The Value of Pain: Leprosy
Post by: Laura Gold, PT, DPT
Leprosy. We’ve almost all heard of it and many of us, at a very early age. It is a common topic in biblical stories and a horrible disease of “biblical” proportions. Leprosy is not nearly as ubiquitous and devastating as it once was — it is far less common, and we have much better means of treating it. Unfortunately, it is still a problem in poorer areas of the world in which people don’t have access to healthcare. But this post isn’t about the epidemiology of leprosy and steps for global eradication. It’s about what leprosy can teach us.
What you may not know is that leprosy is not a flesh eating disease. It doesn’t cause body parts to fall off. It is a bacterial infection caused by the bacterium Mycobacterium leprae. Its primary means of attack is on the peripheral nerves. The damage to peripheral nerves causes a loss of sensory function that results in an inability to sense tissue damage. In other words, in areas of the body where the nerves are damaged (often at the ends of the extremities), people with leprosy don’t feel pain!
And that’s where the disfigurement comes in. If a person can’t perceive damage to the body, they can’t take protective measures to prevent or limit tissue injury. When an individual with normal sensory function has an injury, the body responds by producing pain so that we protect the injured tissue and allow it to heal. Think about what happens when you get a blister on your foot. A little friction on the foot can cause a lot of pain! Once that blister has your attention you might do a number of things: bandage or cushion it, avoid the offending footwear, change your activities so that it doesn’t hurt, or even just walk with a limp — all are attempts at reducing stress on the injured area so it can heal (whether conscious or not!). On the other hand, when your alarm system isn’t working and you don’t have pain, you just keep going. And that blister doesn’t heal. In fact, it gets worse, and soon enough, it becomes infected. And even though it’s quite a terrible wound at this point, you still won’t take the stress off. Eventually the tissue succumbs to the infection, and in a worst case scenario, amputation results. That’s what happens with leprosy; wounds or injuries (even small ones) don’t heal because the infected individual has no means of knowing to protect the affected area. Interestingly enough, if a leper’s wound is protected from tissue damage (by wearing a cast, for example), the tissue can actually go through a fairly typical inflammatory process and heal!
We are constantly making changes and adjustments to protect ourselves from injury, often without giving it a thought! Shifting in your seat, adjusting your grip on a hammer, pulling your hand away from a hot surface — these are all very minor changes that result from a healthy, functioning nervous system and protect us from injury. There are more dramatic examples, too. When we have pain that is very severe, unusual, or persistent, it often drives us to seek help from a medical professional.
The ultimate purpose of pain is to keep us out of danger and help us survive.
So many lessons can be gleaned from learning about leprosy, those who have lived with it, and the idea of “The Gift of Pain”, but there are two ideas that really resonate with me.
While pain is something that I spend most of my work day helping people to combat, it is very valuable to our function and survival. Total, constant pain is a terrible, debilitating state, but so is the total absence of pain.
Our perspective on pain is not insignificant. In my line of work, I see both individuals who have high levels of anxiety regarding even minor pains or injuries, as well as, individuals who ignore their pain and persist in damaging their bodies despite the alarm bells. Both of these are unhealthy situations. As a foundation for therapy, I work with patients on understanding their pain. This step is often critical in achieving the patient’s goal.
A caveat — it is true that pain is a powerful protector, but our “alarm systems” sometimes go awry, and we have pain that does not match the tissue damage (injury) that is present. In these circumstances, pain becomes a major hurdle in day to day function. The problem that must be treated is no longer the original injury but the way the nervous interprets information and responds to it. But that’s another story for another day.
Interested in learning more about leprosy and the significance of pain? Check out The Gift of Pain by Dr. Paul Brand and Philip Yancey.