What's Changing? - Pain

Please see below selected recent pain-related change.

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August 2024

Many of us dimly sense that, despite ourselves, we keep ending up in some very similar dark places: Or else the repeated patterns involve a return to a background mood: yet again we feel highly anxious. Yet again we feel convinced that everyone hates us or that something terrible is about to happen. Psychotherapists have given all this a name. In so far as we keep steering ourselves back to some familiar negative circumstances or emotions, we may be in the grip of what is known as a ‘repetition compulsion.’ We aren’t here again by coincidence, we are - in an unconscious part of our minds - steering ourselves to a place of pain with hidden intent.
The five stages of grief are as much a metaphor for grief as shattered glass, despite the common tendency to take them literally. For many people, this metaphor is effective for making sense of grief. For others, however, shattered glass is a more meaningful and helpful metaphor. It captures a profound insight well put by the philosopher Mariana Alessandri in her book Night Vision (2023): ‘Grief puts us in touch with a basic fact: surviving hurts.’

July 2024

A sufferer of chronic pain asked: what if we faced pain and acknowledged it objectively and clearly, with a sense of curiosity that lacks judgement. This idea grounds various behavioural health therapies such as pain reprocessing therapy and cognitive behavioural therapy, both which have been found by some sufferers to reduce or eliminate pain and require acknowledging pain’s presence. Studies have found that acceptance of pain can be associated with lower pain levels, less psychological distress, and better biopsychosocial functioning.

June 2024

Researchers explored how psychedelics might help the brain “snap out” of chronic pain, a condition that’s sometimes disconnected from any physical injury. Chronic pain can be deeply psychosomatic, reflecting the complex relationship between the mind and body, making it challenging to treat.
Preliminary evidence suggests that psychedelics like LSD and psilocybin can beneficially disrupt the brain’s pain pathways, especially when used alongside more conventional therapies.
A concept called “Skinner’s Law,” named after the American behaviorist B. F. Skinner, suggests that we can manipulate our motivation by making the pain of not doing a task greater than the pain of doing it - or making the pleasure of doing it greater than the pleasure of not doing it. “Commitment devices,” such as setting up rewards or punishments for completing or not completing a task, can help us self-motivate and increase our chances of success.

May 2024

Our bodies keep the score. But what is the score, and how can we discover it? To generalise, our bodies are repositories of pain. The more difficult our trajectory to life has been, the more we are likely to feel negatively towards our bodies and the more troubles they are likely to give us. If early care-givers did not take a delight in our physical form, we are unlikely ever to be able to take pleasure in our own appearance. A second area where our bodies function like recording machines is around fear: how on edge or primed for danger do they feel? Our bodies can be permanently vigilant, as though waiting for a blow or attack. We may have trouble sleeping and our digestive systems may be unable to unclench - indicators of a past filled with cruel or unpredictable dynamics.

February 2024

Pain is the most common reason people seek out medical care, and while there are seemingly infinite causes of pain, there are few options for treating it. Over-the-counter medicines, like ibuprofen and aspirin, are safe and easily accessible, but they are only effective for mild pain. Prescription opioids, like oxycodone and morphine, meanwhile, are highly effective, but they can also cause a “high” that can be addictive and lead to misuse. New painkillers that are highly effective, but non-addictive are therefore one of the holy grails of medicine, and this search has now led to a class of drugs called “sodium channel modulators”.
We sometimes cause ourselves a lot of pain by pretending to be competent, all-knowing, proficient adults - long after we should, ideally, have raised the white flag. For The School of Life, it’s at times like these that we should remember an exercise with a power to assuage our unhelpful rigidity and restore our mental well-being: we should - without any embarrassment or compunction - curl ourselves up into a very small ball.

January 2024

Humans can end up being cruel, not for money or gain, but in the hope of alleviating their own sufferings by making someone near them suffer in their stead. Cruelty is at heart an attempt to make ourselves feel better by doing to someone else a version of what was done to us.

November 2023

The School of Life believes that, to generalise, our bodies are repositories of pain. The more difficult our trajectory to life has been, the more we are likely to feel negatively towards our bodies and the more troubles they are likely to give us. Two problems in particular stand out. Firstly, low bodily self-esteem. If early care-givers did not take a delight in our physical form, we are unlikely ever to be able to take pleasure in our own appearance. We will be tempted to interpret the gaze of others as hostile, we’ll look at ourselves in the mirror and flinch; we’ll feel sorry for a partner who has the misfortune to have to deal with us close-up. And equally, if a caregiver directed contempt towards our characters, a little of their disdain tends to wash over into our physical self-perception.

March 2023

Cicely Saunders, whose work in terminal care research and palliative medicine helped form the hospice movement, believed that physical and mental pain share a relationship and should be thought of together, what Saunders called “total pain". However, our current mental health therapies are not always well-equipped to treat the mental and emotional side of terminal patients’ pain. “Existential distress” of the kind faced by people at the end of their lives is not a mental health disorder found in e.g. the DSM-V.
As the well-known phrase puts it, our bodies keep the score. But what is the score, and how can we discover it, asked The School of Life? To generalise, our bodies are repositories of pain. The more difficult our trajectory to life has been, the more we are likely to feel negatively towards our bodies and the more troubles they are likely to give us.

February 2023

Big Think noted that, according to Buddhism, the path to liberation from suffering and the attainment of lasting happiness lies within the realm of the mind. Through the cultivation of wisdom, ethics, and mental discipline, we can achieve this. By following the Eightfold Path, developing mindfulness and compassion, and accepting impermanence, we can think our way to freedom from existential pain.

December 2022

Psyche research founds that while heartbreak may not be a new concept, it now has a provable medical history. Experiencing the emotional pain of natural disasters, grief, trauma, arguments and even watching sports can potentially have very real physical consequences for our health and survival. We truly can be heartbroken.
Further reading:
- Can we diagnose suffering without knowing a person’s history? - Psyche Ideas

July 2022

Chronic pain, defined as pain felt for longer than three or six months, affects one in five people around the world. It often affects younger people in otherwise good health in their most productive years. Low back pain, the most common cause of chronic pain, is the leading cause of years lost to disability around the world. Yet despite the enormity of the issue, the management of chronic pain has been one of the greatest failures of medicine, warned Psyche.

June 2022

From an evolutionary perspective, it makes sense that we feel pain: It trains us to avoid experiences or stimuli that harm us, but that begs the question, why do so many people choose to pursue things that will bring them pain? To psychologist Paul Bloom, the answer is that living a meaningful life requires that we choose to take on a reasonable amount of pain.
Further reading:
- Safer painkillers: A novel drug treats pain without killing people - Big Think

May 2022

According to the biopsychosocial model, experiences of pain go beyond the purely physical: in particular, your mental state impacts your feelings of pain, which can make such feelings better or worse. Effective treatment of the psychological aspects of pain relies on your self-knowledge, specifically the knowledge you have about your negative thoughts, experiences and beliefs regarding your condition and potential to get better. However, being in pain can tax one’s cognitive resources and experiences that accompany being in pain can provide misleading information about the nature and extent of pain. This points to a potentially surprising conclusion: we can turn to others, such as friends and family, to make it easier to know things about what seem to be such as fundamentally personal experience as pain.
Persistent pain – also known as chronic pain – is defined by the World Health Organisation as pain lasting longer than three months. Persistent pain doesn’t have the same survival function as acute pain. If you had an injury before the pain began, it should heal within this time, yet the pain persists. Crucially, persistent pain also often occurs without injury or in the absence of another underlying medical condition.
Chronic pain affects as many as 50 million people in the US alone, and it is commonly thought to be exacerbated by inflammation. However, a recent study suggested that excessively fighting inflammation can actually hinder bodily healing, causing pain to stick around longer. If confirmed in a randomised clinical trial, the finding could implicate non-steroidal anti-inflammatory medications like ibuprofen and aspirin in causing chronic pain, claimed a Big Think report.
The Footsteps Festival is an online event coproduced by people with pain and providing a wide range of events and activities to help live well with pain.

February 2022

A pain education course can help people better understand their chronic pain (generally defined as persistent or recurrent pain that lasts for more than three months). For example, a course can explain how pain is always real, but that it isn’t always caused by tissue damage, and that it can vary depending on the context you’re in. This kind of psychoeducation can help to reduce the intensity of chronic pain.

January 2022

Humans can end up being cruel, not for money or territory, but in the hope of alleviating their own sufferings by making someone near them suffer in their stead. Cruelty is at heart an attempt to make ourselves feel better by doing to someone else a version of what was done to us. Amidst the seeming normality of family life, people will hence inject someone else (a spouse, a child) with a poison - an ill will, a contempt, a hostility, explained The School of Life.

December 2021

In Dopamine Nation: Finding Balance in the Age of Indulgence, Anna Lembke, notes that very many people have experienced some version of pain giving way to pleasure. Perhaps you’ve noticed an improved mood after a period of being ill, or felt a runner’s high after exercise, or took inexplicable pleasure in a scary movie. Just as pain is the price we pay for pleasure, so too is pleasure our reward for pain.

November 2021

The deep and visceral despair that comes from grief can be a transformative moment in our lives. While we all know, intellectually, that things die, those who have experienced grief first-hand experience the world in a different way. Philosophers have responded to the idea of death in different ways. Kierkegaard saw it as a door to faith, Heidegger as a way to give meaning to life, and Camus the absurdity of it all, noted Big Think.

October 2021

Despite global declines in poverty, increases in literacy and growing access to health care we have seen over the past several decades, many people in the world are in immense pain, which can be seen in disconcerting upticks in addiction, depression and suicide, particularly in wealthier nations. Wealth, technology and other advances may be aiding and abetting this suffering, according to Stanford psychiatrist and author Anna Lembke. What's going on? The human brain seeks balance. When we overindulge in food, drugs or tech, our brains look to bring us back down to Earth, which tips the balance from pleasure to pain. What can help right this balance? Accepting that pain is sometimes OK and learning to sit with it, rather than fight it, Lembke says.

November 2020

Many people today live longer than ever but modern lifestyles often mean too little activity, poor nutrition and chemically deficient food. This can lead to heart disease, high blood pressure, obesity, autoimmune disorders, cancer, chronic pain, and the like. Medicine can treat the symptoms of these diseases, but not always the underlying causes. Sarah Warren, a certified Clinical Somatic Educator, seeks to educate chronic pain sufferers about how to move properly. Warren explains that while poor posture and ingrained muscle patterns contribute to chronic pain, you can train your body to move differently and try to alleviate that pain.

October 2020

Ultra-endurance athletes may have a lower sensitivity to pain than other elite athletes. A German scientist completed a study on the pain tolerance of ultra-endurance runners. Subjects in the study had to hold their hands in ice water for as long as possible. The non-athlete control group lasted an average of 96 seconds before giving up; every single one of the runners, in contrast, made it to the three-minute safety cut-off, at which point they rated the pain as a mere 6 out of 10 on average. There have been some hints in previous studies that pain tolerance is a trainable trait, and that endurance training is one way of enhancing it.

September 2019

Chronic pain blights the lives of millions and imposes a huge burden on health and care systems. Despite advances in medical science, we are often at a loss to understand what causes chronic pain or how it should be treated. Incidence of chronic pain is increasing. This is partly down to an ageing population, with older people more likely to suffer with back or nerve pain and long-term conditions such as arthritis and rheumatism. Our sedentary lifestyles and an increase in obesity are also to blame.What’s more, the opioid drugs which had become the default option to help people manage it are under intense scrutiny because of their high risk of dependency and harmful side effects.
We need pain, even if we don’t want it. Acute pain is a defence against danger, our brain’s way of telling us to react to something that’s wrong. Pain is the natural early-warning system that keeps us alive. But the purpose of chronic pain, which scientists define as pain that lasts for more than three months after its initial cause, is more mysterious. The pain’s origin might be muscular-skeletal – the result of a fall, perhaps – or neuropathic, caused by damage to the nervous system. Or it might be a result of a long-term condition, such as fibromyalgia. Whichever way, it is a pain that has gone on beyond its expected life span and does not respond to medication.

July 2019

Searching for new ways to help people manage chronic pain has become a Holy Grail for the pharmaceutical industry. Demand is rising inexorably while concerns are growing about the effectiveness and long-term impact of established treatments, such as opioid drugs. Stem cell therapy is an emerging treatment option for chronic pain. It uses a person’s own stem cells to repair damaged tissue and regenerate healthy tissue, to help repair and heal damage and degeneration. Stem cell treatments have reduced the need for prescription medication and surgery, proving to be a helpful tool towards managing and potentially eliminating pain in the body. Meanwhile, advances in nanotechnology, which manipulates particles that are 100,000 times smaller than the width of a human hair, may have the potential to transform pain management. The technology supports minimally invasive surgery, which reduces peripheral damage and speeds up recovery, and makes it possible to deliver medication in the smallest doses where it is needed most, reducing potentially harmful side effects.

June 2019

Raconteur noted that, despite advances in medical science, we are often at a loss to understand what causes chronic pain or how it should be treated. What’s more, the opioid drugs which had become the default option to help people manage it are under intense scrutiny because of their high risk of dependency and harmful side effects. Incidence of chronic pain is increasing. This is partly down to an ageing population, with older people more likely to suffer with back or nerve pain and long-term conditions such as arthritis and rheumatism. Our sedentary lifestyles and an increase in obesity are also to blame.
Sometimes the causes of chronic pain are obvious, such as a physical injury or an illness. But there may also be no clear cause. Pain is a very personal and subjective experience. There is no test that can measure and locate pain with precision. Chronic pain may occur in a variety of locations in the body and for many different reasons. So health professionals rely on the patient’s own description of the type, timing and location of pain. This makes diagnosis difficult and complicates the process of identifying effective treatment.

May 2019

According to WIRED, ambiguity has always made pain assessment an inexact science for health care providers, which in turn frustrates the sufferers themselves. A doctor’s assessment may not line up with their sense of the issue; in some cases, patients are told there’s no apparent explanation for their pain whatsoever.
WIRED further noted that many patients, hoping for a second opinion, are turning not to other doctors for answers but to technology. Pain diaries and tracking apps are all over e,g, the App and Google Play Stores, advertised to chronic pain patients as ways to identify trends in their symptoms. Other apps render pain as animations that change in intensity and saturation in place of a 1-to-10 scale, in the hope that a more visual metaphor makes pain easier to talk about or describe.

December 2018

At some point in our lives, many - perhaps most - us will have our heart broken. Imagine how different things might be if we paid more attention to this unique emotional pain, argued a psychologist who revealed how recovering from heartbreak starts with a determination to fight our instincts to idealise and search for answers that aren't there - and offered a toolkit on how to, eventually, move on.
The School of Life cautioned that we are nowadays sold the story that we can, with a bit of luck, all have relatively pain and error free lives. But in fact, life is fundamentally catastrophic and tragic in structure. None of us will get through this life without some grave and searing reversals. It isn't that we've been cursed. We're just human - and we need to be prepared and have plenty of compassion for ourselves and others.

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