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THE TRUTH ABOUT PAIN: IT'S IN YOUR HEAD
DAVID EPSTEIN
August 08, 2011
More often than most other people, athletes have to ignore pain or endure it for long periods. It turns out that in this endeavor, the brain is a very good ally
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August 08, 2011

The Truth About Pain: It's In Your Head

More often than most other people, athletes have to ignore pain or endure it for long periods. It turns out that in this endeavor, the brain is a very good ally

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Later that evening at Vancouver General Hospital, doctors finally saw that five of Majdič's ribs were in fact broken. And the severe pain she had experienced before the final? During the semi, one of the cracked ribs had become dislodged, and a jagged end had pierced her lung, causing it to collapse.

Had the initial examination revealed the broken bones, Majdič's coach and doctors would have stopped her from competing and her Olympic hopes would have been dashed again. "It was luck we didn't know," she said later. Instead, the missed diagnosis was one event in a series that conspired to help her cope with agonizing pain—pain that, for the next four days, would make it nearly unbearable for her to cry (which she did anyway because she had to miss her other events) and, for nearly a week afterward, impossible to walk.

Pain always wins, eventually. It forces sufferers to stop what they are doing, or to turn to surgery or drugs, or simply to live in misery. In his recent book The Greatest Show on Earth, biologist Richard Dawkins struggles with the evolutionary purpose of extreme pain. Certainly such pain sends us useful messages: Don't touch that hot stove again. Don't get back up on those skis. And in rare cases in which people are born immune to it—congenital insensitivity to pain, the condition is called—they often injure themselves without realizing it and die from joint infections that arise because they fail to shift their weight when sitting or lying, as the rest of us do instinctively. But why, Dawkins asks, didn't humans develop just a "red flag in the brain" instead of something so unpleasant as pain? His answer is that pain evolved because it could not be ignored.

In sports, though, pain often must be ignored—or at least endured for as long as possible. Ultimately it sets a limit on what athletes can achieve, and for how long they can achieve it. How a player responds to pain can spell the difference between heroism and failure, between a historic career and a forgotten one. Indeed, many of sports' most remarkable moments—from Willis Reed in the 1970 NBA Finals to Kirk Gibson in the 1988 World Series to Strug at the Atlanta Games—have involved athletes hobbling through or grimacing past or simply shutting out physical agony.

Pain has the power to shape and control our everyday lives, yet it has been remarkably difficult to determine how pain actually works. The explanation that most of us intuitively understand is known to scientists as "specificity theory," because it connotes that a painful stimulus is transmitted along a single pathway to a specific pain center in the brain. French philosopher René Descartes first outlined it in his 1664 Treatise of Man. He reasoned that fast-moving particles from a fire placed near the foot hit a spot on the skin, essentially moving a "thread" in the skin that sends a signal of pain to the brain—"just as by pulling at one end of a rope one makes to strike at the same instant a bell which hangs at the other end," Descartes wrote.

This model endured, more or less—it is still a cornerstone of college biology textbooks—as the details were filled in. While humans do not appear to have a singular pain center in the brain, a lone master bell as Descartes might have envisioned it, there are known pain pathways. Signals from nerve fibers shoot up the spinal cord to the thalamus, a portion of the brain that serves as a sort of hub of pain. The thalamus then distributes its own signals to other parts of the brain: to the sensory cortex, which determines the location and intensity of the pain, and also to areas in the front of the brain, the anterior cingulated cortex and the insular cortex, which modulate emotional response to the pain.

The basics, however, remain intuitive: Something touches the skin, which stimulates a nerve fiber and ultimately alerts the brain. The more severe the stimulus, the more intense the pain. The harder the rope is pulled, the louder the bell clangs. It makes perfect sense and generally backs up our everyday experience.

Except that sometimes the rope is yanked extremely hard and the bell does not ring.

Tim (the Maine-iac) Sylvia, a 6'8" mixed martial artist, was 30 seconds into a 2004 UFC heavyweight title fight against Brazilian jujitsu black belt Frank Mir when Mir made a feline pivot off the Octagon cage, grabbed Sylvia's tattooed right arm, flipped on his back with Sylvia's elbow joint against his hip bone and leaned back like a man pulling a train brake. With Mir's hip as the fulcrum, Sylvia's arm bent back cartoonishly and snapped—loudly enough to be heard on television. The Maine-iac continued to fight, using his left arm to lift Mir off the ground and shake him off. But referee Herb Dean interceded, yelling for the bout to stop.

An angry Sylvia asked Dean, "What the f--- do you think you're doing?" and argued for the fight to go on. Sylvia was distracted by thoughts other than his injury; he was mad that he'd let himself get caught in an arm bar and that he would lose his chance at the title because of it. When Mir approached to console him and promise a rematch, Sylvia said, "We'll fight now, man. It's not over." But it was.

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