HEALTH PLUS:We cannot relieve the pain if we don't listen to the sufferer, writes Marie Murray
PAIN IS protective. It is the body's alarm system. It is crucial for survival. It is excruciatingly effective. It signals indisputably that something physiological is awry that requires immediate attention. It is our most important diagnostic tool. It is the means by which the site, the cause and the solution to illness may be identified. Where does it hurt? Pain tells us.
Pain is at its most proficient when it causes reflexive withdrawal from a dangerous source: fire and sharp implements for example. The acute pain from imminent danger is defensive if aversive. The throbbing pain reminds us to be careful of the tender site. The dull pain demands intervention.
The cessation of pain usually signals that this particular physical problem has been sorted. It is a good default system for our bodies. It works.
Pain is persistent. It continues to signal until all is well. It will not cease until the abscess is attended to, the cut is healed, the eye cleansed, the bones mended, the stomach has settled, the throat has cleared or whatever ails us physically has received the required intervention to ensure safety and prolongation of our lives.
There are some acute pains that recur, unpredictably, periodically and inevitably although precisely when they will flare up can be difficult to estimate. This makes sufferers feel vulnerable and intimidated by the potential to be ambushed by an episode at any time.
Migraine is one example of episodic acute runs of pain. Much of migraine management goes into tracing its personal patterns, learning its advanced warning signals and discovering how to achieve as much proactive defence against it as possible.
Similarly, chronic pain of its nature is persistent and resistant. Like a house alarm that cannot be silenced, it disturbs long after its initial cause has been resolved and its protective function has been served. The code to dismantle it is absent to the distress of all around it.
While multiple theories abound in relation to the nature, cause, complexity and psychology of chronic pain and while many neuropsychological explanations add to our understanding, the reality is that pain is individual, the threshold at which it arises and subsides is specific to each person, antecedents are variable and how it intrudes on individual lives is context bound.
Biomedical models often do not extend into the inexplicable lack of isomorphism, or fit, between the site and symptoms of pain. Motivational models may suggest that people seek malign or manipulative secondary gains from pain, behaviour models may imply learned behaviour rather than real experience. Psychogenic models may consign the entire experience to psychological distress and the connection between depression and pain needs more attention.
For who would not be depressed when suffering the helplessness of chronic pain and who does not become physically depleted when depressed? Depression, whether it is acute, intermittent, recurring or chronic, is real and is experienced in the body as much as the mind. Its physical presence is often described across all the senses and many bodily manifestations.
It is often described in terms of constriction, gasping for breath, weight, dulling of senses, as immobility, shiver, chill, confusion, heaviness and terrible pounding of heart.
Pain, whatever its origin, its function and its pattern, confronts our individuality. It is subjective. It shows how hard it can be to put words on our own experiences, how deep our emotions, how lonely suffering is, how solitary, how much people need their accounts to be listened to, to be taken seriously, to be validated and affirmed. Most chronic sufferers learn how time-limited compassion can be but those who suffer extensively need continued support.
Chronic pain research is clear about the extent to which depression, fear, anxiety and anger often accompany chronic pain which alerts us to the need to intervene swiftly, exploring not just the individual's experience but the other contexts of family, friends, social relationships, belief systems and work situations where economic and organisational loss is enormous.
Where does it hurt? Life can hurt. It can do so in many ways. Unless and until we listen more to those who are hurting, whether it be physically, psychologically, occasionally, chronically or specifically, we cannot provide effective pain management. There is no thermometer: the individual who suffers is the pain barometer. Listening is the first response.
mmurray@irish-times.ie
Clinical psychologist and author Marie Murray is the director of the student counselling services in UCD