The Elusive Nature of Pain

Pain has psychological as well as medical significance. For example, both depression and anxiety worsen the experience of pain. When patients are asked what they fear most about illness and its treatment, the common response is pain.

Pain has been one of the more mysterious and elusive aspects of illness and its treatment. It is fundamentally a psychological experience, and the degree to which it is felt and how incapacitating it is depend in large part on how it is interpreted. Howard Beecher, a physician was one of the first to recognize this. During world war II, Howard Beecher, a physician served in the medical corps, where he observed many wartime injuries. In treating the soldiers, he noticed a curious fact: only one quarter of them requested morphine (a widely used painkiller) for what were often severe and very likely to be painful wound. When Beecher returned to his Boston civilian practice, he often treated patients who sustained comparable injuries from surgery. However , in contrast to the soldiers, 80% of the civilians appeared to be in substantial pain and demanded painkillers. To make sense of this apparent discrepancy, Beecher concluded that the meaning attached to pain substantially determines how it is experienced. For the soldier, an injury meant that he was alive and was likely to be sent home. For the civilian, the injury represented an unwelcome interruption of valued activities.

Pain is also heavily influenced by context in which it is experienced. Sports lore is full of accounts of athletes who have injured themselves on the playing first but stayed in the game, apparently oblivious to their pain. Such action may occur because sympathetic arousal, as it occurs in response to vigorous sports, seems to diminish pain sensitivity. In contrast, stress and psychological distress may aggravate the experience of pain. In addition, shut-ins who have little to occupy their time other than minding their aches and pains may feel each one acutely.

Pain has as substantial cultural component. Although there are no ethnic or racial differences in the ability to discriminate painful stimuli, members of some cultures report pain sooner and react more intensely to it than individuals of other cultures. These ethnic and cultural differences may derive both from differences in cultural norms regarding the expression of pain and in some cases from different pain mechanism. There are also gender differences in the experience of pain as well, with women typically showing greater sensitivity to pain.

Reference: http://en.wikipedia.org/wiki/Pain