Pain has plagued us since the beginning of humankind, its origins explored in frustrated fits and starts by philosophers and doctors attempting to understand and mitigate it. From his Lyceum in ancient Greece, Aristotle, who helped lay the groundwork for modern philosophy and science, said simply, “To perceive is to suffer.” Twenty-three centuries later, beloved author and scholar C.S. Lewis, known for “The Chronicles of Narnia,” described the physical and emotional toll of pain. In his book “The Problem with Pain,” he tells us that physical pain alerts us to injury or illness, and, similarly, emotional and spiritual pain can point us toward areas in our lives that need attention or change.
From Aristotle’s time through C.S. Lewis’, there weren’t many safe and effective ways to relieve physical pain other than folk remedies, until the advent of aspirin in the early 20th century. Pain of an emotional or spiritual nature was often overlooked, or became the province of clergy. A lot has changed over the millennia. Our current pain-reducing options have come a long way, and they don’t always involve taking a pill. They may include physical therapy, meditation, and other innovative and nonpharmacological approaches.
Pain is protective, telling us to stop and pay attention. Talk with your doctor at the onset of any new discomfort, and address it immediately if it persists, recurs, or is unusual. By trying to understand its source and severity, your provider will be able to recommend interventions that may bring relief. This isn’t always easy. Pain comes in many forms, from aching or throbbing to stinging and burning, and myriad other sensations. Because it’s unique to each individual, often shaped by our prior experiences and belief systems, at times pain can defy description, and seem nebulous in origin. Your doctor may ask you to rate it on a scale from 1 to 10, request insight into what makes the pain worse or better, or ask whether there are times of the day when it is most pronounced. Before arriving at a conclusion, your doctor may recommend further testing, like bloodwork, X-rays, an MRI, or any number of diagnostic techniques. Knowing how long you’ve been experiencing pain provides another important clue.
Acute and chronic pain
Acute pain is short-term, often caused by an illness or injury, and subsides with time. Examples are pulled muscles, broken bones, cuts, burns, and dental caries. Medications that reduce inflammation in the area that hurts may increase your level of comfort during the healing process. Your provider may want to keep in touch during your recovery, and may adjust your medications according to your progress. By following instructions carefully and adhering to treatment orders, you’ll better ensure avoiding a re-emergence of symptoms.
Not all pain needs the attention of a clinician. Certain types of acute pain can be self-treated, such as the kind associated with the common cold or flu, although over-the-counter medications shouldn’t be used for more than a few days without consulting your provider, because of potential side effects.
If pain persists for an extended period, it becomes known as chronic. Initially, chronic pain may go through an acute phase until, over time, we come to the discouraging conclusion that it’s not going away. The majority of older adults experience chronic pain in multiple locations, and to a degree, that requires daily management. As we age, the pain signals our brains receive may become more intense, and continue to broadcast even after we’ve healed. This may complicate the course of our treatment. In addition to delivering ongoing discomfort, chronic pain can place limits on our productivity, and lead to depression and anxiety. Its source can be difficult to pinpoint, and may require a toolbox of techniques to be countered. Complementary treatments, from physical therapy to acupuncture, combined with over-the-counter anti-inflammatories or specialized pharmaceuticals, often yield the best results.
Emotional pain
According to the American Psychiatric Association, studies indicate that nearly 40 percent of the population reports a decline in mood in winter, and 66 percent report behavioral changes. As our exposure to sunlight wanes and our bodies produce less of the feel-good hormone serotonin, feeling blue becomes common. Sunlight also fuels the production of melatonin, and our circadian rhythms, part of our sleep/wake cycle, can be disrupted. Other types of emotional pain, such as the kind experienced following the dissolution of a partnership, or the death of a loved one, can bring on great emotional duress. Untreated, emotional pain can lead to physical complaints such as digestive problems, headaches, and fatigue.
Creating a pain-management plan
The ideal way to tackle pain may require using a range of modalities, and finding a provider willing to explore them with you. There are few instantaneous solutions, especially when your suffering is chronic. Finding relief may require a commitment of time, diligence in exploring potential solutions, flexibility in trying new approaches, and trust in your provider that together you will figure things out. Getting a second opinion can help. Doctors are people, too, with a range of experiences that occasionally make their opinions vary.
For those with chronic pain, being screened for depression and anxiety is a sensible first step, and one often done as part of your annual physical. Some people may not be aware they are experiencing emotional difficulties because they are focusing on getting through the day amid persistent discomfort. Over time, exposure to pain can cause chemical changes in the brain that depress the system, bringing unwanted side effects. Emotional pain can be treated with different modalities, including therapy, medication, and self-care techniques. Some medications have the added benefit of relieving physical symptoms.
Physical and occupational therapy (PT and OT) are frequently included in treatment plans. According to a 2024 survey conducted by the U.S. Census Bureau, 86 percent of those who received PT found it helpful. PT and OT work by strengthening gross and fine motor skills. They are based on the presumption that by strengthening our bodies in the right way and in the right places, we can maximize our comfort while doing essential tasks and the things we enjoy. So if your lower back isn’t allowing you to tie your shoes, or the discomfort in your shoulder has curtailed relaxing summer swims, these therapies might be right for you.
Key findings published in the “Journal of the American Medical Association” suggest that a growing number of people are finding relief through alternative modalities. In addition to PT and OT, many complementary therapies exist, including acupuncture, craniosacral therapy, and nutritional counseling, all available at hospitals near us or through their partnering agencies. Thomas Smith, M.D., of Johns Hopkins Hospital reported in a recent “AARP Bulletin” that scrambler therapy, which can reset the brain to inhibit pain for long durations, has helped 60 percent of his patients for up to several months. The National Institutes of Health (NIH) is using meditation and mindfulness to ease the pain associated with the misuse of opioids, drugs that build new pain pathways in the brain, making users more susceptible to chronic discomfort. Both mindfulness and meditation work by helping us learn to disassociate the physical sensation with the unpleasant emotional component, and, conveniently, are techniques that can be practiced in the comfort of our own homes.
Martha’s Vineyard Hospital has a pain-management program for chronic pain patients. See bit.ly/MVH_PainManagement. Other good resources to learn more about pain and its management can be viewed at bit.ly/MC_PainRelief and bit.ly/JAMA_PainTreatment.
It seems we all suffer a bit more during the wintertime. Weather-related fall injuries increase; cold and flu season, with its associated aches and pains, is at its peak; and feeling blue often accompanies shorter days with less light. Addressing pain can be nuanced, often requiring a delicate balance of pharmacological and alternative approaches, the latter of which may enhance the effectiveness of medications or reduce our reliance on them. In concert, they may bring the greatest relief.
For those suffering from chronic pain, it’s important to know that it does not mean you are damaged, or in poor health — rather, the pain pathways in your brain may be igniting long after healing is complete. One of the conclusions that C.S. Lewis drew is that pain can lead to a time of growth, sending us in new directions as we investigate a different way of being; that our suffering isn’t without meaning, and opens up narratives of hope, healing, and spiritual growth. Our ultimate goal is to live well despite our pain.
