PAIN! The curse of suffering?

When was the last time you felt pain? Any kind of pain – the piercing sting of a verbal insult, the cruel intensity of a paper cut, the pounding throb of a migraine, the persistent agony of a chronic disease, or the devastating loss of a loved one. What did it feel like? Where did you feel it? How long did it last?

Was it irritating but bearable, or so excruciating as to draw tears, prompt prayers or render you hospitalized? My apologies for the sullen tone and for quite possibly dulling your mood. I write this with an icepack wrapped around my jaw, dosed in aspirin, releasing an occasional moan of despair. My pain, on this very occasion, happens to be the very lovely sensations of a toothache. Not an ordinary toothache, mind you, but the vengeful pain of dormant wisdom teeth violently erupting. A toothache that could, rather should, have been averted years ago, if only I’d swallowed my fear and actually listened to my dentist (who apparently does know what he was talking about).

When I’m able to look beyond the ominous clouds of selfpity it’s clear that my body is trying to send me a message, and doing so in a manner that would be difficult for me to ignore. Well, my dearest jaw, gums and teeth, congratulations; you’ve got my attention. And while I appreciate the reminder to finally get rid of my wisdom teeth, I must ask – did you have to be so…painful?

A world without pain sure does sound idyllic. And in fact sometime this century a pain-free existence may, scientifically, be possible.

That pain is a blessing, a genius evolutionary phenomenon, is oft forgotten. That there is a difference between pain and suffering is also oft not mentioned. Why would Mother Nature go out of her way and create an elaborate system that takes so much energy and zest of life out of us? So burdensome that many of us spend the major part of our lives doing everything we can to avoid setting the mechanism in motion, even if our attempts at avoidance only lead us towards much more pain and suffering.

Let’s try breaking things down into digestible nuggets of information. Pain can be defined as the uncomfortable sensation(s) we experience when we encounter a harmful stimulus, or according to the Merriam-Webster dictionary: ‘a basic bodily sensation induced by a noxious stimulus, received by naked nerve endings, characterized by physical discomfort (as pricking, throbbing, or aching), and typically leading to evasive action’. But the signal of pain is quite unique from the perception of pain.

The signaling of pain involves pain neurons, called nociceptors, the spinal cord and our brains. In summary, our nociceptors send a message that travels up the spine, via sensory nerves, reaches the thalamus in our brains (our sensory perception and motor function HQ), which then relays the original signal to different parts of the brain to decode the message, i.e. to perceive the pain. All of which occurs within a fraction of a second.

To further ensure that the ‘decoding’ of the message doesn’t slow us down, unnecessarily extending our encounter with the harmful stimuli, our spinal cords have the ability to make basic decisions, called reflexes, on its own. Think about how you will instantaneously drop an excessively hot pot before you even feel a burning sensation – that is your spinal cord serving its role as your super speedy and effective, but limited, middle management.

Hence, at its simplest, pain is an evolved defense mechanism that alerts us to injury, allows us to protect our fragile bodies and not damage ourselves any further, which we, as clumsy, fragile humans, are tragically prone to doing. And it works, extremely efficiently, mind you. Our ‘pain reflex’ is a response that saves our lives over and over and over again. While the signaling of pain is a relatively easy concept to understand, the perception of pain is an entirely different creature.

When the pain signals reach the thalamus there are multiple ways for it to be decoded, understood and expressed. For example, part of the brain is responsible for figuring out where the pain came from, and how it compares to other kinds of pain. Did your little puppy ‘Fido’ just nip your ankle, or was it the vicious monsterdog your horrible neighbors carelessly allow to run wild? Another part of the brain (actually the aforementioned thalamus) facilitates an emotional response – should you feel furious or merely irritated? Does the ‘pain’ warrant a gut-wrenching cry of terror?

Is it worthy of instigating the water works? What your brain understands and decides upon winds up being your subjective experience of the pain itself. So really, the pain isn’t truly coming from your bitten ankle but from your brain’s understanding of the signals received from the triggered nerve cells in your ankle. Got it? We may think that our brains are very reasonable and justified when deciding how to perceive ‘pain’, but unfortunately this is not the case. Though marvelously powerful machines, our brains don’t always work to our own advantage. Our brains are perpetually biased, they have issues, the wires inside often get all tangled up (not to mention our propensity for brain farts). Our individual sensations of pain are influenced by our mood, past experiences and expectations.

If you’ve had a traumatic childhood experience with a dog, as an adult a little nip on your ankle from a puppy may trigger memories of your past trauma, and hence feel much more pain than it should feel. After all, a stubbed toe after a long, frustrating day at work feels entirely different from one experienced while playing with your kids, doesn’t it? While you may barely feel the later, the former is likely to inspire a range of colorful curse words.

For us the sensation of pain is synonymous with the emotion of pain, yet in reality they are two separate things. Our experience of pain is influenced by our transient emotions just as much as it influences them. Researchers have shown that when subjects were made to feel anxious or depressed, their pain tolerance dropped; despite the fact that their nociceptors were sending out the same signal, their brains translated this signal into more suffering. On the other hand other studies show that subjects are willing to endure more pain when they’re motivated by money which, though hardly surprising, demonstrates how pain perception can be influenced by whether or not we have a reason to endure the pain.

Add to this the hugely influential, very unpleasant, and often maladaptive, emotion that is fear. Now not only do we fear feeling pain, and do our best to avoid it, but we also try to avoid the painful feeling of fear itself. Yes, we are essentially creating an emotional experience to protect us from the one we’d rather avoid, only to end up scrambling in distress to avoid both our creation (fear) and the potential threat (pain). Pain combined with the fear of pain introduces the glory of suffering. And boy, aren’t we, as a species, attached to suffering.

If you put someone, against their will, in an uncomfortable situation their cortisol (the stress hormone) levels rise, prompting the experience of anxiety and dread. But if you take the same person, and they voluntarily go into the same situation, their cortisol levels don’t spike as drastically, that is if they rise at all. In other words, accepting or merely refraining from avoiding pain/discomfort, can radically shift our experience of it.

So what does this all mean? Did Mother Nature bless us with the life saving sensation of pain, while we invented the curse of suffering? Or perhaps suffering is an evolutionary development, but what purpose does it serve? And if human beings are, and have been since the beginning of our existence, fully equipped with the tools to eliminate our own personal suffering then why do we hang onto it with such fervor?

I don’t have the answers to these questions, but the more I think about it the less relevant they appear to be. If anything, understanding the mechanics of pain has helped create some distance between myself and the throbbing toothache I’ve been experiencing. I was angry at my jaw for making me cry, but now I’m grateful for the reminder to do what I should have done eons ago. And though it still hurts, a lot, it is now less menacing and fear inducing (I’m no longer ruminating over thoughts of how my teeth might all fall out and I’d have to get used to a life with dentures).

But who am I to talk? My, likely brief, experience of oral discomfort pales in comparison to the pain I’ve witnessed others go through lately, or that which many of you might currently be in the midst of experiencing. Which brings us to another paradox of pain – the soothing universality of pain is negated by the complete isolation of experiencing pain. We all know what it’s like to feel pain, be it physical or emotional, but no one on earth can experience our individual pain.

While we can’t experience other’s subjective pain we’ve been blessed with yet another genius phenomena – empathy. That is, the ability to recognize, identify with and understand the emotions experienced by another being. So not only are we burdened by our own pain and suffering but we have to deal with other’s pain too? Sheesh, Mother Nature sure was determined to make life utterly complex for us. Or was she? Stay tuned for more thoughts on the experience of pain, the evolution of empathy and how to balance a life free of suffering but rich in compassion coming up next month.