What does pain actually look like? Most pain is largely invisible, yes, but with the right instruments and the proper training, one can observe a complex physiological process occurring within the body’s intricately overlapping systems. Nociceptors detect intense heat, pressure, or chemicals released by damaged cells, and signals travel through the spinal cord to the brain, where they’re processed and modulated and sometimes, though not always, experienced as pain. When pain becomes chronic, lingering long after an injury has healed, the brain itself starts to change, rearranging grey matter and the connections between neurons.
Scientists can study all of this in the lab with tremendous precision, and neuroimaging has advanced what we know about pain enormously. But nothing captured in the lab can fully account for the ways pain changes a life.
The scientists I interviewed for my doctorate often knew this better than anyone. One neuroscientist spent his days designing experiments that isolated the unpleasantness of pain from its other components. He told me that if you talk to people who have pain, they’ll tell you that what really matters is the meaning. “This has changed my life,” he said, by way of example. “I used to be an athlete and now I’m a shut-in. I used to be somebody people depended on.” That was what mattered to them. He worried that once you break pain down into measurable parts, what’s left over no longer looks much like pain.
Pain is biological, but it’s also deeply social. The pain studied in labs looks very different from the pain my clients bring to me. When they tell me about it (rarely, if ever, in terms of nociceptors), they talk about not being able to stay present through dinner with a friend, or no longer trusting their body enough to go for a hike. The impacts of pain are physically felt, emotionally experienced, and socially consequential.
This is what social science brings to pain, and it’s what my research centered upon. As a medical sociologist at UCSF, I spent years observing in pain labs and clinics, watching how pain gets measured and treated and paying attention to what the measurements leave out. Pain can be scored and scanned, but it can also be counted in terms of what it does to a life, to someone’s relationships and their sense of who they are.
That’s where my work at Pain Fermata begins. By the time people find me, their pain has usually been measured many times over. So I start somewhere else, with how it’s showing up in their life and how they’ve come to relate to it. Changing how we relate to painful sensations can change how we experience them, sometimes dramatically. I’ve watched this happen again and again with clients, and I’ve lived it myself.
