Revisiting the Cartesian model of pain.
In modern medicine, the Cartesian or nociceptive concept of chronic pain has been replaced with the biopsychosocial model in both theory and practice. This paper presents an argument along with observations in favor of chronic pain as a pure nociceptive experience separate from suffering and outlines theoretical and practical solutions to improve the diagnosis and treatment of patients who experience chronic pain. Theoretical solutions include increasing inhibitory descending neurotransmitters using monoamine oxidase inhibitors of subtype A in combination with dextroamphetamine, increasing beta endorphin through enzymology and/or ultrasound stimulation of the periaqueductal gray, developing long duration opioid analgesics using spin label probes of morphine and morphine analogs and destructive interference of nociceptive action potentials by eddy currents generated by a variable magnetic field. Practical solutions include prolonging local anesthetic blockade of small pain fibers with patient administered local anesthetic storage devices and abandonment of the multidisciplinary pain clinic.
Goldberg
Joel S
JS
Duke University School of Medicine, Durham Veterans Affairs Medical Center (112c), 508 Fulton St., Durham, NC 27705, USA. golb002@mc.duke.edu
D000701:Analgesics, Opioid / Q000494:pharmacology; D000818:Animals; D004723:Endorphins / Q000378:metabolism; D006801:Humans; D008954:Models, Biological; D008962:Models, Theoretical; D008996:Monoamine Oxidase Inhibitors / Q000494:pharmacology; D018377:Neurotransmitter Agents / Q000378:metabolism; D009619:Nociceptors / Q000378:metabolism*; D010146:Pain; D010147:Pain Measurement; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D004723:Endorphins; D008996:Monoamine Oxidase Inhibitors; D018377:Neurotransmitter Agents