What is Pain?

By Wil Forbis
July 1, 2015

As usual with these wacky brain articles, I'm starting by biting off more than I can chew. Am I really going to offer a complete explanation of the mysterious sensation of pain, a torment that has plagued humans and other living creatures since the dawn of conscious species? Even a cursory review of the literature on the topic should make it clear that much of modern science is still vague about the subject. As this blurb on the work of pain researcher Fernando Cervero states...

...pain is the most common reason for people to seek medical attention, but...it remains a biological enigma. It is protective, but not always. Its effects are not only sensory but also emotional. There is no way to measure it objectively, no test that comes back positive for pain; the only way a medical professional can gauge pain is by listening to the patient’s description of it. 

The pain was never sharp or agonizing, but rather a constant dull-to-medium throb, like a fresh bruise*. (I don't mean to downplay it; it was enough to keep me awake many nights.) Somewhere around 2006 I sought treatment. My GP basically scratched his head, told me to wear an arm brace and prescribed a round of physical therapy. That helped a bit but it didn't last. Soon I was back in physical therapy several times a week. I took time off work and began exploring a variety of treatments including acupuncture, massage, trigger point therapy, hot and cold baths, changing posture, stretching (I used to stretch for an hour daily), a weird orthopedic neck traction device, electrical stimulation, epsom salt baths, Feldenkrais, inversion tables and probably a few more I'm forgetting. I ended having several M.R.I.s and nerve conduction tests that did or did not show abnormalities depending on the doctor who was looking at them.

* This sentence highlights a problem that plagues pain treatment and pain science: how do you describe pain? One person's medium pain might be another person's unending agony. Pain charts often use a one-to-ten pain scale, with level ten being something like "the worst pain you can imagine." But if I've never felt it how can I imagine it? The subjectivity of pain makes it a difficult devil.

So I tried Sarno's approach* and, in a nutshell, it worked. It wasn't an overnight process as many of Sarno's success stories are. I read all of his books and several more by people advocating variations of his approach. (For those exploring the Sarno approach, I recommend his books plus Fred Amir's "Rapid Recovery From Back and Neck Pain",  Scott Brady's "Pain Free for Life" and the web site TMSwiki.) I did my best to quiet my mind, to reinterpret the experience of life in a less anxious way. I attempted some basics of meditation and, while I never got far with it, I feel it was beneficial. Mainly, I just took it easy. I would go to the park and take in the air and scenery. I went on long hikes and let my mind drift. The pain left in fits and starts; it would rescind, then return, then fade. Mostly what changed was my attitude towards the pain. It became less something to fear and more akin to an annoying child, a voice that could be tolerated with a certain bemusement.

* I should mention, none of the doctors, physical therapist or other members of the "official" medical establishment ever mentioned Sarno or anything like his approach. They were, at the time, thoroughly invested in structural explanations for pain. My sense is that this is beginning to change.

At the time I was a member of an Internet mail list called Sorehand, a discussion for people with, you got it, sore hands. I started to notice something about the people on the list who would report progress or cures. They were primarily the ones using techniques that calmed the nervous system: yoga, meditation and Sarno's ideas*. And so I started to rethink my ideas of what pain is and what caused it. I moved away from the structural "alert system" view taken by most doctors, physical therapists and so on, and more towards the idea that pain is complex and multi-faceted and interacts with our nervous system (which consists of the brain, spinal cord and nerves and could be said to be the biological correlate of the mind.) 

It was becoming clear to me that the structural view of pain, while doubtless correct in many (if not most cases) couldn't account for everything.

I also discovered that theories of pain that go outside the standard "alert system" model have been around for a while. One theory is Central Sensitization which basically argues that as you feel more pain, you get better at feeling pain and thus feel more pain leading to a horrible feedback loop. Another is the Gate-Control Theory that argues that stimulation of non-pain related nerves and brain areas can inhibit the activity of pain-focused nerves. (In a sense, you can distract yourself from the pain, shutting down the alert system.)

Beyond that, Australian pain researcher Lorimer Moseley has some interesting thoughts on how our conceptualization of the causes of pain can make us more vulnerable to pain. For example, many people fear the back pain that comes with a slipped disc. There's only one problem: slipped discs don't exist. Mosely posits a process by which thinking we have a slipped disc can make us more prone to back pain. (He uses the term "neurotag" to denote the specific network of cells that activate when a person is thinking about a certain idea or having a certain experience.)

If we have the phrase “slipped disc” in our brain... it has to be held by a network of brain cells (we can call this the “slipped disc” neurotag). And it’s highly likely that there are some brain cells that are members of both the slipped disc neurotag and the back pain neurotag. This means that if we activate the slipped disc neurotag, we slightly increase the likelihood of activating the back pain neurotag.

Using this model, thinking that we have a slipped disc has the potential to increase back pain. But what if this piece of knowledge we have stored is inaccurate, just like our notion of a slipped disc? A disc is so firmly attached to its vertebrae that it can never, ever slip. Despite this, we have the language, and the pictures to go with it, and both strongly suggest it can.

When the brain is using this inaccurate information to evaluate how much danger one’s back is in, we can predict with confidence that, if all other things were equal, thinking you have a slipped disc and picturing one of those horrible clinical models of a slipped disc will increase your back pain.

This struggle of conceptualization, this question of "what is causing my pain?”, was certainly something I wrestled with. An orthopedist would tell me one thing, a physical therapist would tell me another, a book I would read would offer a third answer. I remember having a certain sense of relief when one physical therapist confided to me that there was still a lot of mystery surrounding the topic of pain. I realized it wasn’t simply that I didn't "get it" or was being obstinate; pain IS a mystery. And this may be why Sarno's program works for so many people: it offers a explanation for pain that makes sense and  provides steps that can be taken to fix the problem. 

The vagaries of pain resonate with my general understanding of how the brain creates our sense of reality. We look out at the world, smell it, hear it, touch it, and think we are getting an exact representation of what's out there, yet we know that's not true. We know we only see a certain part of the light spectrum. We know we only sense some air vibrations as sound. We know that hallucinations and distortions of our senses are possible.  Pain, I imagine, is capable of being similarly distorted. It is likely we can have hallucinations of pain, sensory experiences that give the impression that something is there when in fact there is nothing.