifests four qualities that interrelate in all forms:
  • solidity or mass which has hardness or softness
  • cohesion which holds together through flowing
  • warmth which allows change through maturing
  • air which gives support to structure through distending
Matter under these four aspects is combined with life energy when the matter is related to life processes such as that forming the six sense bases (eye, ear, nose, tongue, body, and mind).

Matter also forms objects for the first five sense bases. The sixth base can have matter as well as derived material qualities (masculinity, femininity, verbal, and bodily expression, etc.), and non-material objects such as concepts, mental states, and nirvana as its object.

The contact between one of these sense bases and an appropriate object produces a sense consciousness and leads to the arising of the nama aspect of being.

Nama (mentality), like rupa (materiality), is the coexistence of four qualities. In the case of nama, these are
  • vedana (feeling)
  • sanna (cognition)
  • sankhara (mental formations)
  • vinnana (conscious awareness)

These four occur as the first set of factors with all forms of consciousness that arise.

Vedana is feeling, the initial "taste" or essence of an aspect of the object. All contacts, sensory or cognizable (mental), feed vedana. The quality of the food depends on the degree of agreeableness of the object and on the state of the receptive base at the moment of contact.

Sanna resolves, cognizes, and discerns. It perceives the nature of the object without reacting to it. It is an impression of the awareness of an object so that the object may be re-cognized when necessary.

Sankhara is the collection of the coefficients of consciousness that give consciousness activity. Cetana, or intention, [is a characteristic] sankhara, which is like active thought, since it coordinates factors that are present at the time. Purpose, or intention, in relation to the object then arises. It feeds the mind and gives impetus for the wish to have, to know, or to think, that is, the determination to continue being.

Vinnana is that aspect of conscious experience that is actively "minding." It watches and categorizes with vitality, thus feeding the dependence on categories already formed. It is that which carries forward "categorized volition" to condition the subsequent state of being.

This should be distinguished from citta [mind/heart], another aspect of conscious experience, which is based on the heart. Here an emotional and intuitive reviewing and understanding of the object occurs. This is the result of an examination of the object which is wider and so intensifies the knowledge of it.

Contacts allow objects to be experienced from these existing four aspects of nama. Together with contact this group is sometimes termed the sense pentad, which occurs in all spheres of life, providing an apparently "continuous" basis for conscious experiences....Analysis of feeling
  • Read more (essay: sense function and the absorptions)
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