The Experience of Pain
Acupuncture is famous for natural pain relief. Many health problems respond well to acupuncture and moxibustion, but pain conditions can disappear remarkably fast.
Most of the time.
Sometimes intense gnawing pain will disappear permanently in one treatment. Other times, it might take weeks or months of treatment, slowly chipping away at it.
To make sense of why and how acupuncture treats pain, we have to explore pain itself. But not nerve pathways, pain gate theory, neurotransmitters, or any of that.
This is about the experience of pain.
Some pain is deep, old and constant. Other pain is like a flash of blinding light. There is pain that comes from tissue damage, pain from emotional trauma, and pain from a loss of purpose in life. Each one is qualitatively different: fast or slow, deep or shallow, smooth or rough, restricted or scattered. An acupuncturist develops a nuanced vocabulary for pain.
The healing process has to match the specific quality of pain that someone experiences.
For example, if the pain is deep, old and constant, it is like a glacier. To treat it, the method has to be like the sun shining through the atmosphere: steady, big, pervasive.
So the better we can break down different experiences of pain, the more specific and holistic our treatment can be. This leads to a recovery that lasts.
7 Types of Pain
Acute pain is sudden and, usually, intense. This is the pain of a sprained ankle, a broken bone, a migraine, or appendicitis. Injuries start as acute, but can become chronic if they do not heal properly. Internal issues often start as chronic imbalances, behind the scenes, but can become acute when they surface with an intense symptom (like appendicitis or an allergic reaction).
With acute problems, there are two rules:
1. Treat it quickly
2. Treat it completely
One of the lessons I took away from my time in China was the way many people did not let a health problem linger on and on. Small issues like waking up with a crick in the neck or a couple days of constipation would bring people straight to the acupuncture clinic. A couple of quick treatments and they go back to their daily life.
In the West, especially in the hectic rush that is life in Toronto, we shrug off small health problems. They get pushed down on our to-do list. Over months or years, that small problem snowballs into a collection of symptoms that all together dramatically affects quality of life. Over time and under stress, a simple symptom can snowball into a multi-system disharmony. Autoimmune diseases, fibromyalgia, chronic fatigue syndrome, chronic allergies, all tend to be the result of this kind of multi-system snowballing.
Acupuncture and herbal medicine are good at untangling these knots, but it takes a lot longer and requires more commitment to changing unhealthy lifestyle habits.
Quick treatment of a small issue is definitely wiser than waiting to see what happens. And I say this as someone who waited for years, watching as my own stress and poor lifestyle choices caused an inherited predisposition to snowball into ever more dramatic expressions of disease… but that’s a story for another time.
Full recovery is another aspect of acute pain that gets rushed past. A broken bone is a good example. Let’s say you break your right shin just above the ankle. You go to emergency, get a cast, and go home. Come back in six weeks. In those six weeks, you put a lot of strain on your healthy leg, on your hips and your shoulders, as you try to live your life. Your whole body shifts to accommodate the healing process. This is good.
Then the cast comes off. The right leg is thinner, weaker. The right ankle looks different from the left one. You go back to your normal life, figuring that the leg will go back to normal soon too. Muscle mass comes back, but the ankle always looks misshapen. It doesn’t cause any pain, so you ignore it. You continue to favor your left side. Two years later, your left knee starts bothering you. At first you only feel it when you run, then it becomes more frequent. A year after that, your hips develop a constant stiffness. The headaches that you used to get once in a while turn into migraines. They come on with increasing frequency. And then, during a stressful time in your life, your sleep goes off. You wake up 3 or 4 times a night. You used to have pretty bad anxiety and insomnia in high school, but it went away with medication and you thought it was behind you. Finally, you go see an acupuncturist for sleep and stress.
This problem started in the leg, then it spread first through structural imbalances in the skeleton, muscles and fascia, and then through functional imbalances in the circulatory and nervous systems.
I see stories like this often in my clinic. Every system in the body communicates with every other system. Any time that one system screams loud enough, or for long enough, other systems will inevitably buckle under the pressure.
Chronic pain is like grating, irritating background noise. Sometimes you can ignore it or forget about it for a little while, but it’s always there, just on edge of your life. And sometimes it comes to centre stage. At night when you are trying to go to sleep, at work when you’ve been sitting for five hours straight trying to hit a deadline, at home when stress and fatigue weigh on you like a thousand pounds and you just can’t anymore.
Chronic pain can come from an acute cause, like we saw above. It can also be caused by working (in the broadest sense of work) for too long and too hard without a break or support. (Emotional trauma can also create chronic physical pain—we’ll look at that in a bit.)
Treating chronic pain is rewarding. Small gains, like a few pain-free hours after treatment, feel like a huge relief. However, because this pain is burrowed deep into the nervous system, and often involves chronic inflammation, soft tissues damage and an emotional component, it can be very stubborn.
Chronic pain is difficult to treat completely. It takes time. It takes patience. It takes an understanding that there will be ups and downs along the way. But bit by bit, there is change. There are periods of life without pain. And with commitment and some luck, those periods grow longer and deeper.
Recurring pain is a issue of lifestyle, athletics and exercise, or work. Common examples are repetitive strain injuries like carpal tunnel syndrome, tennis or golfer’s elbow, and jumper’s knee. This is an injury that happens one time, recovers, then happens again, recovers a little less, then happens again, and so on.
Each time the injury is re-aggravated, it takes longer to recover. More inflammation lingers. The body remembers the injury and compensates to protect it, which can lead to left-right imbalances. Over time, scar tissue might develop, which can pull the fascia and cause pain in other places.
With recurring pain, we are looking at healing the original injury, reducing inflammation and tissue damage from each recurrence, and also changing habitual patterns of use—the movement that is causing the injury. The longer the pain has been recurring, the more significant that change in the habits of movement has to be.
In these cases, acupuncture is well assisted by physiotherapy, and perhaps occupational therapy. Physiotherapy on its own may not be enough to treat the original injury and chronic inflammation, so the combo is ideal.
Internal pain is caused by problems in the trunk or head. Everything from menstrual cramps to headaches and stomachaches to appendicitis and heart attacks fall into this category.
Internal pain is a great example of the fact that the pain that you are feeling is not the real problem.
Pain is the body’s way of saying that something is wrong.
In the case of a heart attack, the ER physician is not concerned with reducing the pain of the person having a heart attack. Pain is simply an indication that the heart muscle is not getting enough oxygen and the muscle tissue is suffocating and about to die. Tissue death means the heart cannot beat. And that is the real problem.
For internal medicine physicians, pain is a sign post, an exclamation point screaming “PAY ATTENTION!”
External pain covers everything in the four limbs and on the outside of the body, usually the skin and muscles. This is a broad category of pain that includes traumatic injuries and reactions to environmental triggers and stimuli.
Environmental causes of pain can be seen in cases like allergic reactions that cause red irritated eyes or itching rashes. There are also plenty of examples of painful reactions to chemical substances, from headaches caused by perfumes to caustic liquids that burn the skin. Some of these reactions are simply a result of incompatibility (e.g. human skin is incompatible with lye), but other reactions are a result of hypersensitivity or a dysregulated immune system.
Acupuncture can be useful in situations that call for more resilience to normal or mildly abrasive environmental conditions. The human body is designed to be able to thrive in a wide range of conditions, from hot dry desert, to freezing cold tundra, to tropical river deltas. And yet, many of us get thrown out of balance by humidity, pollen, air pollution, flu season, GMO wheat, artificial scents, or even winter itself.
Without a doubt, these things do not make for an ideally healthy environment, but resilience is crucial to thriving on this planet, especially as climate change makes many environmental conditions more extreme, erratic and difficult for all of us to adapt to.
Pain can also come from that enormous part of human experience that we call ‘emotions’. There are some fundamental emotions that are healthy. In fact, there are some emotions that must be expressed in order to be healthy.
Anger, sadness, grief, joy, fear, fright are all important feelings in the right moment, in the right amount. Specific situations demand a specific emotional response. As long as the emotion that arises in reaction to your situation helps you either survive or thrive, and then that emotion fades away, then you are in good shape.
Dysregulated emotions, however, can create both physical and psychological pain.
An emotional imbalance can be too much or too little expression of a healthy emotion, like being unable to let go of anger for days after someone is rude to you or, conversely, not once in your life yelling in anger at another person. An imbalance can also be an inappropriate emotion for the situation, like feeling fear despite being in a perfectly safe environment.
Being stuck in an emotional imbalance can create psychological pain with physical expression. Anger that feels like your blood is boiling. Sadness like a lead blanket. Grief that feels like a raw hole cut into your chest. These are the felt experiences of very real physiological effects. Emotional imbalances change blood pressure, heart rate, respiration. They create muscle tension and chronic fatigue. They have specific neurological patterns in the brain and throughout the body. They can trigger stress hormones to flood your circulation, turn off the immune system and prevent processes that heal inflammation. All of this, in a dysregulated or extreme expression, can create a perfect storm for many different experiences of pain and illness.
Existential pain can be harder to pinpoint than emotional pain. It is bound up with the sense of self and one’s entire relationship to the experience of being alive. It can be the pain of facing death unprepared. It can be the pain of losing the motivation to live. It can be a deep sense of meaninglessness.
This kind of pain is sometimes called a spiritual crisis or a crisis of faith. When your spirits (Chinese medicine describes many spiritual aspects of human life) leave your body, there is a profound sense of loss or emptiness. Imagination, physicality, will, cognition, and consciousness itself are the responsibility of the spirits. Existential pain occurs when you become severed from one or more of these experiences.
If you lose your imagination, you can no longer envision the path ahead of you; you do not dream, at night or during the day; you cannot be creative or inventive. If you lose physicality, your body feels numb; foods lose their flavour, smells are all the same; you lack the strength to work or play. Loss of cognition creates confusion, worry, dwelling on things but not understanding anything clearly (dementia, for example). Loss of will is loss of the primal survival instinct. This is “the will to live”. Without it, one merely waits for death, not through acceptance but from defeat. Loss of consciousness, in the existential sense, is death itself. This loss can be healthy, like the timely and appropriate expression of an emotion. Everything that comes together must eventually come apart. Or it can be untimely, sudden, or violent, as when the will to live clings on desperately at the end, or when dementia denies one the ability to understand and accept that one is dying.
Existential pain comes from one spiritual aspect unravelling, separating from the person, out of sync with the other aspects.
Spiritual or existential loss can trigger emotional responses like fear, depression or sadness, but the pain itself is bigger. Emotions are momentary. We might hold on to a particular emotion for a while, but it is a momentary, conditional thing, like clouds in the sky. Emotions belong to the realm of humanity. The spirits are on the scale of stars and galaxies. The pain of an existential crisis touches on our connection to the process of life and death throughout the universe.
A side note: The classical Chinese medical and philosophical theories on spirit are truly brilliant. In Western traditions, the spirit, or soul, is something completely distinct from the body and anything physical, so they cannot be studied scientifically. In Neijing tradition, the spirits are as much of a physical phenomenon as are the rain and stars. The way they influence our lives is analyzed using the same models used to explain embryology and star formation, i.e. physics and biology. This makes treating the imagination, cognition, will power, etc., a natural part of medical practice.
“All Pain Comes From The Heart”
All pain is ultimately an experience of conscious awareness. In classical Chinese medicine, 心 xin “heart” does not refer to that muscle pumping in your chest, but rather to the seat of consciousness, or 神 shen. This “heart” is the organ of feeling and perceiving everything both within our bodies and in our environment. (The heart muscle is called 心包 xinbao “heart wrapper”.)
According to Chinese medical theory, consciousness is present in every living cell in the body.
All sensations—pain, pleasure, itching, numbness, emotions—require 神 shen and therefore involve the heart.
Western biology has long located consciousness in the brain, but more recent discussions in medicine, biology and psychology are questioning that theory. Scientists and medical researchers are looking at the nervous system more holistically, exploring the idea of multiple “brains” or centers of organization within the nervous system, and also to the interactions between an individual and their social environment.
In addition to taking care of any tissue damage that might be present, an acupuncturist has to keep in mind the person’s experience of their pain, their relationship to it at any given moment, and the capacity of their entire body and mind to manage that experience. This informs our treatment strategy, particularly in how strongly or directly we address the cause of the pain, and in how much we need to support adjacent systems.
All pain, by definition, has multiple aspects. The are always at least physical and mental components. Emotional and perhaps even social factors may be involved as well. An effective treatment of pain has to consider each aspects involved.
In an acupuncture session, the physical, mental and emotional dimensions of pain are treated simultaneously, which is part of what makes acupuncture so effective for many different pain conditions.
Exactly how a few needles, moxa and massage are able to simultaneously treat the body, mind and emotions, well, let’s save that one for another time.