Pain. Almost everyone experiences pain, but do we actually understand it? The Oxford dictionary defines it as “physical suffering or discomfort caused by illness or injury.” This common definition is taught to us as we grow up as kids, and it isn’t far off from how we define it in medicine. However, many physicians and scientific researchers are redefining how we view general pain, stating that this old definition focuses too heavily on tissue injury and individuals’ ability to describe their experiences. Pain is so much more than that. In fact, the International Association for the Study of Pain1, a global organization revised its definition in May 2020 for the first time in four decades, to now describe pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
That is a mouthful and what does it mean? It sounds complicated but let me break it down for you. First, pain is personal and unique to everyone. No one would experience pain the exact same, even if they went through similar situations and circumstances. Additionally, it’s influenced by biological, psychological, and social factors that can work with or against each other, aptly called the biopsychosocial model of pain. For example, if I stub my toe alone in my room after getting a parking ticket, my toe will hurt like heck versus if I stub my toe while I’m with friends having a blast at game night. So what types of implications does this have with medicine?
We’re still figuring this out. Sometimes, pain can be very simply treated, especially if there’s an obvious biological factor that we can see. I’ve seen this many times in my experience as a scribe here with SCCNS. For example, suppose a patient comes in, and the spinal cord in their lumbar spine is tightly pinched. In that case, Dr. Mesiwala and his team go in and decompress that area to make more room. BAM! Problem solved and they feel like a weight has been lifted off their shoulders… or rather their back.
But sometimes, the pain isn’t easily explained as I’ve witnessed with our patients living with chronic pain. Sometimes, there’s no tissue damage and the patient continues to be in such profound pain, then what do we do? Going back to what I said about psychological factors and social factors working with biological factors, there was a study published in 2004 with Cell2 magazine by Dr. Eisenberger and Dr. Lieberman which suggested that social pain and physical pain overlap in neural circuitry and computational processes and may share a broader neural alarm system. This highly cited paper helped to jumpstart and reframe the discussion of pain in science that is starting to influence medicine. An example of this is an integrative pain management team at UCSF3 set out to train their pediatric residents in the biopsychosocial model for pain management through the use of cognitive-behavioral therapy, shortened as CBT, in a scientific article published in 2021. CBT is a psychological treatment that helps people build skills to handle the challenges life throws at them by allowing people to assert more influence over their behaviors, thoughts, and emotions.
There is a need and a desire to redefine pain and pain management occurring in current medical school training. Researchers redefining pain is an example of how much medicine is constantly changing and sometimes that innovation isn’t technological. It also begs the question that with specific social factors, does this mean systemic violence and discrimination may also create circumstances for marginalized people to be more susceptible to developing chronic pain, and with psychological factors, that pain management may need to start being looked at with pain medications, psychological therapy, and resource allocation to allow for people to treat and heal from chronic pain and other chronic disorders? These are complicated questions, but for the most part, I do hope that next time you stub your toe, you do it amongst friends instead of alone with a parking ticket.