The mysterious science of pain - Joshua W. Pate

Prevodilac: Isidora Spasojević Lektor: Milenka Okuka

In 1995, the British Medical Journal

Britanski medicinski časopis je 1995. godine

published an astonishing report about a 29-year-old builder.

objavio neverovatan izveštaj o 29-godišnjem građevinskom radniku.

He accidentally jumped onto a 15-centimeter nail,

On je slučajno skočio na ekser dugačak 15 centimetara,

which pierced straight through his steel-toed boot.

koji je probio njegovu cipelu sa metalnom zaštitom za prste.

He was in such agonizing pain that even the smallest movement was unbearable.

Bio je u toliko mučnim bolovima da je i najmanji pokret bio nepodnošljiv.

But when the doctors took off his boot, they faced a surprising sight:

Kada su doktori skinuli njegovu cipelu, zatekli su iznenađujuć prizor:

the nail had never touched his foot at all.

ekser zapravo nije ni dotakao radnikovo stopalo.

For hundreds of years,

Stotinama godina,

scientists thought that pain was a direct response to damage.

naučnici su mislili da je bol direktan odgovor na oštećenje.

By that logic, the more severe an injury is, the more pain it should cause.

Po ovoj logici, što je povreda teža to je i bol koji je prouzrokuje jači.

But as we’ve learned more about the science of pain,

Ali kako saznajemo više o nauci iza bola,

we’ve discovered that pain and tissue damage don’t always go hand in hand,

otkrili smo da bol i oštećenje tkiva ne idu ruku pod ruku,

even when the body’s threat signaling mechanisms are fully functioning.

čak i kada mehanizmi tela za signalizaciju o pretnji funkcionišu.

We’re capable of experiencing severe pain out of proportion to an actual injury,

Sposobni smo da doživimo jak bol koji nije proporcijalan povredi koja ga izaziva,

and even pain without any injury,

pa čak i bol bez ikakve povrede,

like the builder, or the well-documented cases of male partners

poput građevinskog radnika ili dobro poznatih slučajeva gde partneri

of pregnant women experiencing pain during the pregnancy or labor.

trudnih žena osećaju bol tokom trudnoće ili porođaja.

What’s going on here?

Šta se ovde zapravo događa?

There are actually two phenomena at play:

Postoje zapravo dva fenomena koja su u opticaju:

the experience of pain, and a biological process called nociception.

samo osećanje bola kao i biološki proces koji se zove nociocepcija.

Nociception is part of the nervous system’s protective response

Nociocepcija predstavlja deo zaštitnog odgovora nervnog sitema

to harmful or potentially harmful stimuli.

namenjenog da štiti od štetnih ili potencijalno štetnih stimulansa.

Sensors in specialized nerve endings

Senzori u specijalizovanim nervnim završecima

detect mechanical, thermal, and chemical threats.

detektuju mehaničke, toplotne i hemijske pretnje.

If enough sensors are activated,

Ako se aktivira dovoljan broj senzora,

electrical signals shoot up the nerve to the spine and on to the brain.

električni signali se šalju preko nerava do kičme, pa do mozga.

The brain weighs the importance of these signals

Mozak odlučuje kolika je važnost tih signala

and produces pain if it decides the body needs protection.

i stvara osećaj bola ako odluči da je to potrebno da se telo zaštiti.

Typically, pain helps the body avoid further injury or damage.

Osećanje bola obično pomaže telu da izbegne dalje povrede i oštećenja.

But there are a whole set of factors besides nociception

Ali postoji niz faktora osim nociocepcije

that can influence the experience of pain— and make pain less useful.

koja utiču na doživljavanje bola - i koji čine bol manje korisnim.

First, there are biological factors that amplify nociceptive signals to the brain.

Prvo, postoje biološki faktori koji u mozgu povećavaju nocioceptivne signale.

If nerve fibers are activated repeatedly,

Ako se nervna vlakna konstantno aktiviraju,

the brain may decide they need to be more sensitive

mozak može da zaključi da vlakna moraju biti osetljivija

kako bi adekvtano zaštitila telo od pretnji.

to adequately protect the body from threats.

More stress sensors can be added to nerve fibers

Nervnim vlaknima se može dodati još senzora za stres

until they become so sensitive that even light touches to the skin

sve dok ne postanu toliko osetljiva da čak i blag dodir na koži

spark intense electrical signals.

može da podstakne intenzivan električni signal.

In other cases,

U drugim sluačajevima,

nerves adapt to send signals more efficiently, amplifying the message.

nervi se prilagode da šalju signale efikasnije, pojačavajući poruku.

These forms of amplification

Ovi oblici pojačavanja

are most common in people experiencing chronic pain,

se najčešće sreću kod ljudi koji osećaju hroničan bol,

which is defined as pain lasting more than 3 months.

koji se definiše kao bol koji traje duže od tri meseca.

When the nervous system is nudged into an ongoing state of high alert,

Kada je nervni sistem gurnut u stanje konstantno visoke uzbune,

pain can outlast physical injury.

bol može da traje duže od fizičke povrede.

This creates a vicious cycle in which the longer pain persists,

Ovo stvara začarani krug gde što duže traje bol,

the more difficult it becomes to reverse.

sve je teže da se stvari vrate u prvobitno stanje.

Psychological factors clearly play a role in pain too,

Jasno je da i psihološki faktori igraju ulogu u osećanju bola,

potentially by influencing nociception and by influencing the brain directly.

potencijalno utičući na nociocepciju, kao i direktno utičući na mozak.

A person’s emotional state, memories,

Emocionalno stanje osobe, sećanja,

beliefs about pain and expectations about treatment

verovanja o bolu i očekivanja u vezi s terapijom

can all influence how much pain they experience.

mogu da utiču na to koliko će bola osoba osetiti.

In one study,

U jednoj studiji,

children who reported believing they had no control over pain

deca koja su prijavila da veruju da nemaju kontrolu nad bolom

actually experienced more intense pain

zapravo su doživela intenzivniji bol

than those who believed they had some control.

od odnih koji veruju da imaju neku dozu kontrole nad bolom.

Features of the environment matter too:

Uticaj sredine je takođe bitan:

In one experiment,

u jednom eksperimentu,

volunteers with a cold rod placed on the back of their hand

volonteri kojima je stavljena hladna šipka na gornji deo šake

reported feeling more pain when they were shown a red light than a blue one,

prijavili su osećanje više bola kada im je pokazano crveno svetlo u odnosu na plavo,

even though the rod was the same temperature each time.

iako je šipka svaki put bila iste temperature.

Finally, social factors like the availability of family support

Konačno, socijalni faktori kao što je dostupnost porodične podrške

can affect perception of pain.

mogu da utiču na percepciju o samom bolu.

All of this means that a multi-pronged approach to pain treatment

Sve ovo znači da višestrani pristup lečenju bola, koji uključuje

that includes pain specialists, physical therapists, clinical psychologists, nurses

specijaliste za bol, fizioterapeute, kliničke psihologe, medicinske tehničare

kao i ostale medicinske radnike, često je najefikasniji.

and other healthcare professionals is often most effective.

We’re only beginning to uncover the mechanisms behind the experience of pain,

Tek smo počeli da otkrivamo mehanizme o doživljavanju bola,

but there are some promising areas of research.

ali postoje obećavajuće oblasti ovog istraživanja.

Until recently,

Sve do skoro,

we thought the glial cells surrounding neurons were just support structures,

mislili smo da su glija ćelije koje okružuju neurone samo potporne strukture,

but now we know they have a huge role in influencing nociception.

ali sada znamo da imaju ogromnu ulogu u uticanju na nociocepciju.

Studies have shown that disabling certain brain circuits in the amygdala

Studije su pokazale da ako onesposobimo određene moždane strukture u amigdali,

can eliminate pain in rats.

možemo da eliminišemo osećaj bola kod pacova.

And genetic testing in people with rare disorders

Genetska istaživanja koja uključuju ljude sa retkim bolestima,

that prevent them from feeling pain

koje sprečavaju osećanje bola,

have pinpointed several other possible targets for drugs

precizno su odredila mnoge potencijalne ciljeve za lekove,

and perhaps eventually gene therapy.

možda eventualno i gensku terapiju.