It is part of our existence. One third of Americans are in chronic pain. What is the meaning of pain?
Pain and suffering are part of the human condition – we all experience them. While it’s obvious that pain is meant to protect us from destroying our body (as is the case with physical pain) or to avoid potentially threatening situations (in the case of emotional pain). Many report that peace can be found through the crucible of suffering. This idea is embedded in our culture, religions, and in modern philosophy. At a deeper level, pain can be heavily influenced by our perceptions and expectations. To many, pain may define their lives.
What Is Pain?
Merriam-Webster.com defines pain as “a localized or generalized unpleasant bodily sensation or complex of sensations that cause mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease)” or “mental or emotional distress or suffering1“. It is inherent in the meaning of the word that physical and emotional pain are intertwined.
Physical pain is experienced in part by nociception, the neurological process rooted in the brain detecting extremities of heat, cold, mechanical, and chemical signals alerting the body of potential dangers2. But nociception refers to the system that detects harm, not the experience itself3. Though injury may occur, pain (for all intents and purposes) occurs in the brain, not necessarily in the body. This implies a certain level of perception influences the experience of physical pain.
Emotional or mental pain is found to be related to physical pain as they share the thalamocortical pathway in the brain4.
In the arising of pain in consciousness, we encounter our common pain experience. This is where things get interesting. A phenomenon known as placebo analgesia refers to pain relief experienced after administered a remedy without pharmacological or other known direct effect (also known as the placebo effect)5. This effect appears to be influenced by learning, expectations, and social cognition6. While placebo effects mitigate pain, nocebo effects do the opposite. Nocebo promotes pain, distress, and disease in the body.
Humans possess a large capacity for creating context. It is believed that this is partially the reason for these effects. We possess the ability to learn what certain cues may mean. For example, at the dentist, many of us cringe at the sound of the drill. This is a learned association between what we believe will cause discomfort and an audio cue. Implied is that our expectations of an experience are important in experiencing the event itself.
Studies show that setting expectations for a placebo cause the subject to report an experience closer to the set expectation. This appears to be true even though the placebo remains unchanged among subjects with differing expectations. Many potential explanations exist.
Some studies show that a placebo activates opioid receptors in the brain reducing pain7. Genetics seems to play a role in subjects’ susceptibility to placebos. In other scenarios, subjects can be conditioned to experience the positive effects of a placebo.
Research points to dopamine (the reward chemical in the brain) as the potential causal agent in the placebo effect8.
The Impact of Emotions on the Perception of Pain
Research finds the those who experience depression are more likely to report more severe pain during certain cardiac procedures. Relatedly, those who experienced severe pain were also more likely to self-report emotional distress or depressive symptoms8. The relationship between emotional health and pain appears to be highly correlated. The emotional “setting” seems to regulate attention to the pain. The more attention put on the source of the pain, the greater the pain intensity perceived.
In the case of dental pain, playing music, humorous movies, and filling the air with pleasant scents has been shown to reduce the perception of pain. Those of us with more empathy may also feel more physical pain.
Historically, research has shown that pain is not directly related to the severity of the injury. 9 So this begs the question, what does impact the severity of pain?
Fear and anxiety can cause the blockage of analgesic or pain-reducing neurochemicals10. Two neural pathways create the perception of pain, the anterior cingulate cortex and the medial prefrontal cortex and nucleus accumbens11. The AAC is related to empathy, impulse control, emotion, and decision-making12. The nucleus accumbens sorts out, and identifies rewarding and/or reinforcing stimuli13 while the medial prefrontal cortex is involved in decision making. This pathway is wired in a way where we are urged to decide whether to take action or not (and to what degree) in response to the pain. We can begin to see how emotional states can influence pain in this context.
If there is a high level of fear in response to an injury or chronic pain situation, this could increase the perception of the pain level. The fear may block the analgesics, and the behaviors taken to avoid the pain could be heightened. And if those behaviors are to avoid the pain for fear of it, the cycle may begin and continue until broken.
“We are healed from suffering only when we feel it fully.”Marcel Proust
CBT Approach to Chronic Pain
There are two broad categories of pain, acute and chronic. They are differentiated in that chronic pain lasts six months, and acute pain is due to injury and is short-term (diagnostic timeframes differ)14. Chronic pain is the result of aging, nerve damage, and injuries that have not properly healed15. It is speculated that more than 30% of US adults suffer from chronic pain20.
Often, opioids are prescribed to deal with chronic pain. However, due to the prevalence of opioid addictions and abuse, there is a growing movement towards other tools to manage this pain. Cognitive Behavioral Therapy or CBT attempts to fill this space.
Dr. Muhammad Hassan Majeed believes that Cognitive Behavioral Theory is the only solution to improve patients’ lives16. The risk of opioid addiction has too great a risk, with more than one in ten becoming addicted. It’s reported that forty-six people die each day from prescription opioid use.
CBT seeks to increase patients’ sense of hope, self-efficacy, and ability to cope17. CBT’s aim is to bring patients awareness of negative thoughts and emotions and consciously change them18. Its purpose is to face fears and not avoid them. Additionally, patients learn calming techniques for the body19. In opposition to CBT, opioids (aside from the risk of abuse) cause depression, motivation, and energy issues. For this reason, CBT is becoming the preferred route for treating chronic pain. Long-term opioid use may also intensify the pain as time goes on20.
Pain as a Gateway to Peace
“The LORD is near to the brokenhearted and saves the crushed in spirit.”Psalms 34:18
There is an archetypical way of thinking about pain in our society. As earlier stated, the definition of pain involves suffering. The word suffering comes from Latin and essentially means ” to carry under”.26 In the Christian tradition, we talk about Christ’s suffering, the Buddha teaches the path to enlightenment, suggesting the urge to flee our current plane, and modern athletes break their bodies down to improve their performance. There is admiration for suffering and perhaps to a greater extent, the need to escape it. We seem to instinctually understand that pain is necessary for growth. Those who experience trauma, for example, also experience positive personal growth thereafter21.
Physically, injury or stress can cause a hormetic response. That is, “stimulating or up-regulating existing cellular and molecular pathways improving the capacity of cells and organisms to withstand greater stress.”22. Scars from burns or lacerations are tougher than the skin was previously, the body reconstructing a more resistant structure23. Initially, broken bones grow back with an extra callous of bone-like material, reinforcing the bone’s strength24. On the other hand, severe chronic pain is extremely stressful on the body and can cause death25.
Carl Jung went as far as to say “Neurosis is the avoidance of legitimate suffering.”27 Pain helps us better recognize and experience happiness. Experiencing relief from pain is pleasurable28. And perhaps this is the point in the experience. As we choose to go through it, we are reinforced. We gain a greater sense of self-efficacy and confidence, thinking “I chose the pain, and am rewarded for it.”
We celebrate this in our celebration of athletes who sacrificed their time and bodies to become world-class. We celebrate this in our personal lives when we share stories. Julie went to college for eight years! Now, she’s a doctor. John worked for that company for thirty years; it’s about time he was promoted.
The characters in our movies and stories undergo a character arc. The character we relate to faces a conflict, pain. S/he faces the pain and comes out differently on the other side. Luke Skywalker, for example, is but a child at the beginning of the Star Wars saga. He is frustrated and immature. Not only does he have to face that his father is the biggest monster in the galaxy, but that some of that may lie in him. The choices he makes in the story define him as he experiences the pain. His own father cuts his hand off and Luke suffers physical pain as well. In the end, he is a legendary character barely escaping the temptations of the dark side and a far cry from the young boy at the start of the saga.
This story resonates with us because it is our story.
“Pain unlocks a secret doorway in the mind, one that leads to both peak performance, and beautiful silence.”David Goggins
Pain is the geothermic pressure cooker that turns carbon into diamonds. It is the fire we had to fight through to survive. Pain is transformation.
Fear of Pain is Worse Than Pain Itself
Fear and pain walk hand and hand. Often, when dealing with the pain we are attempting to avoid activating the pain for fear of the experience. However, when we decide that pain cannot defeat us and that our mind is greater than the pain, we find new doorways in the mind. We are not hiding behind squinting eyes for fear of pain. When we embrace the pain, there comes a sense of spirituality in that we won’t let it stand in the way of our higher self.
In the resolution of the movie, Black Swan, the main character dances the difficult piece with elegance and grace. She inspires, performs flawlessly, completely enraptured in the act of the performance. It isn’t until the end, she realizes that she has been mortally wounded. She embraced the pain, made it part of her performance, and used its energy to inspire her movements.
When we move past the fear of pain, we find the remainder of our potential.