Our Perception of Pain Depends on Time and Culture

Pain seems universal and irrefutable. Surprisingly, though, our perception and treatment of pain have always depended on time and culture.

Currently, pain isn’t considered to be as important as the opioid crisis. The voices of people in pain are often ignored. Sometimes, those who have pain are silenced because they fear the consequences — which may include losing their job, their friends, or their status — of telling their stories. That amounts to as many as 100 million Americans who may be actively hiding their pain, and who may feel isolated from a culture that stigmatizes chronic pain patients.

A Podcast About Pain

Joanna Bourke, a professor of history at Birbeck, University of London, talks about how and why our approach to pain has changed through the years in her book, “The Story of Pain: From Prayer to Painkillers.” On an “All in the Mind” podcast, Bourke talks about the cultural impact of pain with host Lynne Malcolm. The segment is called “Considering pain,” and you can listen to it here.

Bourke points out that, in the past, healers asked people to describe their pain so they would be better able to help. As medicine advanced, doctors felt individual stories weren’t as important as test results. Since chronic pain usually doesn’t show up in scans, clinicians now ask people to rate their pain on a scale of 1 to 10.

But a numerical response doesn’t give them the whole story. It doesn’t explain why people experience pain the way that they do. For example, one person may feel that suffering is a punishment for a lifetime of overindulgence, while another person may believe that disease causes pain and should be eliminated. Because of the variances in patients’ belief systems, the experience of pain can differ greatly from one individual to another.

Our experience of pain is affected by external conditions. The weather, the level of our contentment, our family connections, the depth of our friendships, our job security, and even how well our favorite sports teams are faring can factor into how we perceive pain.

Doctors Also Have Their Pain Biases

Similarly, the way that doctors manage the symptoms of people with pain varies. Two physicians might have very different approaches to treating the same patient. If two people walk into the same doctor’s office with similar pain symptoms, they may receive two different outcomes. One treatment approach may not be better or worse than the other, just different. The quality of care patients receive may depend on their age, gender, race, ethnicity, personality, appearance, or profession. As Bourke points out, “there’s nothing democratic about pain.”

In fact, a 2016 Medscape lifestyle survey revealed that 40% of physicians admitted they had biases toward specific groups of people. Doctors may want to be empathetic toward all of their patients. But they, too, are human. They may unconsciously choose to manage pain more, or less, aggressively depending on how well they relate to the patient who is experiencing the pain.

Because pain patients are frequently labeled as whiners or drug seekers, they may not feel free to talk about their pain. Or they may feel that sharing the details of their suffering will inflict psychological pain on others. That’s unfortunate, because one of the ways in which we can help pain patients is by listening to them.

Sharing the Experience of Pain Can Help

When people share their pain, they feel less isolated. Letting their voices be heard can help mitigate their feelings of hopelessness and despair. Just knowing that other people care can enable someone to hold onto hope.

One of my earliest experiences with pain was when my grandmother, who suffered excruciating pain from multiple sclerosis, screamed out. I was just a young boy, and all I could do at the time was to press her feet into a pillow on the floor until the worst of the pain passed. She counted on my touch at those moments. I had no medicine to offer my grandmother, but just being there for her had a healing effect.

Here’s what my grandmother and so many others have taught me. Knowing that someone hears you when you cry out, either literally or figuratively, matters greatly.

Patients can do more than describe their pain on a scale of one to ten. Those numbers hold little meaning, but there are no restrictions on communicating how the pain feels. It can be helpful to find metaphors for the pain that are meaningful and descriptive.

If words aren’t your forte, then you can express your feelings through art or music. Or you can discuss a movie, book, article, or podcast that relates to your experience.

The key is to find people in your life who care and understand. This alone will make life better. Caring might come from unexpected places — an online support group or someone you meet in the waiting room at a pain clinic — so challenge yourself to reach out to just one more person, one more time. Insurance companies can’t deny coverage for the medicine that’s most helpful of all: understanding.

Photo by Tom Sodoge on Unsplash