There is much scientific data on how the body processes pain impulses. I am not here for a discussion of the Anatomy and Physiology of pain. If you deal with chronic pain, you have more than likely had the lecture on how it all works. Gate theory, etc.
What I am referring to is HOW we perceive pain. How we take what the body is telling us and translate that into what we know as pain, based on many factors. These include cultural, familial, personal, psychological, and visceral interpretations of pain. We learn early on that how to deal with pain. Watch a small child skin his knee, take a tumble, and you hear the blood-curdling sound only a child can make. How a parent deals with these early injuries shapes the child’s image of pain and how he deals with it. Most parents coddle a child who has been injured, who wouldn’t? It is about caring and nurturing. Making him feel safe and calming his fears as only a parent can do. But what if we overreact? What if we become hysterical? What kind of image does that send to the child? And next time he is hurt, does our reaction shape how he deals with pain?
In some families, pain as treated as a badge of courage. “Keep a stiff upper lip”. Ever hear that growing up?? Don’t cry, big boys/girls don’t cry! Oh, don’t be such a baby! What kind of message are we sending to our children when we use these terms?? How are we shaping their future ability to deal with and verbalize pain? Much of how we learn to perceive pain comes from watching the behaviors of those around us as we are growing up. I mentioned before that my father was an extreme stoic. Well, funny thing, how do you think I learned to deal with and express my perception of pain? These learned behaviors go way beyond the scope of just pain perception. Think about how we deal with relationships, conflict, stress, most anything in life. And our parents are the first one’s to shape these behaviors.
I have spent much time in hospitals in my life, both as a patient and as a health care provider. Much of this was spent in the E.R. Watching the response of people to various injuries is something that I didn’t really pay much attention to. But slowly, I noticed that the perception of pain was not always proportional to the extent of the injury, so there had to be one or more of the factors mentioned above at work. I would see people with relatively minor injuries coming unglued! Other times, people who should be, were not. And this is taking into account things like shock.
One thing that anyone who has been admitted through or a patient in a hospital E.R. knows is this: The squeaky wheel gets the most grease! If you are in pain and suffer in silence, it will be 5 hours before anyone looks at you. If you are hooting and hollering and letting everyone who is within earshot know about it, bingo, you get attention. Case in point: One night several years ago, after spending a number of hours at home vomiting, doubled-over with abdominal pain, I decided it was time to visit the E.R. It was in the early hours of a new day. I was pretty sure that I had a bowel obstruction. There was a N.Y. blizzard going on outside. From where we lived it was about 13 miles to the hospital. It took well over an hour to get there based on conditions. When we arrived, the place was a zoo. I walked into the intake area and began to fill out paperwork and talk to the triage nurse, explaining why I was there. She explained that it was a very busy night and that it might be a while before anyone could see me. About this time, a wave of nausea came over me, so I grabbed the closest trash can and proceeded to puke my toes up!! Funny thing, they took me right in. And I did, have a bowel obstruction, that is.
I noticed in one of the comments tonight a list of “pat responses” to the proverbial question: “how do you feel?” I have used any an all of those at one time or the other in my history, most many times. But I started thinking about why we choose a particular response on a given day, even though we may feel no better or worse than we did yesterday, or for that matter for the past month! Is it in the perception of pain or in the processing of it that we come up with our response? Or is it purely psychological? Is our response tempered by our ability to cope on any given day? Do we feel “fine” today because we don’t want to admit that we are dying but can’t talk about it at that moment? Or do we say we “feel like crap” because mentally it is healthier at that point in time than denying that we hurt?
I personally think it is a combination of factors. Again, there is no scientific basis for my opinion, at least none that I have researched. It is purely my opinion, based on my own experience. But I do know that chronic pain patients may have relatively stable levels of pain on a day to day basis, but their response varies greatly with what else is happening in their life. Stress plays a big part in pain perception. When you are emotionally or physically stressed, the level of pain perceived is greater. I know this from experience. When you are happy and content, even though physically nothing is different, you just feel better. Think about how you feel during and immediately after sex if you don’t believe me. How many of you can say that you have significant degrees of pain during sex? Not that pain can’t cause issues with sexual performance, it certainly can. But all things being equal, sex is a great equalizer when it come to pain control.
So, many questions, few answers. I would very much like for any and all of you to put in your opinion on what I have written. I know that there are those of you who have pondered this and written about it. Thanks in advance.
