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Pain: The Science of Suffering

Patrick Wall
Steven Rose General Editor
Copyright Date: 2000
Pages: 192
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  • Book Info
    Book Description:

    Pain is one of medicine's greatest mysteries. When farmer John Mitson caught his hand in a baler, he cut off his trapped hand and carried it to a neighbor. "Sheer survival and logic" was how he described it. "And strangely, I didn't feel any pain." How can this be? We're taught that pain is a warning message to be heeded at all costs, yet it can switch off in the most agonizing circumstances or switch on for no apparent reason. Many scientists, philosophers, and laypeople imagine pain to operate like a rigid, simple signaling system, as if a particular injury generates a fixed amount of pain that simply gets transmitted to the brain; yet this mechanistic model is woefully lacking in the face of the surprising facts about what people and animals do and experience when their bodies are damaged.

    Patrick Wall looks at these questions and sets his scientific account in a broad context, interweaving it with a wealth of fascinating and sometimes disturbing historical detail, such as famous characters who derived pleasure from pain, the unexpected reactions of injured people, the role of endorphins, and the power of placebo. He covers cures of pain, ranging from drugs and surgery, through relaxation techniques and exercise, to acupuncture, electrical nerve stimulation, and herbalism.

    Pain involves our state of mind, our social mores and beliefs, and our personal experiences and expectations. Stepping beyond the famous neurologic gate-control theory for which he is known, Wall shows that pain is a matter of behavior and its manifestation differs among individuals, situations, and cultures. "The way we deal with pain is an expression of individuality."

    eISBN: 978-0-231-52940-2
    Subjects: Health Sciences, Psychology, Biological Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-x)
  4. 1 Private Pain and Public Display
    (pp. 1-16)

    It is crucial that we begin with precise and objective reports of what people and animals do when injured. The reports do not match the expectation of the victim or of the observer. In exploring the nature of pain, it will be necessary to separate reality from what we think ought to be observed. We will start with sudden events where a previously “normal” being is abruptly converted to a “sick” one. Of course, no such event occurs in a vacuum, as there is always a surrounding scene and the victim arrives at the accident with a personal and genetic...

  5. 2 The Philosophy of Pain
    (pp. 17-30)

    Before we explore the details of pain, we must consider the general plan of what we expect to find. The most common prevailing opinion, which comes from our intuition and is expressed by the majority of philosophers, is dualistic: that is to say, we have a body and a separate entity, the mind. The body is generally seen as a wonderful intricate machine operating on understandable principles that will be revealed by increasingly sophisticated scientific investigation. It includes a sensory nervous system whose function is to detect events in the world around us and within our own bodies. This sensory...

  6. 3 The Body Detects, the Brain Reacts
    (pp. 31-46)

    In the first two chapters, we dealt with the whole person in pain, but now it is time to turn to the details of what precisely happens when pain is provoked, so that we can later bring these details together to understand the whole. You may not wish to struggle with the unfamiliar territory of this chapter because it deals with the detail of how the nervous system handles the news of unexpected events. If you wish, skip to chapter 4, where I begin to describe the experience of pain as a whole. However, you may wish to return to...

  7. 4 The Whole Body
    (pp. 47-58)

    When thinking about pain, we naturally concentrate on our conscious awareness and tend to ignore all other associated events. We use put-down words such as reflex, automatic, and mechanical to distinguish them from the main event that dominates us: the conscious experience of pain. We should be cautious at this stage of our search. If pain is a puzzle, we should not throw away pieces of the jigsaw just because we are obsessed with a preconceived single solution.

    William James, brother of the author Henry, was a brilliant professor of psychology at Harvard at the end of the nineteenth century....

  8. 5 A “Normal” Pain Response
    (pp. 59-78)

    In chapter 2, I wrote that the most common question I am asked is whether I am working on physical or mental pain. I have given reasons for doubting the validity of that dualistic question. The second most common question is “Why is it that some people are resistant to pain?” I understand the question and why it is asked. All of us fear pain and doubt our own ability to withstand it. That is to say, we fear the onset of private pain and doubt our ability to endure it with dignity in our public display. No one approaches...

  9. 6 Pain with Obvious Causes
    (pp. 79-92)

    In this chapter, the immediate causes of pain and the way in which they develop will be described. There will be no reference to the variation in the amount of pain observed in real life, as discussed in the last chapter. In later chapters, we will bring together the basic cause of the variation.

    We will discuss a selection of common pains, covering the spectrum, from a scratch to an amputation.

    A scratch, by definition, is a trivial injury, but it contains many of the pain-producing components found in much more serious conditions. At the instant of the scratch, pressure...

  10. 7 Pain Without a Cause
    (pp. 93-106)

    For the past two hundred years, the very considerable advances of academic medicine can be attributed to the insistence on identifying a clearly defined cause for each disease. Before the modern era, causes were often mystical and there was little attempt to verify them. The proposals that the patient was suffering from imbalanced humors had been accepted for two thousand years. Treatments that worked were justified by attributing their action to adjustment of the same mystical forces.

    Our language retains the words from the old medicine invented by Galen, who was born in the second century A.D. in Pergamum in...

  11. 8 How Treatments Work
    (pp. 107-124)

    Holistic medicine proposes that pain originates from messages generated by smashed cells or disordered nerve cells that feed into the individual’s brain where the messages are interpreted in the context of the person’s overall needs. Classical academic medicine concentrates only on the incoming messages. In this chapter we shall look at therapies for pain whose rationale is based on stopping the incoming messages.

    The aim of these tests is to reveal the consistent action of the therapy liberated from the bias of patients and therapists who think it ought to work. The major bias is the placebo response, which is...

  12. 9 The Placebo Response
    (pp. 125-140)

    If you have strong reason to expect a pain to disappear, it may disappear. This is called a placebo response. This topic is at the very heart of understanding pain, yet it seems so unlikely that it has been unpopular and has been seriously examined only recently. Pain is usually treated by one of the techniques discussed in the last chapter. However, if a narcotic is given, the placebo response adds to its effect. If the treatment is accompanied by great expectations but has no specific analgesic action, the decreased pain is entirely the placebo response.

    The word placebo was...

  13. 10 Your Pain
    (pp. 141-158)

    The time has come to bring together all the phenomena we have discussed in the previous chapters and ask what precisely is going on in someone who senses pain. There is more to this than a conventional desire for neatness and synthesis because a profound understanding of one’s own pain has itself a therapeutic effect and proposes a rationale for therapy. Furthermore, when our conscious awareness of pain starts and persists, a series of further processes is set in action so chronic pain is more than prolonged acute pain.

    No conscious awareness of anything is possible until it has captured...

  14. 11 Other People’s Pain
    (pp. 159-176)

    Anyone in pain is locked in a struggle for relief. The rest of us have the option of approach or retreat. In this chapter we examine the alternatives.

    Good parents have the right attitude to their children. They always approach and touch, no matter what the problem. For adults faced with someone in trouble, there is a quandary. Do you have the confidence and competence to break the taboo of privacy? Does the social situation permit intrusion?

    A friend was flying over wartime China when he was shot down. He parachuted down, broke his leg on landing, and lay in...

  15. Epilogue
    (pp. 177-178)

    This book has been about the many challenges of the many pains. Inevitably, I have kept returning to the urgent practical question of how to control pains. But beyond that question lie deeper ones, and the practical question will not be answered satisfactorily until we understand more of the context in which pain resides. Pain is one facet of the sensory world in which we live. It is inherently ridiculous to consider pain as an isolated entity, although many do exactly that. Our understanding brains steadily combine all the available information from the outside world and within our own bodies...

  16. Index
    (pp. 179-184)