by Steve Goldfinger

Everyone gets them.  Those brief twists of intestine, small pockets of gas, maybe a swallowed seed in a tight spot before it passes along.  For most, they are mild enough—maybe a 1 or 2 on the proverbial scale of 10 and virtually ignored. But for a few, gut pain can ring in at a resounding 9 or 10, last a day, and obliterate any chance of carrying on with life’s activities.

They come to see me for an explanation, a visit of last resort. In their minds, an answer will assuredly yield the clue to relief. I take a careful history, perform my physical exam, and review each of the many CT scan, MRI, and ultrasound studies as well as the notes of docs who have come before me. Nothing, as I suspected at the start, will ring a cheerful note.

In the end, all I can suggest is that they are cursed with “hyperalgesia,” meaning they are exceedingly sensitive and thus overeactive to minor stimuli that others barely perceive. I describe studies on irritable bowel patients. When deflated balloons are placed in their rectums and air is gently introduced, they feel pressure and pain long before their normal counterparts are perturbed. Do these IBS sufferers have more nerve endings in that nether region? Do their nerve endings release more or different neurotransmitters than they should? Who knows? It’s probably infinitely more complex than this. But whatever the case, we give their pain a name: hyperalgesia.  The name covers our ignorance of what is really going on.

I wish I truly understood this disorder. Without such knowledge, I feel I am little more than a shaman with impressive certificates and degrees on my office walls. I try to compensate for my ignorance by resorting to the usual standbys: showing compassion, suggesting some medicine that hasn’t already been tried, recommending an alternate approach such as meditation or hypnotism. And then, providing the false hope that soon we will really understand the precise biological pathways that cause hyperalgesia and then be able to cure it. “Fat chance,” I say to myself.

Those pathways. I have seen diagrams displaying hundreds of tiny arrows suggesting the incredibly complex interplay of nerves, their neurotransmitters and hormones to explain the so-called mind-gut connection. And then I am reminded of the most fundamental question of all, the mystery that continues to plague neuroscientists and philosophers alike. How does the ephemeral domain of thought arise from the physical world of the brain? Can one even postulate a connection?

Rene Descartes thought he had the answer to the mind-body question with his famous iteration, cogito ergo sum.  “I think, therefore I am.”

Really? Years ago, quick witted philosophers added a playful tag line to dispel Descartes’ facile solution. I remember it from philosophy 101. Cogito ergo sum…cogito.  “I think, therefore I am….I think.”

“This new drug I am prescribing will surely reduce almost all your pain…I think.”

BOLLI Matters feature writer Steve Goldfinger

After a long career in medicine, Steve has been exploring his artistic side.  At BOLLI, he has taken writing courses, been active in the Writers Guild, and even tried CAST (Creativity in Acting, Storytelling, and Theatre) where his imagination made him a singular player!




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