Pain: a psychological and cultural perspective

CONICET/DICYT Marcelo Villar, principal CONICET researcher at the Universidad Austral of Buenos Aires, comments that when he was PhD student and began his study, he would talk to a colleague, an old psychiatrist called Guillermo Vidal. He told him that when he got his degree, he used to work at the Braulio Moyano Hospital – Neuropsychiatric Hospital for women – and administered haloperidol (Antipsychotic medication) right and left to his patients and they improved.

One day he decided to provide his patients with the same drug but he added something: he greeted and patted them on the back. With this technique, he noticed that the patients improved faster; thus reducing the antidepressants. This experience made Vidal write a document – it is not know whether it was published or not- called “La farmacología de la palabra” in honour of that treatment.

Following that line of work, Villar affirms that there are personal components that make each individual experience physical pain in their own way, and that subjective characteristic is conditional on the personal history, value and very often beliefs of the patients. For this reason, emotionality, cognition and emotional nature are factors that should be studied to understand completely the process of a painful experience. The cultural aspect is also very important: for instance, it is only necessary to consider the frequent current complaints about back pain by comparison with resistant to pain in ancient hand-to-hand wars. “The Iliad contains excellent descriptions of injuries with anatomic accuracy but there are no signs of suffering or anguish”, the researcher comments.

This means that not all people suffer from the same things and in the same way. There are people who feel pains that result from specific injuries and other who suffer despite not having an obvious or detectable physical problem. “Some studies show that 65% of seriously injured soldiers in battlefield and 20% of the population who underwent a surgery expressed that they felt little pain or none after the intervention. In contrast, 70% of the people who express pain in the lumbar region lack obvious injury. What do statistics show about the expression of pain? “They demonstrate that the relationship between pain and physical damage is highly variable and complex”, Villar states.

The resulting question for this case is: which factors participate in the painful phenomenon to make it so elusive? The answer still holds some mystery.

The experience for a definition and a historical context

The word “pain” comes from the Latin term “dolores” and is related to “poena”, which means penalty or punishment. But the path towards an acceptable definition was started by Sir Charles Sherrington, one of the twentieth century physiologist, who understood pain as protection mechanism of the individual and said that it was a neutral function in which awareness of its existence had to be separated from the neutral process of the actual information about the pain. The International Association for the Study of Pain defined it as “a sensory and emotional unpleasant experience associated to actual or potential tissue damage.” The truth is that pain has an important adaptive role and is vital to survive.

Villar explains that there are several anthropological and psychological studies that demonstrate that pain is not only the relationship between the person and the actual injury, but also the result of previous experiences such as the capacity to understand the consequences of an injury beyond pain itself. In fact, there are certain cultures that include ceremonies in which some metallic hooks are stuck in the back of a member of the community as part of a celebration. For the researcher, the funny thing is that the people who participate in the rite do not show signs of pain; on the contrary, they are in a certain state of ecstasy. There are several studies that show some similar experiences in which people carry out surgeries without anaesthesia, for instance.

Ancient physicians used to save people from death but nothing was said as regards waning ailments. In 1847, a surgeon used ether in labour for the first time: Calvinists, for instance, stated that “when God threw Adam and Eve away from heaven, he decided that women had to give birth with pain”, and this is why they disagree with the use of ether. Later on, in Vienna, Carl Koller discovered painkilling of local action and had managed to use cocaine with the same objectives.

“Some studies demonstrate that those patients who think they can control their pain, experience it in a better way than those who do not believe it. That is to say, when the mental attitude of a patient is positive, there is more tolerance”, the scientist says.