In order to get anywhere with your pain, you have to understand it. So let’s start simple.
What Is Pain?
The nervous system runs throughout your body and sends electrochemical signals along its network of neurons, up the spine, and to the brain, where your brain interprets the signals it receives. The nervous system is the information highway for pain, but it is not the neurons themselves that “feel” the pain—your brain is what receives the information and draws your awareness to the part of the body that sent the signal. The central nervous system is an incredibly complex, highly developed system whose main purpose is to send messages between different parts of your body—from one cell to another. Pain is just one of these signals. When a part of you hurts, a signal is sent from the sensory receptors at that site, along the neural network to the brain, where the message “pain” is received and interpreted.
Pain serves many functions, but its most basic is to alert you, your consciousness, that something is wrong and a response is required. The response may be simple and reflexive (take your hand out of the fire), or even unconscious (causing your glands to secrete hormones to counteract the situation). Adrenaline may be released. Your body may tense up. Inadvertent and complex results may and do occur as the result of physical pain. But the thing you need to remember is: pain is there to help you. It warns you when something is wrong, makes sure you know to protect yourself. It is a valuable evolutionary tool.
But that is not to say it is infallible. Pain can be misleading. Your brain does not always interpret pain correctly and your sensory receptors do not always receive information accurately. There are many ways your body can fail you when it comes to pain, and one of the most common is for pain to be of a greater magnitude, of a longer duration, or simply from an insignificant cause, leading your brain to overreact and you to feel much more pain than is appropriate.
Broadly speaking, there are three traditional classifications of pain: acute, chronic non-cancer, and chronic cancer pain. While all pain is painful, not all pain is equal or behaves in the same way. Those who experience chronic pain feel changing effects over time, as their nervous system reacts to the environment of ongoing pain. In this way, acute pain is very different, and while they may be hard to differentiate in any given instant, chronic and acute pain are treated differently. Note, however, that acute pain can transition to chronic pain over time.
We’re not going to delve into all of the various pain disorders here, as there are many, and even the same disorders can have different effects on different people. There are also many types of non-physical pain, and this is where life can get really complicated, because emotional pain and physical pain are not mutually exclusive. Feeling physically crappy can cause a negative emotional response. Feeling anxious or overwhelmed or depressed, or any number of other negative emotions, can cause physical symptoms of pain. Emotional and physical pain can become a self-reinforcing vicious cycle. The two go hand in hand, and pretending they don’t means ignoring half of the problem.
Diagnosing and treating emotional pain is an enormous task and one that should, ideally, be tackled with the help of professionals. Later in this book, we will look at some of the specific emotional consequences of physical pain, but the analysis of purely emotional issues is not our target here. We want to narrow our focus to physical pain and its consequences, some of which are emotional.
So let’s look at physical pain in depth. Do you know what type of pain you have? Do you know where it’s coming from or what’s causing it? That can be a simple question to answer if you have a broken leg or a burned hand, and these are relatively easy problems to understand and treat, but it’s much tougher for amorphous pain. One of the most fundamental techniques you need to master, as a starting point for everything else, is understanding your pain. Know it, label it. This is not a one-step process. Your pain may well change over time. You need to be able to bring your awareness to whatever hurts, objectively assess it, and respond appropriately. You have to be able to depersonalize it, every time.
So what’s your pain like? Let’s break it down into some simple components and descriptors.
Classifying Pain
Duration
Acute Pain
Acute pain is typically sudden, intense, and short-lived. It is an immediate reaction to stimuli and is usually solved (or greatly ameliorated) by medical intervention.
Chronic Pain (Non-Cancer)
Chronic non-cancer pain is longer-lasting, often duller, and resistant to medical treatment. It can be linked to a physical or mental illness (other than cancer) but is not necessarily defined by it and can far outlast the original illness. The official definition of chronic pain is pain that lasts more than three months, and this definition can therefore encompass anything from prolonged recovery from injury to long-term illness.
Chronic Pain (Cancer)
Chronic cancer pain is long-term pain caused directly by cancer. Most cancer pain is caused by a tumor pressing on a nerve, bone, or organ. It can also be a result of cancer treatment—for example, pain experienced due to chemotherapy.
Breakthrough Pain
Breakthrough pain isn’t technically its own category, as it’s a form of pain that occurs when an ongoing chronic pain problem suddenly becomes acute—but we’ve kept it separate here because it does behave differently than chronic or acute pain. Breakthrough pain is often caused by a change or failure in medications, and although it is a function of the chronic pain, it acts and feels acute. This is most common among patients who are under treatment and have bouts of severe pain that break through their medication at intervals.
Location
Localized Pain
Most pain stays where it was caused; you break a leg, your leg hurts. You get stung by a bee on your finger, your finger hurts. Localized pain stays at its origin site.
Referred Pain
Referred pain is when pain from one part of your body is felt somewhere else.
Phantom Pain
Phantom pain is where there is pain in a part of the body that has been removed.
Intensity
Traditionally, pain is rated on a simple scale, from one to ten, depending on how it feels to you.