Pain: Contextualizing Our Universal Experience

We cannot control what we don’t understand. This is especially true when it comes to dealing with pain. Pain is one of the common universal experiences we all share as human beings. What is less common though, is our individual experiences of pain and how they can be vastly different than someone else’s.

One person can become so fearful that they try amicably to avoid pain altogether. Another person can be negligent and abuse their body in an effort to not be stopped or held back by it. These extremes color two ends of the spectrum of pain. What is common among these extremes is that our experience of pain can be disempowering when we don’t understand it. In either case, overcoming it is a process of self-empowerment through gaining a better understanding of what pain is and our relationship towards it.

As a doctor, the role I play in this process starts with sharing knowledge, because it is the precursor to adapting our behavior. If our awareness and our tools remain the same, we are likely to continue to try and solve the problem the same way. This is why having a deeper understanding of pain is important to overcoming it. Pain itself is not something to fear or ignore. By doing so, we effectively mute a healthy biological function of our bodies. At its fundamental level, pain is our body’s alarm system. It is something that we feel to warn us of a potential threat. The actions that follow are directed at protecting us and bringing us to a place of safety or survival. Think of placing your hand on a hot stove—the intense pain from the heat causes us to pull our hand away in an effort to not suffer a more significant burn.

Its role in our body is a product of evolution, and it is often influenced by more factors beyond just what we feel physically. This is best understood through George Engel’s Biopsychosocial model. Its premise states that our experiences of things like pain are largely influenced by our mentality, our social settings, our emotional states, our memories and past experiences. Much like a certain smell can trigger a thought or memory of something from our childhood, these non-biological (or physical) cues have the power to trigger things like pain.

This is especially important to understand because we often think that pain is always harmful. Most of the time, this simply isn’t the case. Dr. Lorimer Moseley, one of the leading researchers on pain science, highlights this in his research of those who experience Phantom Limb Pain. This is a phenomenon where people who have had amputations and no longer physically have a part of their body (like a leg or their arm for example), still experience pain as if it were intact. Not only did these individuals who were physically without a part of their body experience pain in something that wasn’t there, often times they were also triggered from intense emotions brought on by things like a memory or place. These cues were so powerful that they signalled the brain’s alarm system to trigger a feeling of pain in something that was not there.

Cover of Dr. Moseley’s book, “Explain Pain”.

If hurt doesn’t always equal harm, how do we come to understand what is okay to push through? And when pain does equal harm, how will I know that I should stop doing what I am doing?

When we don’t realize the amount of things coloring our experience of pain, it can be easy to view the experience as binary—we’re either in pain or we aren’t. When we hold this narrow mentality to how we view pain, we are often left with 2 extremes of trying to deal with it. We either avoid it or ignore it completely, or some combination of the two. But dealing with it in either way isn’t useful if we want to empower ourselves through the process of healing. Therefore, rather than viewing pain as a binary experience, view it as a spectrum. The one I use most often with my patients is the analogy of a traffic light, paired with a number rating from 0-10 (where 10/10 is the most extreme pain we’ve ever experienced).

What do the lights mean?

Green Light (0-3/10) – GO. Feelings of pain or discomfort at this end of the spectrum should not inhibit us from continuing on.

Yellow Light (4-7/10) – CONTINUE, but be more mindful. In traffic, a yellow light is not an indication to stop, but means that you need to be more cautious passing through. It is also an indication that we should also be ready to stop as the light comes closer to turning red.

Red Light (7-10) – STOP. This is when hurt can be harmful. Stop what you’re doing or find another way to accomplish the task where you aren’t at this end of the spectrum.

What I hope this analogy gives you and my patients, is a lens. A lens that we can more accurately use to interpret what our body is communicating to us. But also a lens to more effectively shape how we respond to what our body is communicating to us. Without an understanding of how to be more flexible and adaptable to what we’re experiencing, it’s inevitable that we rely on the extremes to shape how we respond to pain. This is because relying on these extreme narratives of what may be happening is fast, takes no energy to act on and is deeply ingrained to how we function as humans (thank your amygdala). They are protective mechanism that are regulated subconsciously. However, that does not mean they are optimal. Again, we are looking for self-empowerment through this healing process of dealing with pain. Self-empowerment takes effort—not only to learn but also to act, in a way that’s different to how we’ve reacted in the past so that we can achieve a different result.

“Between stimulus and response, is choice.”

— Victor Frankl

When it comes to healing, like recovering from an Achilles rupture for example, avoiding pain all together is not useful because it will make us fearful of loading the injured area at all. That doesn’t bridge the gap from us having an injury to returning to how we lived life prior. But neglecting pain and trying to push through when we may be red lighting the area is not useful either, because it can lead to a potential re-tear, prolonging healing. Like a bell curve, most of the adaptation and self-empowerment happens somewhere in the middle of that spectrum of pain.

So what does this now mean for our habits around pain?

As our understanding of pain increases and we become proficient in more accurately interpreting what our experience may mean, we end up in a place where we can adjust our habits towards pain more favourably. In his book, “The Power of Habit”, Charles Duhigg explains that habits are a 3-step process that happen in order every time. We have our cue/ trigger, that is followed by our reaction/response, which gives us our reward. When our pain is triggered, if we avoid or neglect pain altogether, the reward that occurs at the end of that habit loop is often a false sense of safety or empowerment. We may feel safe by avoiding pain or empowered because we didn’t let pain stop us. But it is a false sense of reward and empowerment because they may only be true for a moment. However, they don’t make the process of healing very productive for a lifetime. But by having a better understanding of pain, we can more accurately interpret our triggers, so we can more effectively act at the reaction/response level of that habit loop, to ultimately bring us to a place of actual self-empowerment throughout that process of healing. This is more favorable because it promotes autonomy and focuses on things we can control, rather than reacting to things we can’t.

So whether you’re getting over a recent injury or you’ve been dealing with chronic pain, know that you can empower yourself throughout that healing process. It starts with understanding what pain is and what may be contributing to it, but also by having a flexible mentality to dealing with it. By doing so, we can more effectively adapt our habits around pain, rather than being oppressed or frustrated by it.

— Dr. Don Rey Juan