What is pain?

Did you know that pain is always subjective? In other words, if two people have exactly the same cause of pain, it does not mean they feel the same degree of pain. In fact, sometimes one can feel pain without a clear physical cause!

The World Health Organisation defines pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

This sentence contains a whole lot of information. If elaborated upon, it means and implies the following:

Pain is unpleasant:

Under normal circumstances one tries to avoid pain. If incurred, one would like to do something about it, like taking pain killers, seeking medical help or avoiding movements or positions that bring on pain or make it worse (e.g. limping).

Pain is a sensory experience:

When pain receptors in the body are stimulated, for instance when you touch a very hot object with your hand, the pain stimulus is transferred along the peripheral nervous system into the spinal cord and up to the brain. (The peripheral nervous system is made up of all parts of the body’s nervous system situated outside the spinal cord and brain.) This allows the body to react appropriately, e.g. the brain sends a signal back to the part of the body that is involved, in this case to withdraw the hand from the hot object.

Pain is an emotional experience:

Some people experience pain in the absence of any actual tissue damage or other clearly definable physical cause.

Backache is a very common example. Several patients seek medical help for pain they feel in their back where despite numerous investigations and tests nothing abnormal is ever found. They go from specialist to specialist, from treatment to treatment, but nobody can help and all treatments fail. They become despondent and depressed, which makes their pain worse and in the end the pain dominates their lives.

They get upset if anybody mentions that it is “all in the mind”. And indeed, it is not all in the mind. They do indeed feel back pain, but the cause is not a slipped disc or any other local problem that can be corrected by surgery, manipulation or physiotherapy. The problem may be brought on by something that affected the person emotionally, like the loss of a family member or inability to cope at work. The body physically “expresses” these feelings in the form of back pain.

Treatment must not focus on painkillers and the back alone, but also on defining and treating the original emotional problem.

Unfortunately, classical Western medicine often forgets that the human being is not just a collection of independent organs under one skin. Those organs all relate to each other, so that, for example, an emotional disturbance might not present as a classical “brain” problem such as depression or anxiety, but rather as a physical pain. It might even make an existing pain worse.

Pain can be a warning signal:

When the body has been damaged, for instance by a cut or a fracture, acute pain is experienced. Acute pain is a warning signal and lets the body know that if nothing is done, there is risk of damage, for example when a very hot object has been touched.

This allows the body to heal or prevent harmful damage. Imagine not experiencing pain after breaking a bone: you would carry on moving around happily with the broken bone, which would never heal. Also, if you didn’t feel pain when touching a very hot object, you would burn yourself. Tissue would get damaged and die off, resulting in local or generalised infection and even death!

Chronic pain, on the other hand, does not function as a warning system. In the case of chronic pain the degree of pain is no indication at all of the severity of the disease. It has been said that chronic pain’s only purpose is to make one’s life a misery!

Reviewed by Prof CL Odendal, senior specialist at the department of anaesthesiology at the University of the Free State, April 2010.

We live in a world where facts and fiction get blurred
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