Some People Surrender to Pain More Easily Than Others

May 14, 2005 — -- You've heard the sayings: No pain, no gain. Mind over matter. Just do it.

Many athletes have used similar sayings as inspiration to overcome pain and will themselves on during competition or exercise routines. We've seen athletes overcome physical pain to perform Herculean feats: Olympic gymnast Kerri Strug standing on one leg, her face contorted in anguish, after completing her last gold medal-clinching vault with torn ligaments in her ankle in the 1996 Olympics; Joe Namath hobbling in the quarterback's pocket before tossing a touchdown; and Mickey Mantle limping around the bases after hitting a home run.

We've all faced pain or discomfort while exercising and competing -- and handled the challenge differently. Why do some people give in to pain while others thrive in spite of it?

"It may be that elite athletes are endowed with more inherent capacity to regulate or modify their pain experiences, along with other talents that training, discipline and motivation can accentuate and optimize." said Perry Fine, professor of anesthesiology at the Pain Research Center at the University of Utah.

"If we could figure out how to 'harness' these capabilities, we would be a lot closer to being able to help alleviate chronic pain," he said.

Opening and Closing the Gates of Pain

Psychologists have been looking for a common denominator among those who are able to perform in stressful situations. That knowledge could help others deal with their pain.

The "gate control" theory, proposed by Canadian psychologist Ronald Melzack and British physiologist Patrick Wall in 1965, suggests that the sensation of pain may never reach the brain in some people.

The theory suggests that there is a "gating" mechanism within the spinal cord that opens and closes and may allow or prohibit pain from registering.

"Back in the 1950s, there was some thought that people experienced pain the same way -- that people who experience the same amount of tissue damage to a particular area experience the same amount of pain, and that just isn't true," said John Lefebvre, professor of psychology at Wofford College in Spartanburg, S.C. "It could be that some people, like runners, don't respond to pain the same way. They are more able to block out the pain while others may become preoccupied with it and feel more pain as a result."

In World War II, some medics reported seeing soldiers with horrific injuries who said they felt no pain until they were treated for their injuries. Patrick Ireland, one of the victims of the Columbine High School shootings, threw himself out of a window to escape and said he did not feel pain as he was trying to get to safety.

"With those examples from World War II and the kid from Columbine, some believed that those people experienced some kind of stress-induced analgesic that enabled them not to feel any pain," said Lefebvre. "But with Kerri Strug, she clearly felt pain. You could see it in her face. Perhaps with the hopes of an entire nation on your shoulders and your being this close to the medal, something you've worked years to achieve, that could be as big a motivating factor as anything."

The Agony of Victory, the Agony of Defeat

Chris Febles, a coordinator for the Make-A-Wish-Foundation, has been well-acquainted with the pain associated with running. He ran long distance in high school and returned to competitive running a few years ago to stay in shape. Last year, the 32-year-old ran in the New York City Marathon.

"It was something I always wanted to do at some point in my life," Febles said. "My brother and sister had done it and I wanted to see if I could do it. … The pain factor was a concern but my coaches always told me, 'Don't worry about it. Just do it.' And that helped."

Febles trained for months, but he almost didn't complete the marathon. Around mile 20, he experienced severe cramps in his abdomen and his quadriceps muscles stiffened. Febles admitted that he didn't follow some of the important principles he had employed while training, such as eating enough before and during the marathon, drinking enough liquids, getting enough sleep and properly pacing himself.

"I just hit a wall. It was brutal. I think I started hallucinating because I thought I saw Elvis and Scooby Doo running past me," he said. "I had to stop at a nurse's station and I must have laid there for about half an hour. But then I decided no matter what, I just wanted to finish the race. … I knew no one would have felt less of me but I just wouldn't have felt right."

Febles finished the 26.2-mile run in slightly over four hours. Despite the pain, he decided he would run another marathon, but take a different approach. In his first marathon, he aimed to finish at a particular time. In his second, he planned to just have fun and "go with it."

Febles is currently training for another run in New York and has successfully competed in Cincinnati's Flying Pig Marathon. He finished that race in about three hours.

"In marathons, it really helps to have that distraction [from pain], to have people cheering you on," Febles said. "It really gets your mind off the agony and keeps you going."

Perception Is Almost Everything

Part of one's ability to block out pain during sporting events or exercise may depend on how an individual perceives athletics.

People who thrive on competition or see athletics as empowering may have little difficulty blocking out pain or finding distractions. However, those who do not enjoy exercise or who have suffered a previous injury will likely be hobbled by pain more easily.

"Some people see exercise as the only time in the day that they're in total control of their lives. I know that when I'm running, it's just me and my music," said Lefebvre. "But others who may have suffered a knee injury may be worried about injuring themselves. There are some people who develop a fear -- a kinetic-phobia -- a fear of movement. You have to help them through initially with baby steps."

Trainers do not recommend that people risk serious injury or try to push through an injury. But some people do confuse pain with discomfort or tend to dramatize discomfort when they have concerns about injuries.

"In my experience, the most common mistakes are either catastrophizing [i.e. turning a mole hill into a mountain] or not appreciating -- or more likely, being willing to acknowledge -- that a rather minor, but nonetheless significant, injury requires sufficient rest and treatments to allow sufficient time for healing, in order to prevent a worse injury," Fine said by e-mail. "But that is the mindset of the competitive athlete. Pacing and 'taking it easy' are not what gets them to the success they've enjoyed. Being driven and overcoming hardship are."

Maybe the secret to pushing through pain lies with women and childbirth. Febles said he marveled at how good his sister looked after she completed a marathon.

"She told me that a lot of women will tell you that competing in a marathon is nothing compared to the pain in childbirth," Febles said. "If you can get through that, then you can get through anything."