Pain has been called paradoxical for various reasons (for example, pain is a mental state and yet we have pains in parts of the body), but I have a particular paradox in mind; the contradiction between the positive impact pain has on our existence and our negative attitude towards pain. Now it may be that my positivity grates with some readers because pain can blight lives, but bear with me.
Years ago I came across a book with the arresting title “Pain: The Gift Nobody Wants” (by Paul Brand and Philip Yancey – later called “The Gift of Pain”), which neatly summarises our complex relationship with pain. On the one hand, pain fulfils the essential function of preventing or minimising injury; on the other hand, we don’t want to be in pain. These aspects of pain are intimately connected. Our dislike of pain motivates us to avoid or inhibit behaviour that causes pain, and in this way we avoid or inhibit behaviour that causes or could cause injury. Although negativity about pain is hard-wired in the experiential sense (we don’t want to be in pain), the functional contribution of pain is overwhelmingly advantageous. So why do we think negatively of pain?
To a certain extent the answer’s simply that we can’t see the wood for the trees – we can’t see pain’s advantage because we dislike being in pain. But many, including some experts, don’t even consider pain’s positive contribution to our lives. They see pain as an abnormality, as a problem in itself. Part of the reason for this is that pain research is heavily biased towards persistent maladaptive pain (often misleadingly called ‘chronic pain‘) – a prolonged episode of pain that’s not fulfilling its evolutionary function of preventing or minimising injury (i.e. it’s not adaptive, hence it’s maladaptive). The economic and personal (in terms of suffering) costs of maladaptive pain are huge, so the scientific and medical focus is understandable, but this does not excuse the widespread negativity that surrounds pain generally.
Pain: The Gift Nobody Wants focuses on people with leprosy; a disease that affects peripheral nerves making sufferers unable to experience pain. Not only are these people likely to suffer major injury, they are also vulnerable to repeated injury of the same part of the body. In this way, minor injuries can become serious enough to threaten survival. In order to prevent these problems an artificial pain system was developed. The prototype system utilised a light to warn the person to change behaviour. The premise that underpinned this prototype was that absence of pain amounts to a lack of awareness – the person injures herself because she doesn’t know she’s damaging tissue. But unfortunately this system was ineffective. You might think that, as rational creatures, knowledge of the (potentially) damaging consequences of an activity would be sufficient for someone to modify behaviour, but it was not. In many cases the desire to continue with whatever the person was doing outweighed any rationally driven motivation to cease.
Instead of utilising a warning light, the second artificial pain system delivered an electric shock to a body part unaffected by nerve damage so that activity likely to injure actually caused pain, but this too was largely unsuccessful. Clearly the pain generated by the artificial system motivated the person to behave in a way that eliminated the pain, but this could be done in one of two ways: by changing the activity causing the pain; or by disconnecting the pain system. It turned out that in many cases the desire to continue with some particular activity motivated people to disconnect the system despite the potential for injury.
What’s interesting is that the rational focus should be injury; after all, the consequences of injury can be very significant. And yet, the evidence is that the motivation to persist with an activity often outweighs any rationally generated motivation to stop. So an experience that warns without negative affect (i.e. unpleasantness) could not have evolved as a means of preventing or minimising injury for the simple reason that it does not work. The unpleasant nature of pain motivates directly and much more forcefully than rationality. The weakness of this means of preventing or minimising injury is that pain, not injury, is the central focus of our motivation; we want to get rid of pain. Hence we tend to see pain as the problem, not as the solution to the problem (of injury). Consequently, we behave in ways that mirror Brand and Yancey’s experiences with people with leprosy; when we take pain-killers our intention is to turn off the pain system. This is an extremely useful ability. It enables us to perform surgery without pain, and to ease or eliminate pain where appropriate (post-surgical or maladaptive pain, for example). Ironically, it’s easy to see the potential pitfalls of abuse of this ability when we reflect on the disconnection of Brand and Yancey’s artificial pain system, and yet we continue to see pain negatively and reach for the pain-killers. The trouble is that there’s a huge and very powerful pharmacological and treatment industry behind pain relief. This industry has a vested interest in reinforcing the natural tendency to view pain negatively, as something abnormal, as something undesirable that must be eliminated. Nothing could be further from the truth!
The Pain Jam 