Since Paul was my namesake, at least my middle name, this latest finding provides a good chance to talk about neuropathic pain. It appears Paul may have had nerve injury pain. If so, maybe he is our patron saint.
One of the great contributions to academia was the copying and publication of some of the early Christian writings. These books, The Patrilogia, are terrifically expensive and you will not find them outside the Reserve Section at big libraries, but you can find translations online. The originals are in Latin or Greek.
If you locate De Pudicitia or (”Chastity”) 13.17 (XIII.17), which was written about 190 A.D. , Tertullian says that the “thorn in the flesh” which Paul endured was pain in the head or ear (”wbat is called suffering of the ears or the head”). This could have been something else, but trigeminal neuralgia (neuropathic pain on one side, which would be from nerve injury pain sited in Cranial Nerve V) more easily fits this description. The trigeminal nerve (cranial nerve V) has branches which supply the front of the ear canal, the dura of the brain, sinus, oral, and nasal pain on that side of the head and sometimes become neuropathic, causing episodes of pain in that area of the head and ear. What an interesting possibility.
What does this idea have going for it?
1) Paul used the word “thorn” and this is consistent with the sharp quality of nerve injury pain in trigeminal neuralgia
2) Tertullian’s description of pain in the head or ear is consistent with neuropathic pain in the Fifth Cranial Nerve. Pain from this nerve also afflicts those with facial Central Pain. Touch sensation in the trigeminal nerve goes directly to the brainstem, but the pain tract of C.N.V descends into the cervical cord, sometimes as low as C5, and then rises with other body pain tracts in Rexed Layer II. Injury to this combined tract then gives rise to facial central pain. It is usually burning in CP and a shooting quality in peripheral injuries of the nerve.
3) Paul’s pain appears to have been intermittent but major, which matches trigmeinal neuralgia.
4) The nature of neuropathic pain in C.N.V ,ie the trigeminal nerve, does not lend itself to easy verbal descrption. It would allow Paul to do his work as a missionary, but it could make it difficult, explain his repeated prayers for relief, and his resignation to the pain and determination to continue.
5) Migraine is not severe enough to cause Paul’s comment, (Cluster headache would be severe enough to cause comment, but would have prevented his wandering missionary journeys). Migraine is also common, and less likely to cause Paul to use vague language.
You recall that “neuropathic” means “nerve injury”. Neuropathic pain out in some little nerve or branch (peripheral neuropathic pain. or PNI) behaves differently and covers much less skin surface than big lesions in the brain or cord (central pain), which may involve half the body (in stroke) or the entire body (in high cord injury). Still, there is some crossover, eg. peripheral neuropathy also involves burning pain.
SEVERE Central Pain is horrific, agonizing, and dreadful, but peripheral nerve injury pain is no picnic either. Such people may have a hand shrivel from disuse because the pain is so bad. Peripheral pain is also termed “causalgia”, if you are reading some of the old texts, you will see “RSD” and “Complex Regional Pain Syndrome” if you are reading the newest texts. These two conditions are the same.
Diabetic neuropathy is not exactly the same thing, being milder, but also prone to cover a very large area of the body, area covered being part of severity. The lighter the pain, the greater the likelihood of responding to medicines like Gabapentin or perhaps the new Pregabalin, a more extensive blocker of Glutamate, one of the pain neurotransmitters. These meds have a much better record in PNI than in CP.
Sympathetically maintained pain is another variant, but despite the name, it is hard to show exactly which tract this pain follows. G.D. Schott has produced strong evidence it is actually going up the visceral afferents which travel with blood vessels, and indeed these patients often show spotty blanching on affected skin, or “livedo”. It was not uncommon to block or remove ganglia from the sympathetic chain in an attempt to relieve CRPS, but currently, the success rate has been questioned. Oral meds to achieve sympathetic blockade, seem to benefit more those with thermal sensitization, but have side effects which limit their use.
Not so long ago, some Europeans attempted to diagnose CRPS by thermograms which show skin temperature changes in the hands or feet, but reliance on this method has diminished with the demonstration of patients who have CRPS but who do not test positive on thermography. The big problem here is that doctors do not distinguish between those with touch sensitization and those with thermal sensitization, so we cannot be sure what is going on. Currently, the diagnosis is often made by giving strong IV blockade of the sympathetic system with drugs like Phentolamine, and determining whether the pain is benefitted. Central Pain from Spinothalamic tract injury, may have an additional component of Sympathetically maintained pain. This may confuse the clinical picture so clinicians must be aware of this. (One author at Painonline has Central Pain but was also positive on the Phentolamine infusion, and so has blotchy livedo which is relieved by immersion of the hands in water of the proper temperature).
Patients with peripheral nerve injury can experience evoked or elicited pain of a heightened nature from light touch or temperature change, just as do those with Central Pain. However, in PNI, the pain from touch is INSTANTANEOUS; whereas in Central pain there is a 20-30 second DELAY (”Mitchell’s delay”) before the summation of events necessary to heighten pain leads to the really excruciating burn of evoked CP.
Paul may well have had PNI neuropathic pain. He thanked the Galatians (Gal 4:13-15) for bearing with his speach despite his “infirmities of the flesh” and mentioned his “thorn in the flesh” in 2nd Cor. 12:7. Trigeminal neuralgia is very painful, and is described elsewhere in this site. It often has a lightning quality.
Various theories have been advanced regarding its cause, including pinching of the ganglion (collection of nerve cell bodies) which supplies that small branch of the trigeminal nerve (C.N. V), or compression of the blood vessels which supply that portion of the nerve. One doctor in New York has figured a way to get to that ganglion through a scope, making what used to be a horrendous operation into a relatively minor one. Success is still not near one hundred percent.
As to Central Pain, relieving cord pressure often works in the early stages, but once Central Pain gets set, decompression of the cord does not seem to confer benefit in removing Central Pain. It is thought that dysfunction in the thalamus has made the cord problem more or less irrelevant. Heavy stimulation of pain tracts in the Central Nervous System, over extended time, chemically and genetically damages the system, right on up to the thalamus, where acids (arachidonic acid, PGE) abnormally increase, apparently contributing to the chronic pain state.
Reference to Paul is not intended to make Painonline into a denominationally preferential site. (See Koran citations elsewhere here), but the greater availability of works in English tends to increase the frequency with which English traditions are cited. Paul clearly referred to his pain as evil, and he termed it a “messenger of Satan”. The point is, we should not say pain is the will of God. We should fight it on all fronts. It IS evil.
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Cranial Nerve V=the trigeminal nerve
RSD=Reflex Sympathetic Dystrophy
CRPS=Complex Regional Pain Syndrome
CP=Central Pain, nerve injury pain in the central nervous system
PNI=nerve injury pain in peripheral nerves, which begin with spinal nerves leaving the cord and extend outward into the body.
Neuropathy=nerve injury pain of any kind
