Monday, 3 August 2015

What is Pain? Part One: Defining Pain

What is pain? It sounds like a simple question, but we challenge you to take a moment to try and define it before continuing to read.  

It’s difficult to do without simply using synonyms (eg. “something that hurts”). It’s also difficult to come up with a definition that includes all types of pain, from the annoying sensation of a paper cut to the overwhelming pain of childbirth, from the sudden, sharp pain of a needle to the dull, aching pain of a strained muscle. There are countless sensations and experiences that can all be described as pain. None of us has any way of truly understanding what another person is feeling when they say they have pain. Perhaps this is one of the reasons there are so many stereotypes and misconceptions about pain. We think it’s very important to define pain, for two reasons: First, for a person experiencing pain, defining it can be the first step in understanding and managing it. Second, for friends and family, a basic comprehension may enable them to be more empathetic and supportive.

We asked for your help in defining pain, and here are some of the comments we received:
  • Pain is discomfort that can occur at infinite levels of intensity (not just a scale of 1-10 like your doctor says).
  • Burning, stabbing, achy. Exhausting, draining, overwhelming.
  • Chronic pain is tiresome; it doesn't leave you alone despite all your efforts to make it go away.
  • Pain is a feeling that interrupts something you may want to do. As it intensifies, it becomes all you can think about and you become obsessed with finding ways to relieve it so you can get back to your regular life routine.
  • Pain can be dull or sharp. It can feel like a knife, like being bludgeoned with a club, or being burned anywhere and everywhere. As shallow as your skin or as deep as your bones; it can debilitate your body, distract your mind, detract you from your goals/dreams, and overwhelm your senses.
  • All of us experience pain in one form or another every day of our lives. Pain varies from the insignificant and fleeting experience of stubbing a toe to the gnawing and persistent pain of an abscessed tooth and the intolerable, totally absorbing, and endless type accompanying chronic diseases. We know the pain from a stubbed toe will pass and soon be forgotten. The toothache, too, is usually quickly remedied with penicillin or sulfur based drugs and a dental procedure. The pain of chronic diseases is the tiger let loose. It is only marginally controllable and its lifespan, completely undeterminable.
  • Pain hurts and affects everything. If I don't react how you think I should, please blame the pain, not me, or you.

You can see how there are many different ways to define pain and the impact it has on life. Each of these comments adds more clarity and a more complete understanding of the experience of pain. There are a few more definitions of pain that we’d like to share with you. These definitions seem to be very widely used and accepted. Like your comments, each of these definitions adds an essential piece to the puzzle:
  • “an unpleasant sensory and emotional experience associated with actual or potential damage” (Merskey & Bogduk 1994).
  • “pain is produced by the brain when it perceives that danger to body tissue exists and that action is required” (Moseley 2003)
  • “Pain is whatever the experiencing person says it is, existing whenever the experiencing person say it does” (McCaffrey and Beebe, 1989)

However, even with all these definitions together, there are still parts of the pain experience that remain unexplained. One reason it is so difficult to understand another person’s pain experience is because there are so many individual factors affecting it. One factor is our mood, as “pain viewed with stress, depression or anxiety is felt more strongly than pain experienced when you are hopeful, upbeat or encouraged” (Richeimer, 2014, p.16). Social factors also affect the pain experience. For example, boys may grow up believing it is unacceptable to cry in front of others (or at all). Even though boys and girls can have the same injuries, they may experience that injury differently because of the messages society has given them. Pain is also affected by previous experiences. For example, Ashley had a family member who had two herniated discs, who was is in excruciating pain and had emergency surgery. Less than 24 hours later,the nurse caring for him was astonished that he didn’t want any pain medication. She asked “Doesn’t your incision hurt?” and he responded “A little, I guess. But it just feels so good not to have the herniated discs anymore.” His experience clearly affected his perception of post-operative pain.There are many other factors at play in our bodies and environment. This graphic demonstrates some of them.

Adding to the complexity of pain is the fact that something so unpleasant is actually very much needed. Our next post will explain why and address the differences between acute and chronic pain. For now, we hope this post has brought some clarity and understanding. If you are experiencing pain, you are not alone. Pain is part of the human condition that we will all experience in some form or another throughout our lives. Understanding it is just the beginning.

A special thank you to everyone who provided their definition of pain.
Pain Experience graphic by Reclaiming Life. Brain graphic (center) from
McCaffery, M., Beebe, A., 1989. Pain : clinical manual for nursing practice. C.V. Mosby, St. Louis.

Merskey H, Bogduk N. 1994. Classification of chronic pain. IASP Press, Seattle

Moseley, G.L. 2003. A pain neuromatrix approach to patients with chronic pain. Manual Therapy, 8(3), 130-140.

Richeimer, S. (2014). Confronting Chronic Pain. Baltimore, Maryland: John Hopkins Press.

1 comment: