Does Pain Serve a Purpose?

May 13, 2005 — -- Remember the 1970s television series "Kung Fu"? Each episode opened with scenes of a stoic Shaolin monk, played by David Carradine, enduring excruciating physical challenges -- walking over burning coals and lifting a hot cauldron with his forearms. Pain was portrayed as a critical part of the monk's path to spiritual and personal growth.

To be sure, individuals can gain confidence and pride by pushing themselves to complete marathons or other demanding physical challenges. But enduring pain or stress injuries on a regular basis serves no good purpose for the body or soul, researchers say.

"Good pain is the body's warning system," said Dr. Edward Covington, director of the Cleveland Clinic's Chronic Pain Rehabilitation Program. "Intense nociceptic pain is the good pain. It's the pain that warns you your appendix is about to rupture or someone has stepped on your foot."

While many would consider a life without pain as a blessing, it is anything but that for those who suffer from a rare disorder that leaves them unable to feel pain. The condition -- called congenital insensitivity to pain with anhidrosis, and also known as CIPA -- affects nerve endings. Because sufferers have no ability to sense pain, they are vulnerable to serious cuts, fractures and burns. Covington said this is a particularly difficult disorder to manage and can leave a person seriously compromised by injury by adolescence.

Most people are not disabled by nociceptic pain, which is pain caused by injury or trauma to the body's tissues, but rather by chronic pain, Covington said. Indeed, about 70 million Americans are partially or completely disabled by chronic, debilitating pain, according to the National Pain Foundation. And despite advances in pain treatment, many people encourage themselves to dismiss or ignore pain.

"We have a tendency to think people who don't complain about pain are macho, Clint Eastwood-types, and those who do complain are wimpy," Covington said.

But research suggests otherwise. "There are a number of genetic differences in enzymes and in individuals' opioid receptors that these 'tough guys' may simply not be experiencing pain," Covington said.

'Good Pain' vs. 'Bad Pain'

When treating pain, patients and their primary care doctors too often overlook the distinction between good pain and bad pain, many specialists say. Patients want to know exactly what's causing their pain, and physicians often go looking for an underlying physical cause. But this is often the wrong approach. "In many cases, the pain itself is the disease," Covington said.

"We need to recognize that all pain doesn't have a somatic [bodily] origin," said Dr. Todd Sitzman, medical director of The Center for Pain Medicine in Hattiesburg, Miss.

Like Covington, Sitzman recommends a multidisciplinary approach to pain management. Cognitive-behavioral therapy can have a great effect in pain management. Through therapy, Sitzman said, "patients can reduce their sense of suffering by changing maladaptive behaviors and learning new coping strategies."

Patients may also need to change their diets, adopt or alter exercise regimes or address psychological problems to make real progress in alleviating chronic pain. But, he admits, "There are no magic potions."

Pain as an Opportunity

Dave Markowitz, author of Perspectives: A Radical Approach to Healing, is on the other end of the healing spectrum. The son of a pharmacist, Markowitz decided to take a decidedly non-pharmaceutical route to addressing chronic pain, using everything from meditation to spiritual channeling with his clients.

Markowitz believes chronic pain can signal underlying emotional or spiritual concerns. He turned to alternative therapies when Western medicine failed to alleviate his pain. And as a man who actually has walked across a bed of hot coals, Markowitz has developed an interesting perspective on pain. "Any situation including pain can be a burden or an opportunity. Pain can be a friend, if we look at it as an opportunity," he said.

For Markowitz, getting to the emotional root of pain can be the key to unlocking it. He said he had an extraordinarily successful session with a client who said she had suffered from sciatica for 40 years. With Markowitz's help, the woman came to realize that her pain was associated with feelings of responsibility, tied to her relationship with her daughter. By the end of the session, Markowitz said, the woman said 80 percent of her pain was gone.

In diagnosing chronic pain, Markowitz said, patients and physicians can get "locked in" to a certain treatment plan. "There are people who really need medication. However, the pain doesn't go away. It just gets blocked with the medication. I believe this can set off a chain reaction, and a downward spiral of ill-health.

"If someone's experiencing pain for decades, it seems sensible that we should look at other types of treatment to address the pain," he said.

Markowitz said he emphasizes personal empowerment, and that healing can come fairly quickly when a client is mentally ready. "The last thing I want is to see a client for six months," he said.

High-Tech vs. Alternative Treatments

These sorts of nontraditional therapies are being embraced by more medical practitioners, but many people still believe a pill or injection is the only way to deal with serious pain.

"Americans have been seduced by technology. It's exciting and sexy and incredibly profitable. But there is no treatment that is as effective as a multi-treatment rehab program," said the Cleveland Clinic's Covington.

"Cognitive therapies, for example, cost less and carry far less risk than surgery and pharmaceutical treatments, but tend to get short shrift and government and insurance companies often don't cover it," he said.

Covington believes that patients and doctors too often want quick and easy fixes to a problem. "You can write a prescription in 30 seconds and the patient can take a pill in 30 seconds. What we see happening is Americans spending more for health care, but they may be getting less health."