Pain was once believed to be very simple, the first theory of pain came from Louise Descartes, the man quoted for saying I think therefore I am. Descartes theory was proposed in the 17th century and is still basically used today. You put your big toe into the fire the information goes up the spinal cord to the brain and we scream and withdraw the toe from the fire. It’s a direct line from here to there. So the thought was that if it were a direct line you could cut it and the pain would stop, similar to the old phones, if you cut the cord the conversation was over. So they cut here and here and the pain did not usually go away. Then they figured out there was an emotional component to pain, so the neurosurgeons figured well cut out the frontal lobe and remove the emotions and the pain will go away and that did not work either. Scientists and doctors are now figuring out that pain is very complex.
How many of you have experienced pain? Pain is a physical sensation that may or may not go along with tissue damage and pain can be an emotional sensation. Is there anyone feeling some sensation of pain right now? By looking at (name) can you tell his in pain? Can you estimate what level of pain (name) is in? (name) on a scale of 1-10 one being a sight sensation of pain and 10 being the worst pain you have ever had, what is your pain right now? Do you believe him?
Pain is a very complex experience, you can’t see it and it’s different for everyone. We have no idea what (name) is feeling right now. As a nurse I was taught that pain is whatever the patient says it is. You can have two patients who have gone through identical procedures and one is have pain of 4 and the other one is a 10.
What makes pain so complex and individual is our perception of pain.
Perception has everything to do with how much pain we have and how long it lasts. There are many factors effecting our perception:
Experience and expectations: At four years old you may see a candle lit for the first time, and your eyes light up and you wonder what the pretty red flickering light is. Oooohhhh, aaawwee. You get closer, at this point you have no experience to tell you this is going to cause pain if I touch it. The brain does not perceive this as a threat, until you touch it. Receptions race information to the brain, sirens go off DANGER, Danger, retreat, get the mommy. The next time you see it you know what to expect you have experience, and your perception is totally different.
On the other side of this same scenario have you seen firewalkers? I chose to have this experience, and while they are burning the wood to make the coals you will walk on, you are going through a process to show you anything is possible. Your breaking wood with your hands, bending rebar in the crease of your neck, by the time the coals are ready most of the people in the group are so pumped up, it feels like there is nothing you can’t do. And so you walk, no pain, you can feel the coarseness of the coals under your feet but I did not feel pain nor did I get burnt. But the people, who hesitated and were sure they would get burnt, did. These really were hot burning wood coals. Perception, experience, and expectation.
Motivation is another factor in perception, athletes will perform through pain, to get the goal, finish a race. What is the achievement motto, no pain no gain. There are stories of unbelievable sales and women ignoring labor pains to get their purchases.
Reward and punishment, have you ever seen a child do something that clear should hurt but with the dad may just shake it off but with the mom may cry? Why because mom may reward with kisses, a treat, love. And dad may tell they to suck it up, don’t be a baby.
Culture, religion, and sex, are also factor in perceptions of pain. As a nurse you need to know that many cultures will not tell you that they are having pain, many religions believe that sacrifice and enduring pain brings you closer to God. Men are generally brought up to be demeaned for showing pain like in the scenario of reward and punishment.
A huge part of perception is our mental and emotional status, how stressed out are you? Are you on your last nerve? I use to say to my kids when I was really stressed out, you’re on my last nerve, and they knew not to push me any further. And if you are so stressed out and you’re on your last nerve and you stub your toe, doesn’t it hurt more then when you’re not stressed, the expletives come out, and you might even cry because it hurts so badly. It’s because the alarms have already been going off, Danger, Danger, it intensifies the pain. When you’re not stressed, you may stub your toe and you say oh darn it and you just go on with what you were doing.
Pain is very complicated, and it’s different for everyone because their perceptions of pain are different. If you expect it to hurt, chances are it’s going to hurt, if there’s motivation to get beyond the pain and finish you probably will finish and then the pain will hit, if you generally get a cookie for a booboo you may cry harder to get two, if their disapproval with showing pain you learn to such it up. And if you’re on your last nerve, stop where you are, because there’s a hot wheels waiting to take you down.
Tina Michaud-Gray, Integrative Pain and Rehabilitation Specialist, RN, LMT, SILC, CH
New England Rapid Recovery Center