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What Is Pain? What Influences the Pain Experience?

Just take a moment and think about pain. It’s in the news; we treat it in our practices, but to frame this discussion, here is a brief definition from the International Association for the Study of Pain. Pain is an “unpleasant sensory and emotional experience.” And those are the keywords. Pain exists to protect us from damaging tissue and/or from further damaging tissue that’s already damaged. Pain is a God-given neurocircuited response to keep us alive and to help us be less damaged. So if you have pain in your ankle, you don’t walk on it because it’s injured. That definition really applies to acute pain, but it is also the only definition we have for chronic pain, and the real key is that pain is an experience. If I interviewed every person in the room and asked you to tell me about your pain, each of you would likely have a totally different report. Maybe similar words, but no one can have the same experience with pain as the person sitting next to him or her.

There are a lot of things that influence pain. One is culture. For example, I was raised in a Jewish home. I will be whining a good part of the afternoon. He has a cold, poor guy, and I have back pain, and I will gladly tell you about it if you want to know because that’s the way I was raised. Whining was sort of what we ate for dinner. My mother was such an expert at it that she didn’t have to say anything. It was just “Ma, how are you?” “Ahhh . . .” And that’s the way it is in my culture. There are a lot of cultures I’m told—personally, I don’t get it—where they don’t express pain; they are stoic, such as the Norwegian, Native American, and African cultures where it’s not acceptable to show any response to pain. These people tend to have less pain. These are cultures where women deliver babies without anesthesia and without uttering a sound. I don’t know how that happens, but it does.