Is it possible that Paula’s ventilatory defect during health releases endogenous opioids and that is why she felt no pain during her extremely laboured but efficient normal [for her] breathing?
Table 43.1The Effect of Changes of Respiratory Rate and Tidal Volume on Alveolar Ventilation
|Minute ventilation (L)||Respiratory rate||Tidal volume (L)||Dead spacea (L/min)||Alveolar ventilation (L/min)|
[A dead space of 150 ml/breath is assumed]. Chapter 43, Respiratory Rate and Pattern Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.Walker HK, Hall WD, Hurst JW, editors.Boston: Butterworths; 1990.Copyright © 1990, Butterworth Publishers, a division of Reed Publishing. NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Maybe permanent involuntary use of these voluntary muscles to breathe deeply and slowly, and to exhale with effort, does release endogenous opioids and maybe it even helps keep breathing slow and deep enough.
Opioids can certainly make you happy, if not outright euphoric.
And when well, Paula is almost always happy. More than most people. It is really nice. And a little annoying too. How many people do you know that are always content?
Maybe painless slow deep effective breathing at rest, endogenous opioids and being happy and content all time are somehow related.
The dysphoria of ineffective slow shallower breathing in depressive insanity, and the too fast breathing in the same person in mania, may be reflective of the handling of carbon dioxide and other gases in the body. Ineffective handling of waste gases will be mildly poisonous and will easily be the cause of [hidden] dyspnea, depressive dysphoria and also manic euphoria. And may affect endogenous opioid receptors and release in ways we don’t yet understand.
“This article reviews the mechanisms of opioid-induced respiratory depression, from the cellular to the systems level, to highlight gaps in our current understanding, and to suggest avenues for further research.“ Opioids and the control of respiration K. T. S. PattinsonBJA: British Journal of Anaesthesia, Volume 100, Issue 6, June 2008, Pages 747–758, https://doi.org/10.1093/bja/aen094
We have so much to learn. So many questions to answer.