The botany of relief

Last week, I went to a hospital basement to find and understand "pain." I realized that in a sense, I was luxuriating in an understanding of "pain" without having to feel it but a chance to better understand "pain" from the experts themselves – the pain doctors – and share it here, could help us all, patients and their loved ones and doctors, in our collective desire to be healed.

What if you had a face that was severely disfigured because of a cancerous tumor that has grown and taken over parts of your face? Or a neck that has a gaping wound? Infections that result from a defeated immune system weakened by cancer? These represent some of the most severe and more graphic images of pain that the doctors in the Pain Management Center of St. Luke’s Medical Center, headed by Dr. Francis Javier, recently showed me. Dr. Javier wanted me to better understand the anatomy of pain and the ways of relieving it. So together with the other members of his multidisciplinary, holistic team like Dr. Antonio Yap, Dr. Luz Kwong, Dr. Francisco Navarro, and Dr. Agnes Bueno, I pursued a more grounded understanding of pain and how we can address it.

Pain is not a message that travels directly from the body part affected to the brain. When a part of your body experiences something wrong (e.g. change in temperature, pressure outside its normal range or actual tissue damage) it sends a signal through nerve cells that extend to the spinal chord – in a part called the dorsal horn. There, the pain message triggers the release of more chemicals called neurotransmitters which process the information that is sent to the part of the brain called thalamus, which is in charge of sending it out to different parts of the brain which eventually configures how you will end up perceiving and interpreting the pain. That is why it is really idiotic and cold to dismiss people in pain and tell them "it is ONLY in their minds" because that is where it really is – that is where "pain" really knows itself to be painful. Without that "mind," there is really no point why pain would even be an issue in human lives. This also explains why some people with the same illness or condition endure or interpret pain differently. The emotional, psychological, social, cultural background, which guide the patient’s expectations, beliefs and values, as well as age, sex and even memories of past pain experiences, all influence one’s perception of pain. It is also why a psychiatrist is part of the pain team as Dr. Agnes Bueno is in the St. Luke’s team. Psychiatrists are there to help you heal because pain is shaped by how you perceive it to be. On top of this, there is also a genetic basis for pain, which was discovered in 1999, which influences one’s susceptibility to pain (see The Genetics of Pain by Jeffrey Mogil: IASP Press: 2004).

Pain is a signal that there is something wrong occurring in your body. It has evolved because without that signal, you will not be alerted to remove yourself or the cause of your pain such as fire if you are singed, an insect when it stings you, or a load when it bears on you. Those are acute kinds of pain – those from trauma or after surgery. But there is also chronic pain that according to the experts, plague as much as 36 percent of adults in Europe, 43 percent in the US and according to an ongoing survey in the Philippines, 10-15 percent. In the country, of the 10-15 percent chronic pain sufferers, 103 die every day of cancer and 65-75 percent of those die of unrelieved pain. When damage occurs in the nerve cells themselves, this is called neuropathic pain and this is also prevalent in cancer-related pain.

To those who have not themselves suffered or seen a loved one in terrible, endless pain, and who insist that pain is a necessary twin to being alive, or worse, some kind of atonement for immoral acts, you may want to visit the Pain Center in the basement of St. Luke’s and reassess your view. Pain needs to be addressed because it gets in the way of healing because in its severity, it could become another level of "disease" that causes negative changes in blood pressure, hormonal production etc. that could adversely influence the treatment of the primary disease. Also, the doctors do not require you to feel the pain so that they could get to the bottom of your disease. Medical school trained them to look for other symptoms to guide them.

But there is a bigger problem with the issue of pain. The pain doctors in St. Luke’s and in every other research paper I came across from the Mayo Clinic to UCLA hospital to other excellent hospitals in the UK, are themselves frustrated over the refusal of patients and even physicians themselves to help relieve patients from the severe kind of pain. The frustration has to do with a plant that has been "demonized" in history: the opium poppy. And in much all else in the history of human pursuits, the "demon" part has more to do with ignorance of how Nature works than with actual plants with horns and fangs trying to possess souls. And before any reader jumps into the conclusion that I am too liberal in my "botanical" views, it might be useful for them to know that the WHO, as far back as 1982, has embarked on a global program to advocate the use of strong opioids for the management of severe pain, particularly those of cancer-related pain. From the data provided by Dr. Javier, from the 87 kg the allocation we are allowed in the country, only 15 kg are imported and not all 15 kg are purchased by hospitals to treat severe pain. The occurrence of addiction to morphine, in cases where it has been prescribed for severe levels of pain, is RARE. What is not rare is the fear of this plant, which looks like a bald head with a laced cap too small for its head, but itself is unaware of what the fuss is all about caused by its natural make-up. So again, as the records will bear, addiction to morphine RARELY occurs in treating the level of pain that I have mentioned.

The plant in question has been cultivated as far back as 3400 BC in lower Mesopotamia, which does NOT mean that it is okay for you to cultivate it in your backyard. In 1753, Carl Linnaeus, in his very useful obsession at classifying organisms, gave it the name Papaver somniferum which implies "sleep," which could be caused by the substance but most of all, it relieves pain. It was only half a century later in Germany when Friedrich Sertuner discovered what is potent about opium by dissolving it in acid then neutralizing it with ammonia, which resulted in Principium somniferum or more commonly known (or feared) as morphine. This process of discovering and isolating the active ingredient in plants suspected to cure certain ailments is what differentiates the scientific process from the backyard picking of branches and their wholesale boiling or chewing "al fresco." It is also what has made drug companies reliably profitable. In 1827, commerce set off the production of morphine under E. Merck & Company of Darmstadt, Germany. By 1837, it has helped patients like the poet Elizabeth Barrett Browning, then only 15, to endure a life-long lung disease. She died in 1861, with a good portion of her life under morphine. This means that she gave us all those beautiful verses even while she was under morphine. This does not mean, however, that morphine deserves the full credit for her sonnets. It would have most likely meant that morphine freed her from the constant severe pain which would have distracted her from fleshing out her true nature – that which she found in writing poetry.

Like most things around us, we burden Nature with our own imaginary fears of the power it has over us when it is really wiser and much more helpful to understand Nature and put its use into perspective, where it could be of the greatest help to humanity, most importantly in our deep desire to be healed or be relieved from horrific pain. Opioids embody the botany of relief from agonizing pain and we now have trained doctors who know how to make it work to our healing advantage in a real demonstration of compassion, expressing that "while pain is inevitable, suffering is optional."

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