Pain and the Mind

I recall a teaching story I learned about patient care. It describes how long ago an older Chinese physician was called to a rural home to help a woman who had been in extended labor, unable to deliver her baby. As the doctor and his assistant approached the home, the doctor could hear his patient crying in pain during the labor process. Before entering, he asked the apprentice to grab a few leaves from the tree by the front door and boil them to give to the birthing woman. The doctor came to his patient, comforting her that she will soon drink some tea that will help her. The assistant came and gave the woman the medicine. Soon after drinking this, she was able to deliver her baby successfully. As they left, the apprentice asked the physician what the leaves that he had picked were. The doctor said that the leaves were nothing specific or particularly medicinal. He explained that he could hear the woman’s fear and knew that it was part of delaying her labor. He realized that just his presence would be comforting to her and help his patient relax to allow labor to proceed.

Thoughts and Emotions Influence Pain

I understood this old story to mean that our thoughts and emotions play a part in our physical processes. This would include the experience of pain and disease, even birthing. Another related thought to consider that comes to mind is the difference between disease and illness. You may understand disease as a disorder of the normal functioning of the body resulting in certain symptoms. While illness would be more descriptive of how a particular individual experiences the disease. Various factors, including their thoughts and emotions about the disease, their culture and socioeconomic class, their religion or spirituality, may all influence what the illness is like.

There was a recent New York Times article about pain and the mind/brain that caught my attention and reminded me of this old story in Chinese medicine. In that article, it describes how the feeling of pain is happening because of how our brain interprets the input from our senses, not solely because of the input itself. Meaning, it’s not just about the pin pricking your finger, it’s about how your particular brain interprets this input. There was an example of a builder who accidentally jumped on a six inch nail that went completely through his boot. His severe pain could only be managed by strong medication at the hospital. When they removed his boot, they found that the nail had gone between his toes, missing his foot completely and not injuring his body at all. His mind’s expectation of pain was so strong from what he thought and saw that his brain told him he was experiencing severe pain. This is an extreme example not meant to say pain is not real, but to show obviously how the brain can interpret pain.

Relaxation and Security Can Reduce Pain

Studies show that being more relaxed and feeling safe can influence the experience of pain from the brain. Like talking to another person, pain can be understood as a conversation between the brain and the body. Nerve endings chemically change in this process. And the longer pain persists, the more sensitive the nervous system becomes. It may be very responsive to the next potentially painful input. Our system can adapt to the pain and perceive it as the new normal which makes it challenging to change.

The commonly accepted definition of pain comes from the International Association for the Study of Pain: “Pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms.” I keep this in mind when I treat my patients each day. Their pain, or really any symptom, is not just a physical but also an emotional experience. Creating a safe, relaxed environment is an influencing part of the treatment and its effect. Deep breathing, meditation, art and music therapy, cognitive behavioral therapy, massage, and acupuncture can all play a helpful part in managing pain.

Future Pain Research Funded

The National Institutes of Health are making the largest yearly investment they ever have in order to address a single problem. They are spending almost a billion dollars to research ways of less addictive pain relief than is commonly being employed. This includes acupuncture, music therapy and other ways to manage pain. This writer is very happy to be reading such articles in the New York Times as science is recognizing a more holistic perspective to part of our individual daily suffering. It seems to me that we may be missing some important pieces in pain management and will be learning more with time.