Eye Pain – what it can mean and what you can do to control or moderate it.
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The perception of pain is a critical function of the nervous system. Children born without the ability to perceive pain tend not to live very long – not just because they can inadvertently inflict terrible injuries on themselves, but because the recognition of pain appears to be the necessary stimulus towards healing those injuries.
For those of you unfamiliar with Dr. Andrew Huberman, he is (unlike me) a neurobiologist and (much like me) an ophthalmologist, who I’ve drawn information from for this blog. I can point you towards his excellent podcast lectures with a link to one specific to this topic, here: https://www.hubermanlab.com/episode/essentials-control-pain-heal-faster-with-your-brain
I’ve posted several times on corneal pain and the role it can play in inflammation. A few posts key to this context can be found here: https://www.eyethera.com/blog/why-do-my-eyes-hurt-even-though-my-eye-doctor-says-they-look-fine and here: https://www.eyethera.com/blog/whats-new-in-2024-lets-focus-on-the-nerves?rq=pain
The point raised by Dr. Huberman that I think is vital to our understanding, is that inflammation is necessary to a healthy life – and therefore a good thing. What is also true, is that unbridled, continuous inflammation is not a good thing – and in the context of dry eye disease, it can be an undercurrent of the root causes of dry eye. Interfering with inflammation in the immediate, healing phase of an injury can dampen the pain response and if carefully applied – while it may draw out the time required to heal - it can also lead to a better result. This is especially true when it comes to many forms of eye surgery.
Glaucoma, cataract, corneal and retinal surgeries all trigger inflammation (and pain). Allowing the healing to occur as quickly as the body can drive it will often result in scarring and can undo the benefits of that surgery - or even result in severe complications (including chronic pain). I’ve already posted a substantial amount of information on inflammation (see: https://www.eyethera.com/search?q=inflammation&f_collectionId=5f1772c75adebf1951219a32 ) – but in the context of healing, we eye surgeons commonly prescribe strong steroids with slow tapering doses to keep a lid on inflammation and slow the healing to a rate consistent with our objectives for the surgery. When it comes to controlling inflammation associated with dry eyes, the same holds true. Our goal is to reduce inflammation and thereby reduce pain, without totally neutralizing the inflammation or the pain associated with this healing (so healing can be effective and complete)..
So, if inflammation is necessary for healing, then pain is a necessary part of that healing. And what is pain, other than a sensation? Well, pain typically begins with stimulation of nerve endings but ultimately is registered, interpreted and acted on, by the brain. Dr. Huberman points to the “top down” aspects of pain, when he uses illustrations such as the case of a construction worker who fell onto a 14-inch nail that skewered his boot. The worker was in such exquisite pain, that he couldn’t move his foot in any tiny direction and had to be carried by coworkers to an emergency clinic. After carefully cutting his boot away, it was determined that the nail had missed injuring his foot by passing between his toes. The perception that it had caused injury caused this severe pain. The “top” – or brain – was “causing” the pain from “down” (in this case, the foot).
Dr. Huberman goes on to relate the work on phantom pain, where an absent arm or leg may continue to cause debilitating pain. A brilliant scientist (Vilayanur Ramachandran: Professor of Psychology, University of California San Diego) constructed a box with mirrors which would allow a patient to put his or her remaining arm or leg in and then view it as if it were the missing appendage. Patients who had been in exquisite pain were often able to manipulate the “missing” arm or leg in the box and imagine it as “normal.” In less than a day, what had been unbearable pain for months or years was reduced to imperceptible – through “altered perception.” This ability of the brain to change how it functions, has been termed “neural plasticity.” Because this can happen from “top down,” it suggests that much of the pain we experience can be modified to become less disabling, by tapping into this ability for neural plasticity. My next post will be more about this!