Transcending Pain

Most human beings understand pain in terms of tissue destruction or disease. For example, an ankle sprain hurts, as does a bout of appendicitis. Most health care professionals think the same way, and the way that they treat pain is to reverse or contain the disease or to assist with the healing. For example, a rheumatologist finds the right combination of medicine for a patient with rheumatoid arthritis and an orthopedic surgeon properly reduces and casts a fractured limb.

This way of looking at pain is called the biomedical model by physicians. Although the model serves physicians well in most cases of acute or temporary painful conditions, it can become a problem. What if the pain cannot be explained by an injury or a disease? What if the treatment does not work? What if the patient has a hard time explaining the pain experience or the doctor misunderstands or simply does not listen? What if the pain begins to change after what everyone thought would be adequate treatment? Do delays in getting treatment change the biomedical model in some way? When these things happen, do most doctors and patients know what to do next?

The human pain experience involves things other than simple tissue destruction or disease, particularly when things are not going well. A person's pain tolerance, for example, can vary considerably because of many factors including genetics. Examples of other factors that can alter the pain experience include:

• Expectation of pain – Most people believe that dental procedures are going to hurt, that an injection will be painful or that all cancers cause pain.

• Fear or anxiety – Some people may have fear about the pain itself or may have anxiety because the pain is present for other reasons (e.g., prisoners of war who are repeatedly physically or mentally tortured).

• Cultural beliefs about pain – Cultural beliefs influence how people relate to pain. For example, most Americans think of pain as a danger signal for the presence of disease; some Native American tribes view pain as a voluntary spiritual cleansing experience; different religious and ethnic groups may view it as a punishment, curse, reward, or simply a part of life that must be accepted.

• Distraction – The soldier wounded in battle or the professional athlete engaged in a contest may not notice pain.

• Environment – A tension headache might feel quite different while lying on a warm beach listening to the ocean as opposed to trying to concentrate in a room full of screaming children.

• Mental state – Anxiety, depression or other mood disturbances or sedation from the use of alcohol or illegal or prescription drugs can alter a person's level of pain awareness.

• Further damage by incorrect or inappropriate treatment – Poor medication choices and unnecessary surgical procedures can increase pain.

When pain specialists pay attention to all of the many aspects of human pain experiences, they are following what is called the biopsychosocial model as opposed to the more traditional biomedical model mentioned above. In other words, they understand that in addition to injury and disease, other things must be evaluated and sometimes included in treatment in order to help their patients.

Transcending the traditional thinking about pain is what this column will be about. We will see how the teachings of some health care professionals and people from all walks of life, including patients, can make the biopsychosocial model come alive for you, even when things seem to be most desperate.

Transcending pain is not about "going home and living with it" or "learning to cope." It is about actually altering the pain experience, educating you and your doctor in ways to relieve suffering, and getting your life back.