None of these models perfectly describe how we perceive pain, but each sheds some light on a phenomenally complex area of human experience.
The Expectations and Goals of Pain Treatment
Like detectives searching for clues, pain specialists study diagnostic results and perform clinical exams to solve the mystery of a patient’s pain. We ask ourselves, “Is the pain adaptive or maladaptive?” Pain is anything but simple. For one thing, we know that the mind can amplify or reduce pain. For example, anxiety about pain or depression because of pain can amplify the perception of that pain. This suggests that developing mental resilience to anxiety and depression might reduce the sensation of pain and, in fact, this has proven to be the case. In fact, simply by engaging ourselves in other activities—work, sports, reading—we occupy more of our brain’s bandwidth and measurably reduce the severity of the pain we experience.
We must be careful not to treat pain in isolation unless we’ve already looked for the underlying cause. We must remember that pain is first and foremost a symptom, an adaptive quality, and to listen to it. Our job is to search for an underlying cause in treating pain. To treat pain as an isolated entity is to risk missing a warning sign that our body is trying to send us.
It’s true that once an acute injury has healed or stabilized, the pain may become chronic. In many cases, we are treating the chronic pain as a separate entity from acute pain. But I would argue that even when pain is chronic, we can achieve success with a multi-modal strategy to manage it as well as to attack the focal source of pain.
The Process of Reversing Pain
In 2004, I was completing my pain fellowship at Brigham and Women’s Hospital in Boston. The Red Sox hadn’t won the World Series since 1918. Fans believed that Babe Ruth, nicknamed “The Great Bambino,” had cursed their team when he was traded to the Yankees. As a result, the Sox would never win the World Series. That October, they defied the curse of the Bambino.
While the city was still buzzing with excitement from the win, I was walking along the Charles River and saw that someone had vandalized a sign on Storrow Drive. The sign had said “Reverse Curve” but someone had changed it to say “Reverse the Curse.” This got me thinking. In some ways, we have been conditioned to view pain as a curse, as something to avoid. If we find ourselves cursed with pain, there is a systematic process to try to reverse it.
Pain is both a positive and a negative. Pain starts with a positive (P), specifically the absence of pain. Then, through an accident (A) or injury (I), it ends up being a negative (N). This negative state has two dimensions, the injury and the unpleasantness of the pain.
Once you have P.A.I.N.2, you can literally turn the word around to use it as a model to grow from the painful experience and build resilience. By doing so, you turn a negative into a positive:
N. Define the negative experience by identifying the source of the pain.
I. Intervene by addressing the source of the pain.
A. Assess the response.
P. Attain a positive result.
You may not know it, but you already use this model on a daily basis. For example, when you touch a hot object, you instantly withdraw your hand because of the pain. The feeling of an ankle sprain is your body’s way of telling you not to run until the pain has decreased, signifying that the injury has healed. This phenomenon is a form of adjustment to the painful experience so you can protect yourself from re-injury.
Let’s walk through the steps of reversing the pain of an ankle sprain:
N: The negative is the painful sprained ankle. To fully understand the negative starting point, you may need to visit a doctor for a complete diagnosis.
I: Intervene and ice the ankle to decrease swelling and inflammation. Consider rest, ice, compression, elevation, and anti-inflammatories. Again, your doctor can help you understand the best course of intervention.
A: Assess the response of your intervention. Are you improving? If so, continue conservative treatment. If not, see a sports medicine or orthopedic physician for additional options.
P: The positive result. After your intervention, your ankle is healed and you are back to your normal activities without limitations. From this positive state, you might also have learned more about your body’s limitations, ways to prevent future sprains, and exercises to strengthen your ankle or adjust your stride.
There are no easy answers or quick fixes, but if you try to apply this “reverse the pain” model the next time you struggle with pain, it will help you become more systematic and effective about processing, recovering from, and growing from that painful experience.
How to Approach Your Pain
Apply a methodical approach to managing your pain. When science fails to give you a complete explanation for a phenomenon, rely on observation. After repeated observation, take what you see and construct a model. With the help of your doctor, you can take that model and test it to see if it holds true in practice. Together, you can study the results of your trials and use statistics to see if there truly is an effect and, if so, how powerful it is.
As Eckhart Tolle suggests in A New Earth: Awakening To Your Life’s Purpose, say to yourself, “Here is the pain, and here are my thoughts around it.” You start to put the pain in perspective.
I would encourage you to find the sources of pain in your own life experiences and learn from them. Reversing the pain can facilitate this process. We know that withdrawing reflexively from a painful situation may confer a survival advantage and is an automatic reaction. According to Isaac Newton, every action has an equal and opposite reaction. In a way, pain is a force of nature, causing you to reflexively back away from a bad stimulus in proportion to the size of that stimulus, keeping you safe. Taking this same reflex and using it to consciously channel painful experiences into something meaningful will, over time, produce an automatic reaction. This feat will require some adjustments in how you consciously (and perhaps subconsciously) process pain, but the resulting learned mechanism will contribute heavily to your survival as a human being.
For example, anterior cruciate ligament (ACL) tears are a common sports injury. The pain from an ACL injury alerts the athlete to a problem. Surgical repair is performed. Knee rehabilitation occurs post-operatively. The knee heals.
Pain is an important part of every step of this healing process. The knee hurts and reminds us we can’t go running or resume sports right away. Much like the pain of a healing ulceration or laceration, pain reminds us not to touch the area; if we get close, it hurts, and we back off. Pain protects you from the risk of an infection or increased scarring in this case. Pain is a helpful reminder not to push ourselves too early while an injury is still healing, or we can potentially worsen it or set ourselves back.
Pain, Inflammation, and Peripheral Sensitization
We now know that there is a clear link between pain and inflammation. In fact, the nervous system, including pain, and the immune system, which causes inflammation, coordinate their activities. When bacteria invade your body, they can directly cause pain when their work is detected by nociceptors, pain-sensing neurons. The immune system can also detect these invaders and respond by coordinating cells to fight them off. Both immune cells and sensory neurons lurk near the places bacteria commonly invade, ready to pounce when the nervous system sounds the alarm. The result? You guessed it: inflammation.
Peripheral sensitization occurs when the pain signal from the injury is amplified, driven by ongoing pain and inflammation.