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Living (Reasonably Well) With Pain

by Jackson Rainer, PhD

Pain has a profound impact on human life. Everyone has experienced pain at some point, and we all fear the possibility of suffering with uncontrolled pain. It is the symptom most likely to bring a person to seek medical care and the number one complaint that physicians listen for. And although we may think of pain as a purely physical symptom, it has a significant mental and emotional component. It can arouse very strong feelings in us, and in turn our feelings and thoughts can make pain worse. The key to living well with pain is to understand what contributes to our perception and experience of it — and to use this knowledge to loosen pain’s hold on us.

Pain is personal

Different people experience pain in different ways and with differing intensities, and your pain is as unique to you as your thumbprint. While friends might empathetically say, “I feel your pain,” they cannot enter into your subjective world and experience the unpleasant sensations and emotions associated with it. Because pain is particular to each individual and felt only by the person in pain, professionals who study and treat pain use several terms to understand individual pain. Pain threshold refers to the point at which you first perceive stimulation as painful. It appears to be determined primarily by physiological factors. Pain tolerance is the highest level of painful stimulation that you can withstand. This limit is often influenced by psychological factors. A middle-aged man’s description of his experience living with rheumatoid arthritis (RA) illustrates the distinction between pain threshold and tolerance: “As my arthritis has advanced, my pain threshold has gotten lower. As a kid, I could be beaten to a pulp and never worried about it; I just didn’t feel it. Now, there are days when the wind blowing on my back makes me hurt. I’ve always had a good pain tolerance, though. I guess I keep telling myself ‘It’s not that bad.’”

A verbal self-report like this one is one of three ways to measure pain. In addition to asking the person with pain for a written or spoken description of the character and intensity of the pain, a doctor or other health-care professional can also assess pain using physiological measures such as blood pressure and heart rate. When the first two measures are combined with a third — observations of behaviors that indicate pain, such as grimacing, moaning, or complaining — a full sense of a person’s pain can be discerned, organized, and understood by others.

Such detailed analysis is essential for a medical diagnosis of pain, which requires knowledge of the duration and location of the pain, its nature and characteristics, any other symptoms, and activities or other factors that may have led to the pain. For example, the man with RA mentioned above provided important information when he said, “I always hurt worse when I wake up in the morning. Getting out of bed makes me moan and groan, crack and creak. I’ve learned to take my medicine first thing and get in a tub of hot water for about 30 minutes while the drugs take effect. This helps me loosen up and face the day. I know the pain is going to stay with me, but this makes things more manageable.” This description tells us that the man is experiencing chronic pain. Chronic pain lasts more than six months and can be intermittent or constant, mild, or severe. Acute pain is temporary and lasts less than six months. Knowing whether a person is experiencing acute or chronic pain can help a health-care professional identify the cause of pain and recommend the appropriate treatment.

The psychological component

Your experience of pain is partly determined by how you perceive and react to it. Your perception of pain depends on many factors, including your age, sex, social and cultural background, and personality type. Research on pain generally indicates that people’s pain threshold increases with age, but this is not as well understood as once thought. As a group, women have slightly lower pain thresholds than men of the same age and stage of life, but the difference seems to be due to situational factors rather than physiological differences between men and women. Across different cultures, there is remarkable diversity in the way people experience and demonstrate pain. Reactions to pain seem to be related to whether people learn to deny pain, deal with it in a more stoic fashion, or allow themselves to express their distress.

Your tolerance for pain may depend on your personal attitudes and the level of anxiety you feel in response to pain. Some people are pain reducers. They tend to see pain as more of a universal experience, rather than something that happens just to them. They often have a strong body image, are extroverted, and know how to quiet negative thoughts. A reducer might say, “This really hurts, but it isn’t all that bad.” Reducers know how to talk themselves down from anxiety about and hypervigilance of their pain.

Last Reviewed on May 2, 2012

Jackson Rainer is a board-certified clinical psychologist who is the Department Head of Psychology and Counseling at Valdosta State University in Valdosta, Georgia. He may be contacted at jprainer@valdosta.edu.

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