Why Would Severe Chronic Pain Evolve? | Hacker News Reader

Why Would Severe Chronic Pain Evolve?

2 pointsNormille6 comments

I'm suffering a flare-up of sciatica at the moment. So 'enjoying' a week or more of barely being able to walk the length of the room and unable to get any sleep. As I lie awake at night, constantly fidgeting to try and find a comfortable position to try and doze off, I ask myself:

What is the point of severe chronic pain? As in 'why would it have evolved?'I can see no biological advantage to it.

With sudden acute pain there's an obvious sense the body is trying to protect itself from injury."Move hand away from hot thing", "Move leg away from spiky thing" etc. And with tolerable levels of ongoing chronic pain, the body is again trying to protect itself by reminding us through that ache in a limb [for example], to go easy on that body part, as its still healing from a previous injury. Which all makes perfect sense.

But what about higher levels of chronic pain? Anyone who's had sciatica will know it can last for weeks and be absolutely agonising for days on end. What evolutionary benefit is my body gaining from that?

I can barely walk at the moment which, in our wilder ancestry would make me extremely vulnerable to becoming somebody's dinner. I hardly ate for 2 days, when it was at its peak and I'm hardly getting any sleep at the moment. All of which seems intended to make my body more vulnerable, rather than protect it. [Another example of a similar affliction involving this kind of ongoing agony would be severe toothache].

So, again, why has such a setup evolved? Why has evolution ended up with a system whereby a tiny minor injury to an insignificant body part can cause the whole system to almost grind to a halt with unbearable levels of pain that seems unending. When a tolerable ache would serve just as well as a reminder to treat the injured area with caution.

Generally interested in reading some scientific theories on this. I've not been able to find anything so far.

No advice, just commiseration. Am going through a sciatic period (in my case it causes numbness down my leg, not pain). For decades I’d sit sort of weirdly with my right leg tucked under my left, it made my lower back feel better, but allegedly trained the sciatic nerve to move to just the wrong spot. Pilates helped mitigate it until Covid.

Everything I’ve read about mitigation involves various piriformis and IT band stretches and posture corrections, as well as hectoring about diabetes (which is both on target and misdirected in my case).

Thanks for the commiseration.

I suspect my case is Piriformis too, which causes the same symptoms as Sciatica, but less likely people would have heard of it. Doubtless self-inflicted too as I'm the kind of "no pain, no gain" person who grits his teeth and carries on exercising through injuries. In this case, I carried on cycling a few times after feeling a pain in my buttock while out on the bike one day. With these unfortunate consequences.

Last time I had a bad attack like this was about 5 years ago, in similar circumstances. Hopefully this time I'll have learned my lesson and will stop working out next time I feel the tell-tale twinge. Twice in one lifetime to go through this hell is enough for anyone!

I had chronic lower back pain and sciatic numbness for years and completely separately (or so I thought) problems with my knee (going down stairs was excruciating). The knee pain was dx'd as IT band / piriformis syndrome. P/T for the knee coincidentally helped alleviate the lower back pain and sciatica. I eventually got into Pilates which seemed to help stave off all three problems (until Covid).

I have a degree in English lit and zero medical qualifications but it sounds like you compressed the sciatic nerve on the ride. Can you get your doctor to recommend some P/T to try to release that?

>What is the point of severe chronic pain? As in 'why would it have evolved?'I can see no biological advantage to it.

Not everything that evolved evolved to an "optimal" level. Evolved just means "mutated into existance and then survived and proliferated because it was useful". Doesn't mean it has the optimal form, just that it's more useful than not having it at all.

That said, the chronic pain tells your body not to try walking/working until the situation fully heals - which could take a long while, lest you make things worse.

  >the chronic pain tells your body not to try walking/working until the situation fully heals

Yes, I mentioned that reason in my original post.

My query [if Evolution can be queried] is why the need for such intense levels of chronic pain? A tolerable ache in a part of the body will automatically make you aware of the need to treat it carefully. I can't see why 100s of 1000s of years of evolution has selected for a nervous system which cranks the pain up to 11 and then maintains it at that level for days, weeks or [in some poor folks' cases], months or years on end, with no respite.

You'd have thought that, over the course of human evolution, natural selection would have weeded out the specimens whose nervous systems render them practically incapacitated for days on end, on account of relatively trivial injuries.

I mean, look at toothache [which I mentioned in passing in my original post]. People have been driven to the brink of insanity with the pain from a broken tooth. Yet what does a broken tooth matter? Humans can still function perfectly adequately after losing all their teeth and a broken tooth can still function almost as well as a whole one. Yet the nervous system often renders people barely able to function, on account of a broken tooth.

Conversely people can be suffering from life threatening heart conditions, kidney disease, liver disease etc. without ever realising it. I seems the nervous system has a very arbitrary 'level of pain = seriousness of injury' scale, when it comes to alerting us that things are wrong with parts of the body.

>My query [if Evolution can be queried] is why the need for such intense levels of chronic pain? A tolerable ache in a part of the body will automatically make you aware of the need to treat it carefully.

Would it tho? I know many people who just brush off tolerable pain and go on, even when they shouldn't.

It's very more common behavior in the "close to nature" / rugged types, which most of our evolutionary ancestors were.

>I mean, look at toothache [which I mentioned in passing in my original post]. People have been driven to the brink of insanity with the pain from a broken tooth. Yet what does a broken tooth matter? Humans can still function perfectly adequately after losing all their teeth and a broken tooth can still function almost as well as a whole one

True. Though a broken touth without maintainance and care can mean many things too, from gangrane to death.

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