Mrs. R was teaching me much more than she knew, and certainly much more than I realized at the time. Though the physical aspects of her hurting proved to have been caused by the gradual collapse of two severely osteoporotic vertebrae, its reverberations could be felt all over her body and within her spirit too. As long as humans have kept records, they have reflected the awareness that there is far more to pain than mere discomfort at the site of injury or disease. To the Babylonians and to the most modern of neuroscientists alike, the evaluation and treatment of pain have been understood to require methods that deal not only with the origin of the noxious stimulus, but with emotions as well. Nowadays, the International Association for the Study of Pain defines the subject of its research as “an unpleasant sensory and emotional experience associated with either actual or potential tissue damage,” but Plato’s description was not much different: he said that pain is physical while also an experience in the soul. Thus, both ancient and modern sources leave wide latitude not only for understanding the complex origins of pain but for seeking clues to help deal with them.
Still, even such generalized words as “physical” and “emotional” encompass far more than merely the site of origin, the neurological pathway to conscious awareness and the psychological accompaniments. Pain when sufficiently severe is capable of setting off a cascade of biochemical actions that affect hormone and enzyme production, circulation, voluntary and involuntary muscle, and reactive tissues in numerous organs of the body. The unpleasant consequences of all these responses are multiple and additive, whether they are expressed as directly as Mrs. R’s hurting all over or in more literary terms as in Cervantes’s, “When the head aches, all members partake of the pains.”
Not only that, but pain’s accompaniments and effects vary from individual to individual, for a combination of reasons that are only partially organic. When we invoke a word like “psychological,” we include in its components an entire set of cognitive factors that are different for each person, including past experiences, cultural influences and the setting in which the stimulus occurs. Even if a jolt of pain were a purely physical phenomenon, it would have a specific meaning to the individual who feels it, and would accordingly be interpreted in ways that increase or decrease its many effects. Pain consciously perceived as a signal of impending death–such as angina–results in a far more profound outburst of the body’s and mind’s responses than pain thought to be caused by an acutely overfull stomach, which is likely to be perceived calmly, resulting merely in the urge to belch.
It is for reasons such as these that the specific pain experienced by any given person is so difficult to evaluate. Pain is notoriously resistant to efforts aimed at objectively measuring it, largely because its degree and its consequences are so individualistic. Both doctors and patients use subjective language when describing it. And it is also for such reasons that anyone’s response to attempts to treat his or her pain is so variable. The reassurance of a placebo, for example, may be very effective in one person and useless in another. Further, every experienced physician can tell tales of varying responses to pain in different ethnic groups, and varying responses to treatment. Does this mean that some are truly based only on emotional factors or does it mean that the physiological consequences are greater or lesser depending on the cultural or personal meaning of the pain? Or are some groups genetically predisposed to feel more?
Complexity after complexity after complexity. And that very complexity is the challenge that so fascinates the wide spectrum of researchers currently approaching the problem on such a variety of fronts. It is a given of science that none of nature’s mysteries is ever considered to be completely solved. But this one, the great mystery of pain, cannot help but yield many of its secrets in the face of such a sustained effort.
