Pain part 1: When the pain doesn't leave

January 19 2017

”Pain is just weakness leaving your body”. Ever heard that statement? It’s a compelling slogan that the US Marine Corps use in their recruitment ads. It may be an effective recruiting tool, but is it true?   

For me it raises two essential questions; Is there just one type of pain and if so, is pain really only weakness? Pain would basically be a lack of strength and if you were strong enough, you wouldn't feel any pain.

For those of us living with constant or long term pain, we know it may be a catchy slogan but it has nothing to do with chronic pain. It may hold some truth in reference to training and trying to get fit and stronger. But chronic pain is a totally different ball game.

Definition of pain

The International Association for the Study of Pain (IASP) have defined pain as:

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Everyone who has had the experience of landing a hammer on the finger knows it's indeed an unpleasant experience. All of us are familiar with pain in one or several aspects. But the definition of pain does not only mention the physical, it also involves the emotional experience.

Emotional aspects of pain

Far too little effort is spent on understanding the emotional component and ramifications for those of us living with chronic pain. This aspect is very important when we approach the coping strategies (covered in part 2 of this blog article).

Pain is one of the very best defensive systems we have. Without that system none of us would be alive today. We wouldn't react in time if we laid a hand on a hot stove, resulting in tissue damage, or if we step on a nail and get an infection.

When the signals traveling through our body are felt for no obvious reason, without any clear and present danger, this presents an issue. The signals become a negative part of our lives, which we try to avoid or escape.

Your mind

Another quote regarding pain is ”it's only in his/her head”, as if it's only something we are imagining. It's a cruel thing to say as it’s not something people make up – but at the very same time it’s true. We can only ”feel” pain in our brains. Dr Paul Brand puts it this way:

Pain does not exist until you feel it, and you feel it in your mind.

The nerves in the body send signals to the brain, but it’s up to the brain to interpret these signals. The brain itself is incapable of either feeling any pain or objectively checking if the signals are correct. The brain has to trust the signals coming from our nervous system and make the best interpretation of the information it receives.

Neuropathic pain

In my case, living with neurological damage that causes neuropathic pain, my nervous system sends corrupt signals to my brain. The brain interprets the signals based on almost 50 years of experience and then tells me that I'm in pain. The irony is that the pain is most severe in an area where I actually have almost no sensation at all.

A lot of the medication that we use for easing pain aims to stop or slow down the signals. If we succeed in slowing down the signals, the pain will be easier to cope with.

Pain seldom comes alone

Pain often has associated knock-on effects. With pain comes fear, anxiety, lack of sleep, irritation, less social contact, less training and gaining of weight. All these things add to the total experience of pain, the pain experience.

At some point we might realize that we cannot do anything more about the pain itself, but it may be possible to get rid of these associated effects. If we are successful, our pain experience may change, a change in our perception and attitude to pain. In my case, my pain is not harming my body – it's not a report of tissue damage. If I can learn to accept that the pain doesn't signal ”danger”, then I will not fear the pain and that will help me facing pain with a different mindset. Read more about that in part 2!

For an inspirational lecture about chronic pain, watch the TED talk with Elliot KranePediatric anesthesiologist at Stanford. 

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Topics: Spinal Cord Injury (SCI), Pain management