Chapter 6 - Health and Illness - Part 3 - Chronic Pain - Part 1

“There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds.”
Laurell K. Hamilton, Mistral’s Kiss

In part three of this series about health and illness, I would like to present some thoughts and ideas about chronic pain.

Pain is defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and is expanded upon by the addition of six key Notes and the etymology of the word pain for further valuable context.
IASP 16th July 2020

The six key Notes, as given by the IASP in 2020, are:

Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
Through their life experiences, individuals learn the concept of pain.
A person’s report of an experience as pain should be respected.
Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

Chronic Pain

I think that it is very important, before we go into details and classifications and things, to first of all always bear in mind that a stubbed toe is a fairly simple form of pain (although it can be very intense) but chronic pain is, in my opinion and experience, always complex.

Pain may or may not have had an origin somewhere in the body. Chronic pain, however, has untold links into our present and our past and can project into our future, it relates to past experiences, to our human basic needs past, present and future, to our fears and anxieties. Often we find it difficult if not impossible to express it in words, our language is not really suited to describing it. It is related to how secure and needed we feel in work, with friends, with family, in our social contexts. It is related to our attitides and experiences with our own bodies.

Almost all parts of our brain can be involved in chronic pain. As is often the case with complex problems, the solution is rarely just finding that one “right” button to press, it needs movement and change in various places and on numerous levels.

Chronic pain can be classified into some broad groups. The pain in any one case can, of course, derive from multiple origins, that is, “mixed pain”.

Nociceptive pain – from pain receptors
Neuropathic pain – from changes or injury to nerve pathways
Stress-induced or nociplastic pain – changes to processing of pain by the brain

A very short history of pain:

17th century – The French philosopher René Descartes describes pain as a simple reflex reaction to damage to the body (see above image). Pain is a signal with a measurable reaction.
1900 – Paul Sudeck describes Algodystrophia, now known as CRPS, in which pain, swelling, sensitiveness and perfusion changes can persist after injury.
1937 – René Leriche describes a pain syndrome and investigated phantom pain. He sees the person as a subject and individual in his/her life context.
1965 – Ronald Melzack and Patrick Wall publish gate-control-theory in which subjective experience and pain processing are investigated.
1974 – John J. Bonica describes multimodal pain therapy and founds an interdisciplinary pain clinic.
1977 – George Engel proposes the bio-psycho-social model for pain.
1983 – Dennis Turk describes self efficacy in pain
21st century – “pain matrix” in which pain is seen as a conscious experience as a result of activity of a network of brain cells distributed over the brain (see image below). (link 1 and link 2)

Some brain areas involved in chronic pain

Some of the areas of the brain involved in pain:

A switchboard for gathering sensory information from the periphery and the spine to these on to the brain
Which part of the body has been affected? How much? What happened?
How much stress do I have at the moment?
My library: in which context has this happened? Has it happened before?
Is it affective, emotional or social pain? Deprivation hurts too.
How am I feeling at the moment? Is there a discrepancy here? Do I need to be worried?
How do I react in my group context? How can I cope?
and much much more

To put it in a more visual way, every person has their own unique “landscape” or “ground” upon which pain falls. Thus, everyone has a different and unique pain experience. So, in order to deal with chronic pain we need to approach the situation with as broad an approach as we can. Different types of medication can, of course, be beneficial at different points in the journey.

We need to start at the beginning with, for example, early life experiences, to look at significant life events, to make a picture of the basic human needs of each individual and how, if indeed they have, been approached and fulfilled. How do I deal with relationships, attachment? How do I interact in my social context? How is my present and what do I see in the future? What other issues do I have and how disconnected are they? How can I tell you about it?

lampart-design has very kindly given me permission to use some of her PAINtings to visualise some of the issues in chronic pain, here are four which wonderfully visualise her view of “body and soul”, “detachment” and “when I try to describe how I feel”. I have included a link to her website above and below.

The artist can be contacted via lampart-design.

Below is a link to a separate gallery of her PAINtings: