How much PAIN can you stand?
Some faint at a pinprick; others endure agony—and enjoy it. A few never feel pain. Here’s an insight into one of the most puzzling paradoxes of human life
Close to the core of human experience lies the indescribable and unmistakable sensation we call pain. Everyone has felt it but no one can define it. Pain remains an enemy the strongest person can’t escape, an enigma the most brilliant doctor can’t fully explain.
To many of us pain comes suddenly, bringing with it a swift terrible awareness of the frail physical shell in which we live. Surging through us like a barbarian army, pain may lay waste our bodies and besiege our minds until we are wholly in its possession. Chronic pain has driven invalids to suicide and unnumbered others to euthanasia, the unrecorded murder whose only motive is mercy. Yet the relief of pain is often accompanied by a curious amnesia that makes it impossible for us to recall the most agonizing sensation once it has disappeared.
Although it hasn’t even begun to solve them, science is devoting more and more study to the paradoxes of pain. Why does the smallest pain sometimes reduce a healthy man to whimpering self-pity while a weaker person may endure agony for years without complaint? Why do some people take exaggerated precautions to avoid pain while others welcome physical suffering and become depressed when their health is restored? What abnormalities of mind or body cause some rare individuals to feel acute pain after a minor injury while others, equally rare, can burn and mutilate themselves without feeling anything at all?
The one safe general answer to all questions about pain is that pain is as variable as human nature. Each of us reacts to it differently because the way we feel any hurt, like the way we see or hear or remember things, depends on the in-
credibly complex response of our whole personality. A lighted match dropped on a sidewalk llickers and dies out; tossed into grass in late summer, it fires and devastates a hayfield. In the same way, an injury that has little effect on one man may cause another real anguish. It's impossible to separate pain from the person who feels it.
Although we each interpret pain in our own way, we all share certain body mechanisms that trigger the sensation of pain in the nervous system. If a pin pricks you continued on page 51
Electrical impulses flash word to your brain when you’re hurt. But tears depend on your personality.
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How much pain can you stand?
skin, electrical impulses flash along nerve fibres and up a nerve tract in your spinal column to your brain. When these signals reach a part of the brain called the thalamus you feel pain; when they reach the cerebral cortex, the brain’s highest level, the pain develops its emotional overtones. After the first sharp localized pain you feel a duller, more diffuse sensation, the result of impulses traveling more slowly along smaller nerve fibres.
If it were possible to divorce this physical process from the psychological reaction that always accompanies it, would everyone be equally sensitive to bodily pain? Doctors disagree about the threshold of pain, the point at which you feel the first trace of pain from stimulation such as heat or a pinprick.
According to a group of scientists at Cornell University, all people have approximately the same threshold of pain, regardless of age, race, sex, emotional state or fatigue. After testing thousands of subjects with a pain-measuring instrument called a dolorimeter. Dr. James D. Hardy, Dr. Harold G. Wolff and Helen Goodell reported that most people first feel pain when their skin is heated to about 45 degrees Centigrade, the temperature at which it begins to burn.
On the other hand, similar experiments by other investigators indicate that the pain threshold varies considerably ' in different people and even in the same person at different times. During menstruation, for instance, women often experience a lowering of the pain threshold due to general malaise and increased irritability.
How a fakir walks on fire
While the controversy over its threshold is hotly debated in the laboratories, most doctors feel that in actual practice there isn’t much point in trying to measure separately the bodily factor in pain. For pain is made up of two components, physical and mental, and its total is arrived at not by addition but by multiplication. If you add two and two you get four. If you add two and zero you still get two. But multiply two by zero and you get nothing. Hence, although the physical side of the equation may be the same for everyone, it’s possible for two people to suffer the same blow and for one to find it unendurable and the other unnoticeable. One multiplies the physical factor by a huge mental factor, the other by a negligible mental factor.
It may therefore be true that an Indian fakir who walks barefoot over hot coals and a child who faints at the prick of a vaccination needle theoretically feel the same amount of pain. But because they have been differently conditioned by experience they respond to pain in enormously different ways. “The more I think of it, the less convinced I am that experimentally produced pain and the painmalady can be regarded as one and the same thing," wrote Dr. René l.eriche, an internationally famous French surgeon. “Physical pain is not the simple affair of
an impulse traveling at a fixed rate along a nerve. It is the result of the conflict between a stimulus and the whole individual.”
Current treatment of pain takes full account of its mental elements. Doctors know that the slight aches you normally encounter and disregard in the course of a day swell out of all proportion when you’re in a psychological jam. People leading happy, active lives can tolerate pain more easily than those who are lonely and depressed. The more pain disrupts your life pattern, the more it hurts. Dr. Henry K. Beecher of Harvard Medical School, comparing seriously wounded soldiers with hospital patients who had undergone surgery, found that only one soldier in four complained of pain as against three quarters of the civilians. Beecher pointed out that surgical wounds usually mean trouble and disease, while war wounds signify the end of combat and return to safety.
Distraction blunts your perception of pain. In daytime you may forget the abscessed tooth that keeps you in agony at night. Under the stress of emergency, seriously injured people sometimes disregard their pain for hours. During a tennis tournament, for example, a student felt a sudden intense pain as though his stomach had burst but he pulled himself together, played forty minutes longer, drove to hospital and collapsed with a perforated ulcer. Dr. Wolff of Cornell estimated that distraction such as adventure stories, clanging bells and the effort to concentrate on a series of numbers raised the pain threshold as much as forty-five percent. Suggestion has an even stronger effect: led to believe that they had taken a pain-killing drug, two medical students had their pain thresholds raised ninety percent and felt no pain when their skin blistered from intense heat.
A pain in the neck is real
On the other hand, suggestion can be used to cause actual pain. “Under certain conditions, any sensation may cause pain,” explains Dr. Donald J. McCulloch, director of the out-patient department of the Ontario Hospital, Toronto. “If you tell someone under hypnosis that you’re going to burn him, then touch him with a pencil, he feels real pain. The imaginary flame may even produce a real welt because his vascular system responds to his belief that he has suffered pain.”
“Pain may be the direct expression in the body of emotional discomfort,” says Dr. Keith A. Yonge of the University of Saskatchewan. Fear often produces emotional tension which the body translates into muscular tension that causes pain. You may blame overwork, diet, allergy or the weather for minor pains whose real source is emotional stress. This kind of pain usually hits the head, back and stomach whose muscles arc especially responsive to emotion, causing disturbances such as fibrositis, ulcers and “tension headaches.” Trapped in an argument, you may rub the back of your neck because your antagonist is literally giving you “a pain in the neck.”
People obsessed by guilt are especially susceptible to physical pain that has no organic cause, and may actually welcome it as a form of self-punishment. Strong emotion directly affects your perception, and just as some people hear voices or see visions, others suffer symbolic pain in which their emotion is projected into the appropriate part of the body. Hands and teeth, which represent aggression, and the genital organs are typical targets for symbolic pain. A soldier with sharp pain in his fingers baffled doctors until
psychotherapy revealed that he was so consumed by pent-up rage that he enjoyed killing animals with his bare hands. His feelings of guilt focused on his hands because they were his outlet for hostility.
Pain from an emotional source causes just as much suffering and bodily damage as pain that begins in a physical cause. There is no such thing as imaginary pain. Pain is always a real and immediate experience, impossible to imagine or “invent” after it disappears. Old-fashioned doctors who said, “Your pain’s all in your mind,” lost the confidence of the patient who knew he had a pain because he could feel it.
Whatever its source, intense or longcontinued pain can throw your whole personality off balance. It alters your breathing and pulse rate, reduces your circulation and increases your general sensitivity. Dr. Leriche describes the way suffering builds up: “In a very short time, pain will convert the brightest spirit into a being haunted, driven in upon himself, thinking only on his disease, selfishly indifferent to everything and everybody, and constantly obsessed by the dread of recurrent spasms of pain.” Undoubtedly pain contributes to the relatively high suicide rate of older people who live alone and suffer from chronic disease.
Your reaction to pain depends to a large extent on the amount of pain you encountered in childhood and the way your parents taught you to meet it. Though a newborn baby responds instinctively to pain by crying or jerking away, you take years to develop the complex psychological response of a normal adult. If you were never exposed to injury you would never learn to recognize pain. In a recent experiment at McGill University, Dr. Roland Melzack of the department of psychology reared two dogs in isolation where they were completely protected from pain. Released at maturity, they rushed about so excitedly that they often got their tails and paws stepped on but paid no attention. Pain meant so little to them that, months later, they still thrust their noses into a lighted cigar.
Unlike Dr. Melzack’s dogs, a healthy child gradually learns to handle the mechanics of the world around him by coping with pain in small doses. Doctors advise parents to avoid over-protection while guarding their children against intense pain that would leave them emotionally crippled and fearful of being hurt again. A child who is reassured but not fussed over accepts moderate pain with equanimity.
“Kids who haven't been scared by their parents usually have a high pain threshold,” a Toronto dentist says. “When I give them an anesthetic 1 tell them the needle prick is a mosquito bite and they think it’s a joke. The one time 1 said, This may hurt a bit,’ the little girl cried.”
Workers in certain occupations are conditioned to pain by repeated exposure. Some waitresses learn to carry plates most of us would find too hot to handle. A Toronto electrician has developed a local resistance to shock that prevents him from feeling the current in an ordinary household outlet with his hand or arm below the elbow, though other parts of his body have normal sensitivity. Because he has no warning of injury, he ölten burns his hands.
Your cultural background has much to do with the way you handle pain. While warrior tribes like the Spartans and Cossacks trained themselves to remain impassive through agonizing ordeals, some races are habitually more demonstrative. A recent study of three ethnic groups at the Kingsbridgc Veterans Flospital in New York indicated that
third-generation Americans try to hide their pain while Jewish and Italian patients openly show emotion. A typical Italian complained freely about his pain and cheered up quickly when it was relieved. Jewish patients, on the other hand, worried more about the effect of their illness on their future health and the welfare of their families. They were reluctant to take drugs, which they felt provided only temporary relief at the price of possible addiction, and remained skeptical about the doctor’s ability to check their disease at its source.
By protecting us with drugs and anesthetics, medical progress has at the same time increased our general sensitivity. According to Leriehe, “We are more susceptible to pain than our ancestors. We try to avoid the slightest pain, because we know that we have the means of doing so. And, by this very fact, we make ourselves more readily susceptible to pain, and we suffer more.” Our modern reluctance to endure unnecessary pain received papal sanction last February when the Pope approved the relief of pain by such means as anesthesia, drugs, medical hypnotism and painless childbirth.
The pain of a lost limb
Labor pains, hot-grease burns and the spasms of angina pectoris and tic douloureux are considered the most intense of all pains. Tic douloureux, a kind of facial neuralgia, is a sudden flash ol agony that lasts only seconds but keeps its victim in such dread of the next attack that he may resort to suicide.
The most bizarre kind of pain is felt in the ghost of an arm or leg after amputation. Most amputees continue to “feel” the missing limb because everyone carries a body image mapped out on the parts of his brain that associate complex ideas. If the real limb was painful, the pain tends to linger on after amputation. Phantom-limb pain may also stem from irritation of the stump or from the emotional shock of losing part of the body.
Equally strange is causalgia, a fierce burning pain that sometimes follows nerve injury, especially after war wounds in the arm and leg. In some mysterious way it seems to set up a permanent or self-renewing change in the nervous system that keeps the stricken part untouchably tender and spreads sickening pain through the whole body.
A few rare individuals are born without the ability to perceive pain. Although not psychotic or mentally retarded, they apparently lack the brain structures that warn us of damage to the body. By trial and error they learn to avoid injury, but burns and broken bones often mark their childhood. One three-year-old habitually chewed his fingers until they bled. A man who took advantage of this condition
was Edward H. Gibson, a vaudeville actor of the Twenties who billed himself as “the human pincushion,” and once climaxed his act with an on-stage crucifixion. The performance was broken up by the collapse of several spectators when an assistant drove the first goldplated spike through the palm of Gibson’s hand.
Like the children who can’t feel pain, all of us might suffer more physical injury if pain didn’t sometimes force us to call medical help or at least to rest our overworked bodies. But many diseases of the heart, lung and kidney progress beyond cure without causing pain at all. and leprosy, which actually destroys sensitivity to pain by damaging nerve endings, is often unsuspected until the victim notices that cigarette burns don't hurt him. Nowadays doctors feel that the usefulness of pain as a danger signal is far outweighed by its corrosive effect on the person who suffers.
Current medical practice has marshaled formidable weapons against pain:
• Pain-relieving drugs range in strength from aspirin to powerful narcotics such as codeine, morphine, and demerol. Though narcotics always carry a heavy addiction risk, especially for alcoholics and other emotionally disturbed patients, no other drugs work so well against pain. Their action can be supplemented with tranquilizers and stimulants such as Largactil, Miltown and Ritalin, newly developed types of drug aimed at mental tension, depression and other psychic states on which pain thrives.
• Local anesthetics such as procaine are used to block nerve pathways and to infiltrate painful tissues.
• Surgery can he used to cut the nerve fibres and tracts that carry pain-causing sensations to the brain. Lobotomy, the most drastic pain-relieving operation, severs the connections between the thalamus and the front part of the cerebral cortex, so that the patient still feels the sensation of pain but is no longer bothered by it. Apart from its use in the treatment of mental illness, lobotomy is usually reserved for conditions such as incurable cancer because it sometimes causes changes in personality.
• New psychiatric techniques, backed up by sympathy and advice from the patient's own doctor, are used to free him from painful fears and build up his emotional resistance.
But we are still far from conquering or even comprehending pain. Lighting pain is like trying to dam a river that can spring up from nowhere, renew itselt indefinitely and reappear just out of reach whenever we find new ways to block its channels. No matter what its intensity, pain is always an urgent, dynamic force that leaves us damaged in some degree. As Leriehe says, the only pain we find easy to bear is the pain of others. it