In Pain in the Membrane (Lessons from Opioids and Jelly Beans)

Pain is an example of a naturally occurring baseline in our brains. We all have our own “threshold for pain,” or can picture the famous hospital “pain assessment tool.” We know about the tough guy who cries over a hang nail and the Black Knight who loses his arm and says, “Tis but a scratch.” Besides being experienced personally, we also have to realize that this baseline can actually move.

When we feel pain, we ask ourselves, “compared to what?” Pain is a sensory signal. My back hurts more than it did yesterday but nowhere near as bad as the time I threw it out. We feel, we compare. That is how humans are hardwired. Pleasure is a sensory signal too. This is salty and good (sea-salt caramel) that is salty and bad (a mouthful of ocean water). Again: we feel, we compare.

One of the most daunting aspects of the opioid epidemic is that when these drugs are used over time, they actually move the baseline. Opioids work by hijacking the network that senses and translates pain in our body. They block the pain signals and also replace them with a reward signal. Because of this dual purpose of blocking pain and replacing it with a reward, our bodies start to look for that reward like Cookie Monster looks for cookies, or I look for sea-salt caramels – subconsciously ignoring the long-term ramifications.

An inverse scenario is the Jelly Belly game BeanBoozled. They give you a box of normal looking jelly beans and sometimes you get a red one that tastes like strawberry-banana smoothie, and other times your red one tastes like dead fish. Its extra amusing if you don’t tell someone they’re playing the game and let them try a handful. Once they realize you’ve replaced a reward with a penalty, they’ll start avoiding your candy dish like the plague.

In both scenarios, the messed up part is that our internal baseline – our benchmark – is being moved as a result of our sensory experience. Most of the time we think of our perception as it drifts on its own from a fixed point, like on a scale. All we know is that we’re still asking, “Compared to what?” However, those fixed points are frequently just myths to begin with. Our perception of the experience can actually shift without us even realizing it. What do we do?

For jelly bean “addiction” (please note, I’m not belittling addiction, just illustrating a point), BeanBoozled could be an answer. Likewise, imagine if Cookie Monster was handed an equivalent “nasty” cookie instead. He’d be thrown for a real loop. The unexpected sensory response will trigger a reevaluation of the baseline.

For opioids, the answer is much more important and far less clear. All we know is that it is likely buried somewhere in an understanding of how our senses influence the vicious cycle, and how they can be used to stop the baseline-decline and hopefully reverse the course. See the Scientific American article, “Case Study: When Chronic Pain Leads to a Dangerous Addiction,” from March 1, 2017 for a look at how researchers are addressing this problem.

The key here is that when we ask, “Compared to what,” we also need to be aware of if that “what” is actually stationary. In many cases, it is not – so we should consider what impact our sensory triggers will have on the baseline over time. Pain and pleasure can have different impacts, which mean we need to be extra conscientious of the effects of repetition. Whether opioids or jelly beans, know that senses can shift baselines.