The Mystery of Pain

"When I realised that the bone was being chiselled and that I was not experiencing any pain, for the moment I felt myself becoming angry, as I thought that I must have been given an injection without my knowing it."

These are the words of Australian Psychiatrist Dr. Ainslie Meares describing a difficult tooth extraction for which he had chosen self-hypnosis rather than anaesthetic to control the pain. It lends weight to the notion that the experience of pain is heavily influenced by psychological factors and in turn can be modified by psychological strategies.

Victor Rausch, a dental surgeon in the US who used hypnosis with his own patients decided to use self-hypnosis for his own major abdominal surgery (a gall bladder operation) in spite of the warnings that it involved the deepest levels of pain. At all times Rausch was fully alert, and in complete control, yet he says he felt like an observer, while he chatted with the operating team. He felt no pain, he walked back to his ward after the operation, went home five days later, and returned to work ten days after surgery.

Perhaps the most interesting thing is that Rausch insisted that he was a poor hypnotic subject by all of the usual measures, so that if the procedure worked for him, maybe it could work for many more people.

Of course we all know of situations in which people put aside their pain for a time while they get on with things. Footballers play on with injuries that would stop them in their tracks if they happened in other circumstances. Mothers will suffer dreadful burns unmindful of the pain while they pluck their children from a burning building. Soldiers fight unflinchingly at desperate times, oblivious to their injuries. So what is the relationship between physical injury and pain?

In fact there is no consistent relationship. Professionals who work in the area of rehabilitation know that equivalent injury rarely leads to the same report of pain. In fact, medical diagnostic procedures for many kinds of injuries (e.g. back problems), are often so imprecise, that the specialist has to give great weight to the subjective report of the client in assessing the case. But how can we reliably evaluate someone else’s pain?

Many things seem to affect the pain experience, and a lot of them are psychological. That is to say, things that are not related directly to the injured area often combine to make pain worse.

Here is a list of some of these factors:

* Stress. This is one of the most obvious factors. Stress can create pain, and the stress can come from the tissue damage itself, or from outside pressures. Stress can lead to increased muscle tension which might increase pressure on a damaged joint, or irritate a vulnerable nerve, or create new pain after fatigue occurs in the muscle, or it might simply increase the feeling of suffering as anxiety levels are raised.

* Self-Esteem. Low self-esteem is often associated with higher levels of pain. The loss of normal family roles through injury is very threatening to self esteem. Management strategies that focus on the improvement of self esteem often lead as well to a reduction in pain.

* Losing our normal range of interests. People who are injured are often unable to do the same things they could do before. Because of this restriction they have more time to think about themselves and their problem. They have less to distract them, to take their minds off themselves. Thus they have more time to think about the pain.

* Reducing physical activity. Because movement leads to pain, people often restrict their activities greatly. It is hard to do otherwise. But one of the consequences of this is muscle wastage, and even loss of bone mass. The body that is so weakened becomes less capable of sustaining normal movement, and of avoiding the pain.

What kinds of things can people do about their pain? The answer is it depends on the rate and stage of tissue recovery that is evident, on the kind of support that is available(both social and environmental), and on the capacities that the individual brings to the situation. Current research with chronic pain suggests a number of strategies for pain management programs.

* Firstly it seems to be of crucial importance to build up activity levels once again. This may mean substituting new activities for old ones. Wilbert Fordyce, former Editor of the Journal "Pain", claims that it is generally bad advice to say "let pain be your guide". Healing is promoted by use and interfered with by too much rest. In general those people who push themselves hardest (though following the cautions that their doctors require) recover most quickly. Many people keep their pain too long through not being prepared to thoroughly explore the available options for physical activity.

* Secondly learn how to achieve the altered state of mind that goes along with deep relaxation or self-hypnosis. This can lead to the direct control of pain - about 10% of people can learn total pain control this way, and another 70% to 80% get substantial relief - and it helps to eliminate the stress symptoms that pain produces. For many the stress symptoms are nearly as uncomfortable as the pain itself.

* Thirdly, develop distraction techniques. These include the use of images of beautiful places and happy times (during relaxation especially), the use of activities like walking in pleasant surroundings, or finding absorbing hobbies or interests. For one man I met, the breakthrough for him was the purchase of a home computer which was endlessly fascinating for him. For another it was the recollection during relaxation of both the happy and sad times of his youth. Another person described to me how her desperation gave way to hope when she committed herself to sewing hundreds of items for children's uniforms. She became so involved that for the first time in months she forgot the pain for a while.

* Fourthly, deliberately arrange things so that your family and friends notice your improvements. Make sure they encourage you for any gains you make. The reward of this attention can help to encourage you further.

All this is easier said that done, especially for people injured at work or in motor vehicle accidents especially where getting compensation depends on having injuries. Such systems make it virtually impossible for people to follow the kind of recommendations that I have made, largely because they have to prove that they are sick. I don’t mean they deliberately stay in pain. Pain is much more mysterious than that.

Injured people often face dreadful financial hardship made worse by the quite unreasonable time it takes to settle such matters. The stress of this, the damage to self esteem, the inhibition for activity, the punishment for improvement are obvious. I hope for a better systems in the future. Ones that will recognise how chronic pain develops and that will allow injured insurance cases the same opportunities for recovery as other members of the community.

More readings will be added to my blog from time to time. Have a quick look now to see the first posting on my blog PSYC1PLUS