Is your pain real?
The other day, in a social setting, a former client was sharing how it had been eye opening for him to make the connection between how his thoughts and emotions had an effect on his physical pain, when a mutual friend broke in with, “Well sure, but this pain I have in my hip is real.”
This isn’t the first time this has happened.
I was on a bike ride with a friend some months back who was telling me about a runner she knew that was having some knee trouble.
I started in on what I thought was a perfectly sound explanation of descending modulation, when she broke in…in a sort of vehement denial, “Oh no, so-and-so’s pain isn’t like that…it’s real”
What is pain that is “real”?
And what is pain that is “not real”?
How would you tell the difference?
When people talk about pain that is real, what they mean (so far as I can tell) is that they are definitely connecting the pain to their body. It shows up in a consistent area usually with a consistent type of aggravating activity.
This leads to the idea that there is something happening in their body part that is causing pain.
So if something is happening in your body part that is causing pain, then it must be real pain.
Then there is the other type of pain that people don’t so much talk about, as deny having…the “not real” pain.
Unless someone is fabricating a story, maybe to get out of work or extend insurance benefits or something like that, then the experience they are having is real.
What we’re referring to as “not real pain” might be that experience that many of us have had, of having our spirits so depressed by the prospect of something undesirable in our future, that it has a physical effect on us.
Shel Silverstein has a poem about a little boy who had a terrible cold and thought he was going to die–and then found out it was Saturday and was instantly ready to go play.
I recall clearly many years ago when I was living in the city and going to massage school. I was on the edge of a cold, achy and lethargic, and feeling like I needed to spend the day in bed. Yet I knew that if I could just take a little time and get out into the woods that all my symptoms would go away. I just had a hard time being in the city and it got to me.
In other words, it was a great example of me “making something up” and yet at the same time I really did feel how I felt, and I felt badly, both physically and mentally.
Is it just me, or is there a cultural prohibition on admitting stuff like that? You know what I’m talking about, don’t you?
Now, if we take one of these to be “real” pain and one of these to be “not real” pain then, how do we tell them apart?
The real pain seems to be connected to the body in a specific way.
The “not real” pain seems to be connected to the body in a non-specific or whole-body sort of way, and seems to be tied to emotions.
Again, I’m throwing out the idea that any of this is made up. I take for granted that if someone is telling me about their experience, then they are sharing with me as clearly as possible what it is they are actually experiencing.
Which gets me to an important point. No one but the person experiencing the pain has or can have any idea of how intense the pain is, or even whether it exists at all. Pain is not measurable. There is no nerve activity that can be tracked that will tell a third party what someone’s pain experience is like. There is also no structure that can be identified (such as a herniated disc, arthritis, cartilage degeneration) that is a consistent indicator that someone has pain.
I suppose we’ve all seen someone ham things up a bit to get some extra attention or as a learned response. And we all don’t want to be mistaken for that person so we rationally connect our pain to something plausible that is or could be happening in the body.
It can be relieving to get an MRI and find that there is indeed some structure that seems to be causing the problem. It can be very unnerving to get a test and find that “everything looks normal” because we need a reason for the pain. We don’t want people to think we’re just making this up.
But when we do this, when we look for a structure to explain our experience, we seperate the mind from the body, and we give up half our power to improve the situation.
People fall easily into this mind body separation because it has been culturally promoted since the time of Descartes, when science was emerging to explain things in the world and it challenged the religious view of reality. To solve the problem the mind and body were divided into separate jurisdictions…and it’s still going on today. Now it’s so deeply ingrained that it’s a point of view that is taken for granted.
When we look for a source of pain that is physical, and ignore everything else that is a part of our experience and a part of who we are, then we are limiting ourselves to resolving pain only by physical means. This closes off the opportunity to use our mind, our emotions and our awareness to find the solution to the situation. It also takes away the contribution of half of the therapeutic team, because no one can know what’s going on inside you as well as you do. And no one can have as big an effect on what’s going on inside you as you can.