¿Por qué hace daño el dolor?

La del dolor es una experiencia conocida de todo el mundo, pero su naturaleza sigue siendo un enigma perturbador tanto para los pacientes como para los científicos. ¿Por qué pacientes diferentes y sometidos al mismo procedimiento quirúrgico experimentan un dolor postoperatorio sensiblemente distinto? ¿Cómo es que personas con un dolor persistente que tiene poca o ninguna explicación médica llegan a quedar parcial o totalmente impedidas por él, aun recibiendo un tratamiento exhaustivo o toda clase de tratamientos posibles?

A muchos médicos les gustaría considerar una simple sensación que resulta útil para señalar a nuestra atención una enfermedad o una herida, pero el dolor se resiste a su explicación como una simple sensación, del mismo modo que la música se resiste a su explicación como simples tonos. Una autora contemporánea no médica ha descubierto, entre las cualidades del dolor intenso, las de ser extremadamente desagradable, tener la capacidad de aniquilar los pensamientos complejos y otros sentimientos y la de destruir el lenguaje y oponer una fuerte resistencia a la objetivación. Dicha autora recuerda a los médicos que, para la persona que sufre un dolor intenso, lo que predomina en la conciencia por encima de todo es una poderosa emoción negativa.

La mayoría de las veces, el dolor se produce después de que terminaciones nerviosas simples adviertan una herida en un tejido de diversas formas y emitan señales que se transmiten hasta la espina dorsal y por ésta hasta el cerebro. Durante muchos años, los científicos pensaron que dichas señales se transmitían por unas rutas bien determinadas para llegar a una estación retransmisora en el cerebro llamada tálamo. Desde ésta las señales -pensaban los científicos- seguían hasta la parte de la corteza cerebral que regía la conciencia del cuerpo y de algún modo la corteza las convertía en una experiencia consciente. Por desgracia, la trayectoria neural correspondiente a los mensajes sensoriales de una herida en un tejido explica sólo en parte cómo experimentamos el dolor. No puede explicar por qué el dolor entraña emoción y conocimiento.

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