Pain
I am passing through Kuta, Bali on my way to Saigon, Vietnam. I’m on another holiday jaunt. I’m having a back massage. My back is always much better after a massage. Something seems to free up with a massage. I get fewer aches when sitting at this computer. The masseuse is a big strong girl. She is quite strong with her application of her elbows when separating the bones of the backbone and elsewhere. She gives a ‘chuffaw’ in amusement at my audible groan as her elbow goes into my back. Does she get some enjoyment out of my apparent suffering? Perhaps it is just professional amusement as she is aware of the benefits of her elbow in the joins of my backbone. She certainly has an understanding of the workings of the body with its bones and muscles and their interaction. You have likely worked out that I am facing downwards. What surprises me is that the muscles of my face are working overtime each time she buries the elbow into my back. My face is quite contorted and the movements are completely in response to the pain inflicted by her elbow. I am facing down so the facial contortions are not done for anybody to notice. I have nobody to whom I am trying send a distress message of pain. I reason that the facial contortions are entirely unnecessary. I decide to cease contorting my face. What is strange is that the pain becomes much more difficult to tolerate. Not only is the facial muscle movement useful to let others know of my pain but it enables me to live through the pain without taking evasive action. One of my pain expressions is below. It was taken after I had been pepper sprayed by the French Gendarmes who were not agents of peace but acting as government thugs.
In July 2020, The International Association for the Study of Pain revised their definition of Pain. Their definition reads:
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,”
The association expanded the definition with the addition of six notes.
- Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
- Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
- Through their life experiences, individuals learn the concept of pain.
- A person’s report of an experience as pain should be respected.
- Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
- Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
Often the cause of pain is obvious, a broken leg, or a bruise. But there are times when the source of pain is unseen, for example a slipped disc. Occasionally it is very difficult to find the exact cause of a person’s pain. [1]
Health professionals use different terms for different types of pain. [1]
Short-term pain is called Acute Pain. An example is a sprained ankle.
Long-term is called Persistent or Chronic Pain. Back trouble or arthritis are examples.
Pain that comes and goes is called Recurrent or Intermittent Pain. A tooth ache could be one.
The only way of knowing if a person has pain is if they tell you – as pain is a subjective and personal experience.
Pain is a symptom, but many are calling for some chronic pain presentations to be called a disease.
The Global Burden of Disease Study 2016 found pain and pain-related diseases, particularly low back pain and migraine, are the leading causes of disability and disease globally.
Pain is a serious issue for some people. Here is a the first paragraph of an article:
I’ve lived with chronic pain for nine years now—and counting. Every second of every minute of every hour of every day of every week of every month of every year, I’ve been in excruciating pain—the kind of pain that only a select group of people understand. No matter what I do, or not do, the pain is with me. Even at 4:00 a.m. while I am sleeping, a part of my mind is aware of the pain coursing through my joints, muscles, spine, and brain.
Pain can have the positive function of telling us to avoid using a damaged limb or it can be the ultimate evil. We have pain for a good reason. When we have damaged the tissues of our body, we need a messaging system to force us not to use a damage limb until it has healed. We inherited this from our ancestors – the reptiles. We can assume that the reptile has the same pain system. The reptile has no neocortex. It does not ‘think’ for itself. It operates on instinct alone. This is very useful for us as we would continue to use a damaged component if there was no pain, just as we drive the car with a fault light on the dash or worn tyres. Our pain is not a ‘logical’ construction but comes from the subconscious reptile brain. When I broke my rib a few years ago, I felt little pain initially. I crawled away out of the path of oncoming motorcycles. I was attended by an ambulance. I got back on the motorcycle and rode the next race although I did need some assistance to zipper the zip on my race leathers. Later that evening, I was in severe pain when ever I moved. I could breath lightly but any large movement of the body was massively painful at the pint of the broken or cracked rib. It took many weeks for the healing and for the pain to subside. My ‘fight or flight’ response allowed me to move with little pain following the incident. Pain only grew subsequently. One can reason that the pain is not generated from the broken rib directly or the pain would have been consistently painful from the moment of impact. I must assume that the pain is generated in the reptile brain to prevent usage of the damaged area of the body. Here is a very interesting video by Lorimer Moseley called: “Why Things Hurt”. Lorimer Moseley claims pain is an illusion: “The pain is an output of the brain designed to protect you. It is not something that comes from the tissues of your body.” And: ” ….. pain is a construct of the brain.” “We can mess with pain really easily without touching the tissues.”
Here is an explanation of the ‘fight or flight’ situation from psychologytools.com.
Description
The fight or flight reaction is associated with activation of the sympathetic nervous system. The chain reaction brought about by the fight or flight response can result in the following physical effects:
- Heart: Increased heart rate; Dilation of coronary blood vessels; Increase in blood flow Increased availability of oxygen and energy to the heart.
- Circulation: Dilation of blood vessels serving muscles; Constriction of blood vessels serving digestion; Increased availability of oxygen to skeletal muscles; Blood shunted to skeletal muscles and brain.
- Lungs: Dilation of bronchi; Increased respiration rate; Increased availability of oxygen in blood.
- Liver: Increased conversion of glycogen to glucose; Increased availability of glucose in skeletal muscle and brain cells.
- Skin: Skin becomes pale or flushed as blood flow is reduced; Increased blood flow to muscles and away from non-essential parts of the body such as the periphery.
- Eyes: Dilation of the pupils; Allows in more light so that visual acuity is improved to scan nearby surroundings.
In addition to physiological reactions there is also a psychological component to fight or flight response. Automatic reactions include a quickening of thought and an attentional focus on salient targets such as the source of the threat and potential avenues for escape.
A more modern understanding of the fight or flight response is reflected in the work of Schauer & Elbert (2010). Their more elaborated model of physiological / psychological / behavioral responses to threat is termed the ‘defense cascade’. They describe a series of stages which individuals exposed to threat or trauma may go through, including: freeze, flight, fight, fright, flag, and faint. [2]
Because of the nature of pain, other people cannot see it. That hard for the sufferer as other think you look fine. There are no external tell-tales. Those around the suffering individual don’t see the issue and neither do they appreciate the issue. No one can see it whilst the individual is dealing with it inside. The pain and it consumes all their energy to fight it.
[1] British Pain Society. https://www.britishpainsociety.org/about/what-is-pain/