Insensitivity or Indifference to Pain

By | December 1, 2011

This man has learned to dissociate the impulses from his feet from the pain centers in his brain.

It turns out that there a several rare conditions where patients are either insensate to painful stimuli or fail to recognize a sensation as painful. The conditions where patients are completely insensitive to pain are often accompanied by defects in the autonomic nervous system. This is very interesting because there are a number of pain conditions, which can be treated with sympathetic nerve blocks. Conditions where patients can feel noxious stimuli, but do not interpret them as painful are even more uncommon. There are usually no associated autonomic disturbances.

While not numerically significant in and of themselves these conditions point out that there are several steps in the transduction, transmission and perception of painful signals that can become deranged. More important from our point of view since these conditions are inheritable, there are likely to be multiple genetic variants for each step in the process.  While not well understood at present, when the mechanisms are elucidated they may provide an explanation for the great variety in the ways that chronic pain patients perceive and respond to pain.

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