THE PHENOMENON OF PAIN ITS NATURE AND TYPES:Perceiving Pain

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Health Psychology PSY408

Lesson 23

THE PHENOMENON OF PAIN

ITS NATURE AND TYPES

Wouldn't it be wonderful never to experience pain, many people have thought when they or others they

have known were suffering. Pain hurts, and people typically dislike it and try to avoid it. But being able to

sense pain is critical to our survival--without it, how would we know when we are injured? We could have a

sprained ankle or an ulcer, for instance, without realizing it, and not seek treatment. And how would we

know we are about to be injured, such as when we approach a hot flame without seeing it? Pain serves as a

signal to take protective action.

Are there people who do not feel pain? Yes--several disorders can reduce or eliminate the ability to sense

pain. People with a condition called congenital insensitivity to pain, which is present from birth, may

report only a "tingling" or `itching" sensation when seriously injured. A young woman with this disorder

seemed normal in every way, except that she had never felt pain. As a child she had bitten off the tip of her

tongue while chewing food, and had suffered third-degree burns after kneeling on a hot radiator to look out

of a window. When examined by a psychologist, in the laboratory, she reported no pain when parts of her

body were subjected to strong electric shock, to hot water at temperatures that usually produce reports of

burning pain, or to a prolonged ice-bath. Equally astonishing was the fact that she showed no changes in

blood pressure, heart rate, or respiration when these stimuli were presented. Furthermore, she could not

remember ever sneezing or coughing, the gag reflex could be elicited only with great difficulty, and the

cornea reflexes (to protect the eyes) were absent. This disorder contributed to her death at the age of 29.

People with congenital insensitivity to pain often die young because injuries or illnesses, such as acute

appendicitis, go unnoticed.

Health psychologists study pain because it influences whether individuals seek and comply with medical

treatment and because being in pain can be very stressful, particularly when it is intense or enduring. In this

and coming lectures we will examine the nature and symptoms of pain, and the effects it has on its victims

when it is severe. As we consider these topics, you will find answers to questions you may have about pain.

What is pain, and what is the physical basis for it? Can people feel pain when there is no underlying physical

disorder? Do psychosocial factors affect our experience of pain? Since pain is a subjective experience, how

do psychologists assess how much pain a person feels?

What is Pain?

Pain is the sensory and emotional experience of discomfort, which is usually associated with actual or

threatened tissue damage or irritation (Sanders, 1985). Virtually all people experience pain and at all ages--

from the pains of birth for mother and baby, to those of tummy ache and teething in infancy, to those of

injury and illness in childhood and adulthood. Some pain becomes chronic, as with arthritis, problems of

the lower back, migraine headache, or cancer.

People's experience with pain is important for several reasons. For one thing, no medical complaint is more

common than pain. According to researcher Paul Karoly, "pain is the most pervasive symptom in medical

practice, the most frequently stated `cause' of disability, and the single most compelling force underlying an

individual's choice to seek or avoid medical care" (1985, p.461). As we know that people are more likely to

seek medical treatment without delay if they feel pain. Also, severe and prolonged pain can come to

dominate the lives of its victims, impairing their general functioning, ability to work, social relationships,

and emotional adjustment.

Last, pain has enormous social and economic effects on all societies of the world. In the United States at

any given time, a third or more people suffer from one or more continuous or recurrent painful conditions

that require medical care, and tens of millions of these people are partially or completely disabled by their

Health Psychology PSY408

conditions. Americans spend tens of billions of dollars each year on pain-related expenses, such as for

treatment, loss of income, disability payments, and litigation.

The Qualities and Dimensions of Pain

Our sensations of pain can be quite varied and have many different qualities. We might describe some pains

as "sharp" and others as "dull," for example-- and sharp pains can have either a stabbing or pricking feel.

Some pains involve a burning sensation, and others have a cramping, itching, or aching feel. And some

pains are throbbing, or constant, or shooting, or pervasive, or localized. Often the feelings we experience

depend on the kinds of irritation or damage that has occurred and the location. For instance, when damage

occurs deep within the body, individuals usually report feeling a "dull" or "aching" pain; but damage

produced by a brief noxious event to the skin is often described as "sharp".

The painful conditions people experience also differ in how the pain originates and how long it lasts. We

will consider two dimensions that describe these differences, beginning with the degree to which the origin

of the pain can be traced to tissue damage.

Organic Versus Psychogenic Pain

People who suffer physical injuries, such as a serious burn, experience pain that is clearly linked to tissue

damage. When discomfort is caused mainly by tissue damage, it is described as organic pain. For other

pains, no tissue damage appears to exist--at least, medical examinations fail to find an organic basis. The

discomfort involved in these pains seems to result primarily from psychological processes. For this reason,

this type of discomfort is described as psychogenic pain. I once witnessed an extreme example of

psychogenic pain in a schizophrenic man: he claimed--and really looked like--he was "feeling" stings from

being "shot by enemy agents with laser guns."

Not long ago, researchers considered organic and psychogenic pain to be separate entities, with psychogenic

pain not involving "real" sensations. As pain researcher Donald Bakal has noted, a practitioner's reference

to pain as "psychogenic" was taken to mean "due to psychological causes," which implied that the patient

was "imagining" his pain or that it was not really pain simply because an organic basis could not be found.

Psychogenic pain is not experienced differently, however, from that arising from physical disease or injury.

Psychogenic and organic pain both hurt.

Researchers now recognize that virtually all pain experiences involve an interplay of both physiological and

psychological factors. As a result, the dimension of pain involving organic and psychogenic causes is viewed

as a continuum rather than a dichotomy. Different pain experiences simply involve different mixtures of

organic and psychogenic factors. A mixture of these factors seems clear in the findings that many people

with tissue damage experience little or no pain, others without damage report severe pain, and the role of

psychological factors in people's pain increases when the condition is long lasting. When people experience

chronic pain with no detectable physical basis, psychiatrists diagnose the condition as a pain disorder

(classified within somatoform disorders) and often assume the origin is mainly psychogenic. Keep in mind,

however, that failing to find a physical basis for someone's pain does not necessarily mean there is none.

Unfortunately, many health care workers still think pain that has no demonstrated physical basis is purely

psychogenic, and their patients struggle to prove that "the pain isn't just in my head, Doc" (Karoly, 1985).

Acute versus Chronic Pain

Experiencing pain either continuously or frequently over a period of many months or years is different

from having occasional and isolated short-term bouts with pain. The length of experience an individual has

had with a painful condition is an important dimension in describing his or her pain.

Most of the painful conditions people experience are temporary--the pain arrives and then subsides in a

matter of minutes, days, or even weeks, often with the aid of painkillers or other treatments prescribed by a

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physician. If a similar painful condition occurs in the future, it is not connected in a direct way to the earlier

experience. This is the case for most everyday headaches, for instance, and for the pain typically produced

by such conditions as toothaches, muscle strains, accidental wounds, and surgeries.

Acute pain refers to the discomfort people experience with temporary painful conditions that last less than

6 months or so. Patients with acute pain often have higher than normal levels of anxiety while the pain

exists, but their distress subsides as their conditions improve and their pain decreases.

When a painful condition lasts for more than 6 months, it is called chronic. People with chronic pain

continue to have high levels of anxiety and tend to develop feelings of hopelessness and helplessness

because various medical treatments have not helped. Pain interferes with their daily activities, goals, and

sleep; and it can come to dominate their lives. Pain patients frequently say that they could stand their pain

much better if they could only get a good night's sleep... They feel worn down, worn out, exhausted. They

find themselves getting more and more irritable with their families, they have fewer and fewer friends, and

fewer and fewer interests. Gradually, as time goes by, the boundaries of their world seem to shrink. They

become more and more preoccupied with their pain, less and less interested in the world around them.

Their world begins to center around home, doctor's office, and pharmacy.

Although pain itself can interfere with sleep, intrusive thoughts and worry before getting to sleep may be a

more important factor. Another problem of people with chronic pain is that many leave their jobs for

emotional and physical reasons and must live on reduced incomes at the same time that their medical bills

are piling up. The experience of pain is very different when the condition is chronic than when it is acute.

The effects of chronic pain also depend on whether the underlying condition is benign (harmless) or is

malignant (injurious) and worsening and whether the discomfort exists continuously or occurs in frequent

and intense episodes. Using these factors, researchers have described three types of chronic pain:

1. Chronic-recurrent pain stems from benign causes and is characterized by repeated and intense episodes

of pain separated by periods without pain. Two examples of chronic-recurrent pain are migraine headaches

and tension-type (muscle-contraction) headaches.

2. Chronic-intractable-benign pain refers to discomfort that is typically present all of the time, with varying

levels of intensity, and is not related to an underlying malignant condition. Chronic low back pain often has

this pattern.

3. Chronic-progressive pain is characterized by continuous discomfort, is associated with a malignant

condition, and becomes increasingly intense as the underlying condition worsens. Two of the most

prominent malignant conditions that frequently produce chronic-progressive pain are rheumatoid arthritis

and cancer.

As we shall see later in this lecture and in the next one, the type of pain people experience influences their

psychosocial adjustment and the treatment they receive to control their discomfort.

Perceiving Pain

Of the several perceptual senses the human body uses, the sense of pain has three important and unique

properties. First, although nerve fibers in the body sense and send signals of tissue damage, the receptor

cells for pain are different from those of other perceptual systems, such as vision. For instance, the visual

system contains specific receptor cells that transmit only messages about a particular type of stimulation--

light--there are no specific receptor cells in the body that transmit only information about pain. Second, the

body senses pain in response to many types of noxious stimuli, such as physical pressure, lacerations, and

intense heat or cold. Third, the perception of pain almost always includes a strong emotional component.

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As we are about to see, perceiving pain involves a complex interplay of physiological and psychological

processes.

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