What are pain and the inconsistencies of pain?
Pain is a curious thing. For years, we analyzed tissues: muscles, nerves, and bones, trying to understand what causes pain. Unfortunately, the more we learn, the more confused we become. With a million techniques, thought processes, and tools out there to relieve pain, what does the research say? This is the second post on a series about the psychology of physical pain. My first post, about color, while light-hearted, shows how much psychology influences pain. Now we will look at cases of the inconsistencies of pain, and how they don’t always make sense. We do this with intention of explaining how pain occurs.
The first story comes from the British Medical Journal (1). They report:
A builder aged 29 came to the accident and emergency department having jumped down on to a 15 cm nail. As the smallest movement of the nail was painful he was sedated with fentanyl and midazolam. The nail was then pulled out from below. When his boot was removed a miraculous cure appeared to have taken place. Despite entering proximal to the steel toecap the nail had penetrated between the toes: the foot was entirely uninjured.
So here the brain communicated with the builder a nail punctured his foot. So he decided (unconsciously) that his foot hurt. Understand that this response is psychologically normal. He did not have psychological issues. His pain was real even if the tissue had no damage. The point to take home here: psychologically normal people feel pain even when there no tissue damage exists. This example seems extreme but happens to all of us to some degree.
‘Tis but a flesh wound
Beecher (2) researched pain in soldiers from WWII and found that the size, depth, or amount of damage done to tissue did not correlate with the amount of pain the soldiers experienced. Of the soldiers (cleared of shock or any psychological issues) with very extensive wounds, only a quarter considered their pain high enough to need to do anything about it. Beecher thought may be these soldiers had hardened their pain tolerance from their service. He found, though, many would experience significant pain when given shots from nurses. He concluded the severe injury didn’t hurt because the soldiers perceived it as an escape from the war. It wasn’t a threat; it was a savior. This explains the key to understanding pain: your mind creates pain when it perceives a threat, regardless of whether or not tissue damage occurs: NO EXCEPTIONS.
The one good thing about music, when it hits you, you feel no pain. -Bob Marley
I Feel Your Pain Bro
The perceived threat doesn’t even have to be to yourself. Most of us experience an emotional response to someone else’s pain. Most of us cringe or look away in a movie when someone gets hurt. There is, however, a certain population who physically feels other people’s pain. People with this skill have pain synesthesia (3) (these people make good massage therapists by the way). So, if they see someone injure their knee, their knee starts to hurt too.
These weird relationships we have with pain can contribute to chronic pain. Your mind, consciously or not, often believes a threat exists (even when it doesn’t). Phantom limb syndrome demonstrates many of the characteristics of pain that we have discussed so far. You may have heard of this phenomenon before, but let’s review it. Phantom pain occurs when a person feels pain in a limb, even though the limb has been amputated and is no longer there. For example, a person who loses their right arm will feel pain in their right hand. In medical fields, physical therapists use mirrors so that the patient can see the reflection of the remaining limb. It looks like the amputated limb still exists. The patient then moves the remaining limb while watching the missing limb. Eventually, the pain goes away. Many energy workers work on the limb energy to get rid of the phantom pain. The important thing is, your mind decides the threat no longer exists. So the pain goes away.
My personal story
As a child, I broke my left arm three times. The last time was at school on the playground. I don’t remember whether or not a felt pain. I have a feeling I experienced some but not a lot of pain. However, I do remember viewing it more of an annoyance than a trauma. I remembering feeling like, “great, here we go again.” I didn’t cry. Afterward, I got a lot of compliments from classmates on my bravery for not crying. Later that year, I went camping after getting my ears pierced. The ear grew around the earring back, so I couldn’t take it off. We went to the emergency room they pulled the earring back out of my ear. I cried uncontrollably. The thought of someone pulling something out of me felt incredibly threatening, and so I felt a lot more pain. In conclusion, pain has to do with perceived threat tissue damage. This doesn’t mean tissue damage can’t cause pain; it just means it’s not the only answer.
(2) Beecher HK. Relationship of significance of wound to pain experienced. JAMA. 1956 Aug;161(17):1609–1613. PubMed #13345630.