Pain is an opinion. Too harsh? Have I no sympathy? Well, I’m not suggesting people in pain are just looking for sympathy, or that all they need is to change their attitude in order to take up their pallet and walk. Allow me to expand this concept of pain a bit. If I instead say, “Pain is an interpretation,” will I get a few minutes of breathing room?

Pain is inherently subjective anyway and, thus, difficult to study objectively. While I wish to stay clear of the scientific notions of pain here—others elsewhere in this issue do a better job anyway—we must notice one oddity of our neurology: there are no nerve endings specifically for pain, as there are for heat, cold, vibration, and pressure, for instance. Mostly, simple free nerve endings serve to send us those signals we read as pain. And yet there is a nociceptive system—ascending nerve tracts where pain signals (and the pain system includes some of the fastest [for burn] and slowest [for throb] nerve signals around) are carried up the spinal cord to be interpreted by the brain. Some of the signals that ride this system—itching, for example—we do not tend to put in the category of pain. So the interpretation part starts way out in the peripheral nervous system, as signals are shunted into this system before it even gets to the brain.

Pain is widely perceived to be a warning of current or imminent damage to our tissues, and in most cases it is. But like many things in our coevolved world (and evolution is awesomely intelligent design), its workings are quirky and inexact. Some people have advanced tissue damage, via cancerous tumor growth for instance, without feeling the least pain. The first notion that Sigmund Freud had of the jaw cancer that would kill him was blood dripping from his beard—and he knew that blood without pain was a very bad sign. Yet, one can create very persuasive pain by simply pinching the skin or (a favorite of pain researchers) putting the fingers in icy water, without the least threat of tissue damage.

On the other hand, there are a few people with a condition where they never feel pain. A blessing, you say? Not at all—these people often die an awful death at a young age, and not because they sit on a hot stove or anything like that. As you stand in line at the post office, sit reading, or lie in bed, the pressure of your body on your joint surfaces and skin pushes fluid out of the tissue, keeping it dry. Just as when you step on wet beach sand, your weight dries the sand around your footprint temporarily, but wetness flows back in as soon as you step away. When pressure happens in tissues, after a bit they cry out for hydration, and these signals are carried up the nociceptive system. You wouldn’t call the sensation painful, if you even noticed it, but you nevertheless switch from one hip to the other, shift position slightly in your chair, or roll in your sleep. These people who have no perception of pain fail to shift their weight often enough, and their joint tissues necrose and die, producing debilitating and life-threatening infections.

So, to summarize, pain is an inexact warning signal, but one you do not want to be without.

Secondly, we live in a pain-averse culture. You may say, “Don’t be silly, everyone is averse to pain.” True, but earlier cultures, or earlier generations of our own culture, would simply have borne pain that sends many of us Western industrialized wusses to the doctor or the medicine cabinet. My wife is an animal whisperer, and she asked one of our horses if they feel pain, and the clear psychic answer was, “Of course we feel pain, but it doesn’t bother us as much as it bothers you.”

Sounds like “pain is inevitable; suffering is optional” to me.

Pain’s Nuances

We comfort-driven moderns are prejudiced against pain, and like most prejudices, it tends to blur distinctions. The Inuit Eskimos have eighteen words for different types of snow. Our aversion to embracing pain as an inevitable part of life causes us to develop low sensation thresholds and lump all of the nuances of pain into one word, equating that word with suffering, which we then seek to avoid as quickly and completely as possible. This weakens us as a culture, and as individuals. The extreme athlete, the passionate lover, and the disciplined artist all understand the value of pain, but we don’t teach that in our schools. But before I sound too much like a right-wing roughrider, or a Depression-era father (“You kids …”), let me focus on the experience of pain in manual therapy.

As remedial therapists, we need to appreciate pain’s nuances. Words like autism or arthritis are wastebasket words into which many differing conditions are thrown. Pain is another—asked to bear the weight of a stubbed toe, a healing wound, a broken heart, or a lost soul.

So right away, let us make one categorization among the many we might use to distinguish different types of pain: there is pain entering the body, pain stored in the body, and pain leaving the body. This distinction is particularly crucial for hands-on therapists. Pain entering the body is the familiar hammered thumb or sliced finger. In bodywork, it is us coming in too hard or too fast so that the client flinches away from our hands.

Old Ida Rolf used to tell us, “Pain is sensation accompanied by the motor intention to withdraw.” Your myofascial or trigger-point work may be quite “sensation-ful” for clients, but if they are not trying to get away from you, then they are not interpreting the sensation as pain. Sometimes however, clients say, “It’s okay, go for it. I like deep work,” but in fact, if you are attentive, you will feel their tissue harden against you as you enter. In these cases, you are sadly contributing to more pain entering the body, as they are having “sensation accompanied by the motor intention to withdraw.” (You’re also breaking your fingers for no particular good reason.) Having been guilty of this for many early years in my practice, I am now more gentle, and when I teach my version of Rolf’s deep work, my students and I spend many hours developing the sensitivity to hear the subtle signs of withdrawal, even before the clients themselves are aware of painful sensations.

The threshold where sensation turns into pain is roughly equivalent to the place where turning up the volume on your speaker system starts to produce distortion. Up until then it is signal, beyond that point, it becomes noise. Signal is information that organizes the body and mind; noise disorganizes it. Unlike your speakers, the client’s threshold can change from session to session or even minute to minute. It depends on tangibles like prior intake of caffeine, breathing patterns, and muscle tension, as well as intangibles like anxiety level and the level of trust they hold for you. Working slowly, with maximum contact and communication ensures you will get the deepest change with the minimum of distortion.

The Other Dimensions

Pain stored in the body—the second kind of pain—is not often felt as pain. We move in such a way as to avoid actually feeling stored pain, but it’s there just the same. It is felt as fatigue, apathy, inability, and limitation of motion. Energy is our birthright; lack of energy, in my long experience of working with people, is often the result of pain avoidance.

So the answer is the third kind of pain: pain leaving the body. The psychic equivalent here is the pain of telling the truth to someone (or yourself) after living a lie. It can be painful in the lead-up, and in the telling, but the relief afterward is exuberant. Likewise in bodywork, often the pain has to be experienced as it leaves, when the statically held trigger point gets rehydrated through movement or pressure, or the fascial adhesions burn their way free. This can be a problem for our pain-averse clients, but once they feel the energy flowing back into the area, and realize the pain was not imposed but rather simply exposed by the bodywork, they often enter enthusiastically. Hopefully not into a masochistic frenzy of tearing up every muscle, but a gradual, layered, and coherent clearing of the built-up pain inside the structural-locomotor system. Just as a healing diet can clean the organs, and cogent psychotherapy can clean the mind, good bodywork cleans our moving self, expanding the space within.

Ben Benjamin wrote a book with the wise title, Listen to Your Pain. If we choose to listen carefully to its varying messages, we can clear more and more of it out of ourselves, leaving room for all the other delightful sensations the world has in store.