On Pain and Suffering
Pain is a fact of life.
Can there be pain without suffering? The image shows a child in tears and unhappy. This is a classic pained look and unhappy face. Photo by Arwan Sutanto at Unsplash.
I teach mindbody arts (Qigong, Tai Chi, Yoga, and Sound Healing) at two pain centers as part of the functional restoration programs, which are basically rehabilitative programs for people suffering from chronic pain conditions who want to get back to work. Pain is a mindbody experience as defined by the International Association for the Study of Pain : “Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” In the definition, the unpleasant bodily sensory experience is simultaneously engaged with the mind through the emotions. By definition, it is impossible to experience pain without both the physical and emotional/mental components. If you take the emotional suffering out of the equation, pain becomes pure sensation. The mindbody arts can help people create that little space between the mind and the physical experience of pain so that people can function and restore their lives and health.
There are many kinds of pain. I count at least seven kinds in the people I work with: neuropathic, gastrointestinal, musculo-skeletal, migraine, face pain, complex regional pain syndrome, and phantom pain. Pain psychologist, Dr. Beth Darnall, of Stanford University says that you don’t even need a body to feel pain, as is the case with phantom pain or pain that persists even after a limb has been amputated. Pain can be felt and perceived in a limb that is not there, because the experience of pain occurs through the nervous system, spinal cord, and brain—the neurological communication system in the body that talks to all other bodily systems. On the human level, the seven different kinds of pain in the list have one thing in common, which is the experience of suffering. But it is also important to remember that not everyone in pain actually suffers. While he was alive, the famous Yogi Ramana Maharshi had cancer that caused pain so severe, he would cry out. His students were surprised that he would cry out like that. Students expected that their guru would somehow transcend pain and presumably not feel it or at least not complain by yelling out like that. But when his students asked him about it, about being in pain and transcending pain, Ramana Maharshi, said yes, he is in pain, and it hurts, but there is no suffering. Ramana Maharshi had a loving and compassionate attitude toward his suffering body and for others who came to visit him and felt the shock of seeing him so weak and in pain.
This story of pain without suffering really is a puzzle. How is that even possible? I believe this story speaks to the heart of the matter of a pain experience either our own or that of someone in our care. How can we help people suffer less when they experience pain, especially pain that seems to last a long time (6+ months), which is defined as chronic pain?
The pain centers where I work use a methodology of treatment called the biopsychosocial model of care. This means treating the whole person. It is important to realize that pain tends to turn life upside down. A pain situation is hard to be in, and I do not wish it on anyone. However, pain is a fact of life and existence, and somehow it is part of how we are built and even part of survival on planet Earth.
Why is there pain?
It is helpful to do a thought experiment to understand the value of pain as an experience: imagine what life would be like without pain. There is actually a small portion of the population that experiences a life without pain due to patterns in DNA, and these people tend to sustain injuries to eyes, skin, joints, and muscles repeatedly. Many do not make it to adulthood. Other people may have a reduced experience of pain due to nerve damage or drug use. People who do not feel pain do not feel the cold, and so are susceptible to frostbite when the temperature drops. They do not feel the heat of a hot stove in time to avoid a burn when they touch the hot surface. This is to say that pain serves to protect a person from potential harm or further injury. Pain also helps a person recognize the presence of an injury, so they can get help or treatment, which then becomes a signal to others. In this way, pain seems to be a “check engine light” signal that indicates that some kind of course correction or change is needed. Experiencing the signal is a moment of recognition that can feel terrible, and lead to suffering. However, understanding what is happening and managing the moment can help reduce the suffering.
The suffering
The suffering is the chaos that results from the pain experience. The image of life turning upside down is appropriate. When pain comes, it appears that things do not make sense, and a person’s actions can be limited by pain leading to a feeling of not being able to just live life and exist. So, in the biopsychosocial model of pain, there is a concept that pain affects the whole person. Below are brief descriptions of how life areas can be affected by pain that seems to take over a person’s life:
Behavior. There are pain behaviors that will be adopted when a person deals with pain for extended periods. Here are some examples: Stopping certain activities you used to do, because you don’t have the stamina, strength or interest. Guarding or tensing or protecting, not moving, hiding, wincing, holding or massaging the areas that are painful. Or doing things like taking a nickname (“Roman” – like Roman ruins) or buying creams and ointments, braces and supports that innocently prepares you for when the pain comes or when it gets worse. Sometimes the pain comes and goes in a hard-to-detect pattern that can be very stressful, and so activities like stress-eating to feel better can also happen.
Emotions. The emotions will be involved. Pain interrupts life, and so it can be frustrating to do anything and being at a loss for expressing needs and concerns is common. There can be impatience and anger with the situation. The pain experience is stressful and exhausting and can lead to anxiety about things getting worse or the ongoing discouragement can become depression, all of which affect energy levels.
Psycho-social and cultural factors. Having pain and expressing pain is totally influenced by what you learned about pain where and when you grew up. For some people being in pain is not supposed to happen at all, or being in pain is a sign that you or someone around you did something wrong. Also, your doctors and health care providers will have ideas about pain that can influence you. People in pain may also isolate themselves or have trouble socially, because they don’t have people to talk to about their situation or other people don’t understand what they go through on a daily basis.
Cognition/Thinking. Pain can influence thinking and decisions, beliefs, attitudes, intentions, and motivations. Pain thoughts can take over, and sometimes those pain thoughts can lead to unhelpful patterns like rumination, helplessness, and expecting and dreading things may get worse. These thought patterns can affect not only your capacity for problem-solving, but when left unchecked these “automatic thoughts” can also negatively affect the response to treatment like surgery, therapy, or medication. It is important to remember that this can happen very innocently and without a person realizing over time. As Larry Dossey, MD, says “Thought can become biology.”
Spiritual. The spirit is definitely involved in the sense of entertaining the big questions of human existence that include understanding our will to live, having a sense of our place in the world, our relationship to a Higher Power and organized religion, the nature of the mind and consciousness, our family history and origins, and our very purpose and destiny on earth. These are all matters of spirit that pain can awaken. For example, there can be a feeling of injustice or punishment that may feel like reckoning with an angry God. There can also be feelings of victimization and disempowerment as people wonder why pain is happening. Having compassion for our own suffering comes from understanding what the pain is animating on many levels.
The Spirit and Pain
Psychologist, Dr. Kimeron Harding, is the director of one of the pain centers where I teach classes, and he is also the co-author of a beautiful book called, The Chronic Pain Control Workbook. Over the years, he has observed many people who tend to resolve their pain and get back to work, back to life. I interviewed him about this, and he shared his observation that the people who resolve their pain situation and get back to work are the ones who have discovered the meaning of their pain. Think of it. If pain can affect life on so many levels noted above, pain can mean many things to the person in pain. Somehow, if you find the meaning of the pain, you know how to be with it, you know what to do, and you know how to respond to it. For the people at the pain centers, this journey to find meaning can take time, a lot of practice in doing things differently and constantly finding solutions that work for the circumstances.
Curiosity about What Pain Means
The important thing is tapping into a sense of curiosity about what things mean. I invite the patients in my classes at the pain centers to be curious about what is going on in their experience. This can be challenging, because a useful strategy of a lot of people who experience pain on a regular basis is distraction through food, work, or entertainment and just not thinking about the body or pain or the situation. Distraction works—up to a point. Obsessing about the situation is another option, but that is not the same as curiosity. True curiosity is educating yourself about your body and how it works. This translates to pattern identification, which takes time. Knowledge is power, and learning mindbody practice can help with sharpening your powers of focus and observation which helps in pattern identification and stress management.
I like to remind patients and students that curiosity is a result of relaxation, so relaxation is a great skill for people in pain. Through the curiosity about experience, compassion arises, and from compassion the meaning of the pain experience is revealed. Life changes and the pain changes as a result.