Pain is a Subjective Experience

Seeing patients with chronic pain in my clinic, doing research on work-related injuries in factories, and teaching neuroanatomy has lead me to ask (almost everyone):

• What is pain?
• How can we define it?
• Can pain be described so that others can understand what the pain really feels like?
• Can the complexity of this very personal experience be explained anatomically?

After quite a few dumb stares from people who either thought the answers were impossible or obvious, I was pleased to find there were thousands of professionals asking the same questions, and some devoting their lives to finding answers.

The International Association for the Study of Pain gives this definition

• PAIN is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, ar described in terms of such damage".

This definition makes a lot of sense, but it implies that if we are not aware of it we cannot suffer the effects of pain. The concept of unconcious pain is currently a matter of debate among experts in this field.

INFORMATION ON PAIN

I was asked to summarize our current understanding of the anatomy of pain for the Ontario Inter-Urban Pain Conference on November 29, 1996. This paper is updated from time to time as new information becomes available. Read it for the latest details.

The Human Brain is a mysterious organ. It is the place where all sensation is registered. Given this information we can think and express emotions. So where is the mind and what part of the brain controls our emotions, so important in the effect of pain in our lives?

Even as an anatomist I never cease to be amazed by the new knowledge that continually pours across my desk and reaches me over the Internet. Much of it is also useful in clinical practice. Does the brain contain the soul and if so where? Some people think it resides in the temporal lobe while many others say there is no such thing at all. I recently had a chance to prepare a book review at the request of The Medical Post. This book is a fascinating read and I highly recommend it. If you are interested, have a look at my book review.

The emotional function of the brain is particularily fascinating, not only for those in pain but for all others too. After all, the brain is recognized as our biggest sex organ. So what does it mean when someone tells you, "I love you with all my heart", or "You have broken my heart?" When my own father died due to a cardiac rupture, my mother was told he died of a "ruptured heart" and for more than a year she greived over the thought that she had caused him severe emotional distress. This was not the case at all but I was in India as a missionary surgeon and had no chance to console her until I returned.

So is the heart really a part of the brain? Go to this "link" to find out.

You might also be interested to learn of my experiences in India--so disturbing that I have had to describe them as fiction. This "novel" is co-athoured by a friend who had a bad time in Africa, a painful time. But now we are talking about emotional pain.

For those who suffer from back pain, here is some information on back pain.

The following are excellent sources of more information on pain in general.

• The International Association for the Study of Pain (IASP) has a wealth of information on the internet for professionals.

• The Canadian Pain Society will be of special interest to Canadians involved in the management of people in pain.

• The North American Chronic Pain Association of Canada, (NACPAC), has a directory of pain clinics and pain specialists online that will be useful to many people.

• The Canadian Pain Coalition (CPC), is the national voice of people with pain.

• The Chronic Pain Association of Canada, (CPAC), provides education, support, and answers to many of your questions.

• The Canadian Association of Pain Management, (CAPM), offers courses, news letters, and other information of value to those treating chronic pain.

• Information on pain in the workplace is available on this website for those with a special interest in chronic work-related musculoskeletal pain.

In my clinic I perform Independant Medical Evaluations, mostly following motor vehicle accidents, and we all know that soft tissue injuries heal within three months. Yet in a significant percentage pain may persist for many years. Why is that? In recent years I have had a chance to work with Dr John Baird of Markham, Ontario and he has a method of examining the neck and back to see if the ligaments have healed in such a way that stability of the spine has been restored. He uses a technique known as Digital Motion X-ray. Here is information about this tecnique and Loss of Motion Segment Integrity that can cause neck or back pain to persist long after soft tissue injuries have healed.

Many of my clients have children or grandchidren who find it extremely difficult to understand that person cannot play games with them or pick them up. It is very hard to explain pain to children. Now there is a book that explains pain with clever pictures and a few brilliant phrases that speak to children in their own words. I highly recommend it for children in pain and for children who have relatives in pain. To learn more, visit the website of author Cathryn Morgan.

I will not get into the very complex subject of pain management here because my interest in pain is largely anatomical. But all drugs used to relieve pain and its consequences are only able to act because there are anatomical sites where thay can attach to elements of the nervous system. One such substance that recently has risen to prominence is marijuana.

Created by: ranney@hsfx.ca 1997/02/11.
Revised by: ranney@hsfx.ca 2011/07/12.