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The experience of pain

A good friend recently asked my opinion on an article on a Christian response to pain. This and the next four blog posts have come from my reflections as I read the article. The others are on Pain in our Culture, Hard-heartedness, Suffering and Character, and The Redemption of Pain.

The experience of pain

Pain itself can be an intensely isolating experience; there is no reference point for pain outside of one’s self, which makes it difficult to know whether a person – including one’s self – is being ‘pathetic’ or is being excessively stoic. This can lead to internal battles in which one struggles to cope with pain at the same time as castigating one’s self for being pathetic. And no-one can see the pain, making it difficult for them to remember that you’re still experiencing it.

Chronic pain is isolating, because we cannot compare it with how other people experience pain. For acute (temporary) pain there may be similarity, such that we can talk about how much a bee-sting hurts, or the pain of a shallow cut or pinched skin. But chronic pain changes the response to acute pain. The same stimulus in someone with chronic pain can cause more pain than it would normally be expected to do, and the result is that chronic pain sufferers can’t even say ‘it hurts as much as pinched skin’ because our experience of pinched skin may score as a 5 or 6 out of 10, rather than a 3 or 4.

In terms of the physical model of pain, it helps to understand that the brain picks up huge amounts of sensory information all the time, but the vast majority is not brought to our conscious awareness. Think about how it felt the first time you wore a watch – at first it felt strange and you were constantly aware of it, but over time whilst the physical presence and pressure of the watch remained the conscious awareness of it stopped. Our brain only brings important things to our awareness, and not things that are mundane or routine. Out of a multitude of sensory information, much of it very similar, it can pick out and bring to our attention the things that are likely to be important – like the sound of our name spoken in a room of chattering people. The room is full of sound waves from multiple conversations, yet without even intending to we pick up on the specific sound waves that correspond with the sound of our name.

In contrast, moderate or severe pain, unlike other physical stimuli, doesn’t stop being brought to our attention. Instead, the brain brings our attention to pain more and more, making the experience of pain more intense. The brain is panicking; it wants us to take action to relieve the pain, and when we don’t – because we can’t – it shouts all the louder. It can reach a point where, in conditions like fibromyalgia, the brain is so hyper vigilant to the painful area that it interprets any physical sensation, like pressure or temperature, as pain. It thinks any stimulus from that area must be pain, just as a blow to the eye can be registered as light because that’s what the brain expects to receive from the eye.

The emotional connection is separate. We can feel pain, and not find it emotionally distressing. Children find pain more distressing than adults. And the strongest painkillers – the opioids – don’t so much reduce pain as stop the emotional distress. Endorphins also reduce the emotional connection to pain; whereas distress can increase both the perception of pain and, more prosaically, the causes of pain – such as tense muscles. There is, therefore, a connection between emotions and pain, as Emlet describes.

Personally, I’m wary of linking pain and emotions, perhaps because it doesn’t seem to act that way for me. Certainly my pain is worse when I am stressed, but it’s not the pain that I’m stressed about. Usually it’s benefit claims and appeals that make me stressed, or a particularly bad social policy that the government intends to enact. At those times my pain does tend to get worse, but it’s part of a suite of symptoms all of which have got worse. In contrast, endorphins – whether induced by exercise or social activity – have never noticeably influenced my pain. Instead, the effort entailed by the activity itself usually causes my pain to worsen. On the other hand, the stronger opioid painkillers are effective.

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