“How bad is it out of 10?”
Anyone who has seen a doctor for a painful injury would have heard these words. The “Out of 10 Pain Scale” is common and simple. You might think, “its not very scientific”, but think about it, what other way do we have to establish just how painful an injury is?
You would think that for something so prevalent as pain, we would have worked out a decent method of objectively studying pain. But we don’t. Is childbirth more painful that a ruptured Achillies? Or more Irukandji sting? Is a papercut more painful than a blow to the testicles? We just don’t have a way to answer these questions other than asking the afflicted for a score.
But what about damage to the affected area? Surely by looking at bone and tissue damage, we should get a decent understanding of how painful it is.
And it turns out we do, for acute pain. Acute pain is the immediate sensation after damage to parts of the body which contain pain-receptor nerve endings. A lot of damaged nerve endings usually means a lot of pain (although the mind and body can protect us from overwhelming pain through various methods including endorphins, the body’s feel-good, home-grown drugs).
But the matter is not settled because a great deal of pain lasts days, weeks, and even years after damage has occurred. It sometimes lasts even beyond the healing of all damage. This is chronic pain. And when it comes to chronic pain, pain is not damage.
Pain is not damage
Pain is not damage: it’s worth repeating.
Yes, anyone who has had a cut or a bruise (i.e. everyone) knows that damage is painful. But the opposite is not always true. The existence of chronic pain does not indicate damaged tissue or bones.
If chronic pain is not damage to tissues or bones. Where does it reside? Is it the damaged nerves that have never stopped firing?
Yes, pain is clearly an activation of the nervous system. Why can’t we just scan for nervous system activation?
It turns out that activation of nerves correlates pretty poorly with reported pain. Some treatments, such as nerve blockers do dimmish chronic pain, but not always.
So, if not the nerves, where? Surely not in the mind?
Anyone with a pain condition hates being told “its all in your mind” or its even more toxic cousin, “you’re faking it”. Pain conditions are debilitating. The person who experiences them really does experience pain.
But consider this: The brain is a just a big bundle of nerves. The nervous system is just the brain plus all of its projections around the body. It is justifiable to say that the brain doesn’t end at the neck but is distributed the whole way around the body. No one can say definitively where the brain ends. Our mind, as it lives in the nervous system, is spread throughout our body – not just within our skull.
It makes you think about pain being in the mind, right?
Pain is complex. It is not simply about what is happening at the pain site. It is also about what we feel and believe about the pain. It is also about our (usually unconsciously) learned responses to our pain. Pain (and I know I’ll lose some of you here) is in part, a habit. The more we build our life around pain (avoiding it, relieving it), the more entrenched the pain-habit becomes.
Emotions can further strengthen this pain habit.
When we feel bad about ourselves, or anxious or helpless, we are sensitised to pain. Emotional pain and physical pain are conjoined twins. The mind/body feels physical and emotional pain. And the big daddy treatment for physical pain, opioid medications, like Oxycontin/Endone, are better at healing emotional pain than physical pain.
Pain is not Suffering, Life is suffering
And emotional pain will always be with us, because as the Buddha reminds us: “Life is Suffering”.
Opioid addiction blew out of control in the USA after doctors started wholesale prescribing of Oxycontin. Addiction to this powerful medicine especially took hold in parts of the USA that had been economically disadvantaged by industrial change. This addiction epidemic was suffering induced.
We will always suffer because reality will always fall short of the ideal. We are all capable of imagining a more preferable world. Maybe the past was better, maybe the future – when we think like this, we deny the present. We try to push away unpleasantness and grasp hold of the pleasant.
Pain is a severe unpleasantness. We suffer when we obsess on wishing it away. We suffer when we do not accept pain.
A way out of the suffering?
Pain is not the same as suffering. Pain is always with us, but suffering is our attitude to pain. Suffering is the non-acceptance of pain’s presence.
I suppose that some who have lived with excruciating pain (I have not) will dismiss what I’m saying. Will read these words as being yet another person, a supposedly compassionate psychologist no less, invalidating their experience once again.
I am not. I know that pain is painful. I know that some are, unfortunately, doled out more than their fair share of pain. I also know that when faced with this pain, there are better and worse ways to proceed.
One of the most promising psychological treatments for chronic pain is mindfulness meditation. Mindfulness means perceiving and accepting the world as it is. Sitting with reality, good and bad. And in fact, discarding the good/bad labels. Just letting reality happen.
When chronic pain is faced mindfully, the experience of pain loses much of its power.
Mindfulness does not rid us of pain, but that’s not the point. Mindfulness makes room in life for pain, then creates space for other things as well. It takes the energy out of the struggle with pain. Once the struggle is gone, coexistence with this uninvited unpleasantness can proceed peacefully, so we can get on with living.
Still pain, yes, but perhaps not suffering.