Claiming Multidimensionality of Pain Part III

Claiming Multidimensionality of Pain: Part IIIPain transcends constructed categories

by Ma'ayan Simon

Pain is experienced in many forms, yet we are conditioned to conceive of pain in narrow terms. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (Thernstrom 284). However, this definition applies primarily to anatomical pain despite a range of interrelated “types” and presentations of pain. To this end, I include anatomical, emotional, social and spiritual pain as part of the "lexicon" of pain [see box 1].These labels are intended to describe "types" of pain enacted in our individual experiences, though the generators of pain can be vast, including feeling pain over a political situation, the environment, the state of our world and beyond. How we embody these “types” of pain overlaps, and all of these experiences have tangible, physiological effects that transcend “category.”Even within a single "category" of anatomical pain the variability of the presentation and experience is vast, to say nothing of the range of anatomical pain from nausea to muscle pain. For evaluating anatomical pain alone, Dr. Ronald Melzack and W. P. Torgerson created the McGill Pain Questionnaire, which contains methods of discerning attributes of pain, such as temporal dimension, intensity; and descriptions such as flickering, pulsing, quivering, throbbing, and pounding (Thernstrom 60).Anatomically, pain is a function of the brain, spinal cord, and the nervous system (Butler and Moselely 64, 73; Thernstrom 6, 128). Yet, there are myriad, possibly even infinite, "causes" for pain, its precipitators, why different kinds of pain affect different people differently, and why some people are more predisposed to experiencing pain (Butler and Moselely 20-25; Thernstrom 138-139, 173, 181). Chronic pain is comprised of inextricably linked, often indiscernible factors of biology, psychology, and society (Butler and Moselely 108, Thernstrom 285) [See box 2]. Context is hugely influential in experiencing pain as can be season, stress level, inflammation load, and environmental factors (Butler and Moselely 18).Pain can also be as much about what is not occurring: for example, decreases in seratonin, norepinephrine, adrenaline (adrenal fatigue), reparative sleep, and atrophying gray matter in the brain (Butler and Moseley 84, 85; Thernstrom 157, 186). When we view pain it is important to look at what is not happening as much as what is, such as supports and needs that are not being met, re-traumatizing experiences, etc. The combination of factors that generate the experience and cascade of chronic pain extend far beyond anatomy.Pain is not a weakness or character flaw, as is often overtly or covertly suggested (Cohen et al. 1638). Research supporting a strong genetic predisposition that influences and often determines chronic pain conditions is continually being discovered (Thernstrom 141). Gender, race and ethnicity also significantly contribute to variability in pain processing (Thernstrom 176, 179). Compounding genetic and other predispositions to pain is sensitization of the nervous system, a primary result of pain, which can amplify smells, sounds, sensations and further increase sensitivity (Butler and Moseley 37, 76, 78). Additionally, Thernstrom cites many potential factors of pain sensitivity including, but not limited to culture, personal history and trauma.If a person has experienced harm historically, that person's perception of threat will often adapt to be more reactive as a protective, self-preservation response; subsequently, pathways become further ingrained, increasing activation and hyper-vigilance response (Butler and Moselely 72, 78, 84, Thernstrom 128). Nociception, nerve signals alerting the spinal cord and brain, actually translates as "danger reception" or "the beginning of hurt" (Butler and Moseley 32; Thernstrom 26, 198). Thernstrom notes, "Early exposure to pain has been shown to lower pain threshold by damaging the undeveloped nervous system" (181). The more trauma and pain a person experiences, the more the brain changes in an effort to protect the body, which can further increase pain (Butler and Moselely 83, Thernstrom 128).For this reason, among others, it is my contention that populations that have been subject to persecution, systematic and institutionalized oppression, including trans-generationally, have an elevated risk of chronic pain and illness. (I will be writing a future paper to this point.)While we are all people in pain to varying extents and degrees at different times, for some people pain and trauma become distinguishable disease processes in and of themselves. Check back next week for the final installment about pain as a disease and an illness!Box 1: “Types” of Pain

• Anatomical pain encompasses sensations experienced in our fascia, nerves, viscera, muscle and bone.
• Emotional pain includes feelings such as anguish, despair and loss. Emotional injuries and wounds.
• Social pain is the internal experience of feeling that we cannot be ourselves in social situations, such as difficulty interacting, relating or connecting, or others being unable to relate or connect to us as we desire. Whereas society as a factor that causes pain is external, social pain is an interior state.
• Spiritual pain, what you may think of as "existential" or "psychic" pain, can include feeling disconnected from a sense of purpose, alienated from or abandoned by greater wisdom, the universe and/or ancestors, or hurt as in feeling "unloved" by the universe. I call these experiences of feeling intrinsically out of alignment with our greater wisdom "soul aches" or "soul flares."

Box 2: Influences of Biology, Psychology and Society

• Biology can include genetics and epigenetics, inherited predispositions and traumas, congenital conditions, changes to one’s body due to environmental exposures, and processes that happen throughout the body, which are catalyzed by effects of psychology and society.
• Psychology is how our combined biology, environment, and circumstances affect us, which encompasses how we respond to and are changed by our individual experiences and traumas, and how our biological factors are expressed to impact our perceptions.
• Society influences, and in large part defines, how the impact of our biology and psychology relates to our experiences, and vice versa. Racial, socioeconomic and other oppression and are key to how society influences pain. Attitudes, beliefs, religion, stigmas, and prejudices can all be generators of secondary trauma.

Works Cited

Butler, David S. and Moseley, G. Lorimer. Explain Pain. Noigroup Publications, Adelaide, Australia, 2003.

Cohen, John et al. “Stigmatization of Patients with Chronic Pain: The Extinction of Empathy.” Pain Medicine, Wiley Periodicals, Inc., 2011, pp. 1637-1643.

Edwards, Laurie. In the Kingdom of the Sick: A Social History of Chronic Illness in America. Walker & Company, Inc., New York, New York, 2013.

Thernstrom, Melanie. The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering. Farrar, Straus and Giroux, New York, 2010.