No Pain No Gain

Every now and then we get patients with chronic pain in our clinic, so I was really interested when I saw this case report about a 71 year old woman who feels no pain. I was hoping to find ways to really help these chronic pain patients.

She was found to have two notable gene mutations, FAAH-OUT  which researchers know to have links to pain sensitivity. The second was a microdeletion in the FAAH gene which reduces pain sensation, accelerated wound healing, reduced anxiety and enhanced fear-extinction memory.

This lady sought treatment for a hip issue and was found to have severe degeneration in the hip despite feeling no pain. When researchers looked into her case file, they found that she never reported experiencing pain or needed pain medication after surgery. Even during childbirth, after broken bones and cuts. She was burnt once, but only realized it after smelling her flesh burning!

I was then thinking, if an elite athlete had that sort of mutation and felt no pain, would that be a real major performance enhancer? That would surely not be considered as doping.

Think of how it would affect you if you were running and attempting to beat your personal best in the marathon. If you didn't feel any pain, nor the burn of accumulating lactate in your muscles when you were clicking out each kilometer at your goal pace. Surely you would be able to keep pace to beat your target time.

After thinking about it for a while, I realized that it is not possible. If you experience no pain while training, it would definitely expose you to injuries. Pain is necessary during training to help provide feedback and modulation and of course for adaptation to training.

During races, your performance is affected because pain impacts pacing. If you can't feel pain, you wouldn't know how to back off, when to slow down. You will purely be running by numbers (time) and not physiology.  That means you wouldn't know when to rest. Over training will become common. Mild injuries will then become severe.

Like what I always tell the athletes that I treat, "make pain your best friend". If you can tolerate pain, you will be able to perform your best.


Reference

Habib AM, Okorokov AL, Hill MN et al (2019). Microdeletion In A  FAAH Pseudogene Identified In A Patient With High Anadamide Concentrations And Pain Sensitivity. Br J Anaesthesia. DOI: 10.1016/j.bja.2019.02.019

Signed by David Butler himself in 2003.