I’ve had this thought bouncing around in my head for a while and thought I’d share. I talked about it with my wife already, and admittedly it is a little bit trippy. Stick with me though, because you could use this to start an interesting conversation sometime soon. Or just skip down about four paragraphs to see what I’m getting at. 

What’s the worst pain you have ever experienced? Some readers may have some horrific trauma, like a car accident, perhaps, that left them with multiple physical injuries that were extremely painful. Maybe a compound fracture of long bone, where part of the bone was even coming through the skin? It could be a burn or series of burns, which are incredibly painful. Whatever it is, think back to what it felt like. How would you describe it? Pain is often described with words like sharp, dull, burning, throbbing, pulsing, or heavy. Pain is also the reason most patients show up in a doctor’s office to have something examined.

But pain is really strange. Years ago pain was thought to be a strictly physical phenomenon. For example, if I were to drop a heavy piece of furniture on my foot, it would cause damage to the cells in my foot, which would then send signals to my brain saying “The foot says it is hurt”, and I would then perceive pain in my foot. This misses out on several key components of pain, however. People perceive pain differently, and some are better able to handle it. Even the way we are trained to ask about pain is subjective. If you’ve been asked to rate, on a scale of 1-10, how bad you pain is, that puts me in a tough spot to evaluate. Consider a professional athlete or manual laborer, used to dealing with pain and its symptoms, who tells me this pain is a 9/10. That’s much different than hearing the same thing from a 16 year old who plays video games all night. 

This is where it gets really weird. It might not even matter, as pain is subjective anyway. It doesn’t matter if there is a physical basis for the pain, some people have chronic unexplained pain. Veterans with amputations frequently experience “phantom pain” in the limbs that they lost. Stress can cause headaches that hurt extremely badly. People can experience chronic back pain with or without bulging discs and other physical problems. Treating pain in these patients is confusing. Is pain a symptom, or the problem? Or both? 

I had to put a picture in here somewhere. Get it? UnBEARable? Sorry.

This brings me to the final point I wanted to make here, one that might make you think a little bit harder (or not) tonight. We don’t truly ever experience the world around us. Our body, instead, carefully remains separated from it as much as possible. Consider your skin as one giant shield to keep out everything. The rest of your body is generally sealed off from the exterior, except for one hollow reservoir which cycles air and another hollow tube the runs from mouth to anus. Everything else on the inside is kept at stable, comfortable conditions, similar to climate controlling a building. So our cells exist in this cozy, carefully maintained interior of our body, happy and warm. Everything we sense is then just a relay from nerves to brain, letting us know what’s going on outside of our climate controlled self. When the temperature drops outside and we begin getting cold, we sense that and have mechanisms to deal with it (shivering, moving around, or putting on a coat). 

What if it isn’t cold outside? Is it possible for that sensation to be activated while it’s a nice balmy day? Can the pain pathway I mentioned earlier be started without having furniture dropped on it? If so, it may not matter whether or not it happened, because MY FOOT HURTS. That’s why treating pain must be incredibly tricky, and that’s why pain is weird. 


2 thoughts on “Unbearable

  1. elequestrienne

    What a great, uncluttered way to explain that we all experience out own version of pain. I’m hoping to specialize in PM&R and have suffered from chronic pain for 6+ years, so I appreciate this rare perspective!

  2. Pingback: Amazing Reasons You Stay Alive | Basically Useless - A Med School Blog

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