Community Coalition for End of Life Care

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This is the first in a series of articles presented by the Community Coalition for End of Life Care, a working group of health care providers, administrators, educators and representatives from the law, arts and religious communities trying to improve how we, as a community, care for those suffering from life limiting conditions.

What is pain?

We all have felt pain. But nobody fully understands pain. In fact, pain is one of the most misunderstood human experiences: misunderstood by those who live relatively free of pain, by those experiencing it on a daily basis, and by those caring for people in pain.

We usually think of pain as a sensation that occurs as a result of real damage to parts of our bodies. But it is much more than that. Pain can be due to real damage or potential damage. Why does a needle hurt so much more for a child who is fearful of getting a shot, than when the same child is distracted, comforted, or calm. Studies recurrently show children who are sitting in parents laps, feeding (including breastfeeding) experience far less pain than those put on an examining table to receive immunizations.

The brain is the organ that experiences pain, not the part of the body where the message may be coming from. And therefore state of mind has a huge effect on what we experience. Press on your fingernail until it hurts. Rate the pain on a scale of 0-10 (0 being no pain and 10 being the worst pain you can possibly imagine). The answer (even if you use the exact same pressure each time) will depend on how well you slept last night, whether you are scared it is going to hurt or confident it is not a big deal, whether you are fearful of your partner’s unpredictable mood swings or whether the partner you trust is gently hold your hand. That number can vary from as low as 2 or 3 out of 10 to as much as 8 or 9 out of 10! This is a well studied fact. If the same injury or insult to the body occurs each time, how can this be?

The brain is complex and imperfect. Positive messages (laughing, relaxation, trust, a sense of control…..) decrease pain experience. You can think of it as if these positive messages close gates that partially block the pain pathways in your brain. Negative states (lack of sleep, anger, distrust, loneliness, anxiety, fear...) open those gates allowing a stronger message to get through.

Sometimes the pain messages themselves can be confused. For someone who suffers chronic pain, those messages often carve a path in the brain so well worn that the brain feels the pain even when the message is no longer being sent. Or small messages (small insults) fly down that well worn path so quickly they cause significant pain. It is as if all those protective gates got blown open so long and hard by the chronic pain that they are broken and are hard to fix.

The brain's pain pathways are also not only affected by physical insults or injury; but also by psychological, emotional or spiritual states.

Because of the many myths in our culture surrounding pain, we often feel and express our pain physically. We feel and express our emotional, psychological or spiritual pain as physical (we get headaches or belly pain when our relationships are not going well; that bad knee hurts when our job is stressful or we are working long hours; or we ache all over when we lose trust in our God or a major project in our life fails).

You might say, "but that isn’t real pain. That is just me being weak or faking it." But nothing can be farther from the truth.

Pain is an individual, subjective experience. Only the person who actually experiences the pain can know what it feels like. And the experience is real, even if, sometimes, the experience is different from the cause.

Once we understand our pain, we can more effectively control it.

This is the first in a series of articles presented by the Community Coalition for End of Life Care, a working group of health care providers, administrators, educators and representatives from the law, arts and religious communities trying to improve how we, as a community, care for those suffering from life limiting conditions.

Related Article: Pain myths and pain truths


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