We’ve Been Thinking About Pain All Wrong
If you ask most people to explain how pain works, they’ll say something like, “Well, you have an injury, and the ‘signal’ travels up to your brain, and your brain interprets it as pain.”
Sounds plausible, right?
It’s essentially the same theory René Descartes described in his 1664 Treatise of Man. Descartes believed a “little thread” transferred pain to the brain, “just as, by pulling one end of a cord, you ring a bell which hangs at the other end.”
It’s a nice analogy — but it’s utterly wrong. According to today’s science, almost exactly the opposite is true.
“The type of thinking captured in Descartes’ model has led to some amazing advances in clinical medicine,” wrote Lorimer Moseley, arguably the world’s foremost pain scientist. “But the evidence against it is now almost as compelling as that against the world being flat.”
Here’s how we’ve been thinking about pain all wrong and why understanding pain’s purpose helps us control it, rather than letting it control us.
Two Snake Bites: One Real, One Fake
Moseley became interested in pain because of a weird personal experience he had while camping with friends south of Sydney. While walking barefoot along a riverbank to take a dip in the river, he felt something scratch his ankle. Thinking nothing of it, he brushed it off, kept walking, and got into the cool water.
The next thing Moseley recalls is waking up in a hospital bed. He’d been bitten by an eastern brown snake — one of most venomous snakes on earth. Doctors told Moseley he was lucky to be alive, but what astonished Moseley was what happened when he ventured back into the bush six months later.
As he set out on a hike in a nearby national park with a companion, Moseley again felt something scratch his ankle. But this time, he was immediately overwhelmed with agony, describing the sensation as, “a white hot poker of pain screaming up my leg.”
Fearing the worst, his friend called an ambulance. However, there was no snake bite this time.
Rather, the source of the pain was nothing more than the scratch of a twig.
“But the thing is,” Moseley told a newspaper reporter after the incident, “it really hurt … I had groin pains for about a week later, just as I had for a week after the real snakebite.”
Moseley’s painful brush in the bush is unusual, but it’s in line with similarly strange phenomena involving pain.
A Tale of Two Nails
In 1995, a 29-year old construction worker was rushed to the emergency room after stepping on a 6-inch nail. The nail had punctured through the sole and exited through the top of his boot, jutting out below the laces. A case study in the British Medical Journal reported, “the smallest movement of the nail was painful.” The man’s discomfort was so severe, he “was sedated with fentanyl and midazolam,” powerful opioids to relieve his suffering. And then, the miracle.
First, the nail was pulled out from the sole. Then, when the doctors removed the boot, “a miraculous cure appeared to have taken place.”
There was no wound. “The foot was entirely uninjured.” Hallelujah!
Of course, there’s more to the story. Upon further inspection, the doctors discovered the man was not healed through divine intervention after all. Rather, the nail had passed between his toes, never puncturing his foot. Yet, moments earlier, the man was in excruciating pain.
In the case of another construction worker, the physical harm was undeniable and horrific. Patrick Lawler, 23, was using a nail gun at a job site in the Colorado mountains. Suddenly, the nail gun backfired. Lawler was relieved to find a nail stuck into a piece of wood near him thinking he’d narrowly missed the projectile. What Lawler did not know however was that the gun had fired two nails, not one.
Six days later, Lawler felt a minor toothache. Thinking not much of it, he popped a pain killer and ate ice cream to numb the sensation. Lawler’s wife, Katerina, worked at a dental office and persuaded him to go for a check-up where Patrick was x-rayed.
“We all are friends,” Katerina told USA Today, “so I thought the (dentists) were joking.” But this was no joke. The x-ray revealed the cause of Lawler’s toothache was a four-inch nail lodged deep inside his head. The second nail had entered through his mouth, sticking one and a half inches into his brain and millimeters from his right eye.
The miracle, in this case, was that Lawler was alive and to everyone’s astonishment in relatively little pain. “The doctor came out and said ‘There’s really a nail,’” Katerina said. But it was only after Lawler began to believe the dentists urging him to go to the hospital, that “Patrick just broke down.”
The nail that nearly killed Patrick Lawler elicited a very different response from the one that had entered the construction worker’s boot. One caused terrible pain but did no physical harm, while the other almost killed a man but hadn’t bothered him much until he realized what had happened.
Similarly, Dr. Moseley’s twig scratch during his hike created searing pain, but only after he’d been bit six months earlier in the same spot by the snake. What is going on here?
Physical Damage is Not the Sole Cause of Pain
As Moseley put it, physical damage is “is neither sufficient nor necessary for pain.” In other words, it is possible for the body to be harmed and for the brain not to generate pain, and, equally, for the body to be safe but for the brain to launch into agonizing panic mode because it has misinterpreted some stimuli as an attack.
The main purpose of pain is not to alert you of physical harm, but to motivate you to get out of a harmful situation and into a safe one.
This is not to say pain isn’t real. Pain is real.
But as Moseley says, “it occurs because the brain is trying to protect body tissue.” Pain is produced by our brains, in order to protect us. And our perception of whether we need to be protected can amplify or suppress pain to a surprising degree.
When Moseley experienced the first (real) snake bite, he had no idea anything was wrong. As a result, although his body reacted to the snake’s venom, he didn’t feel much pain in the moment. His brain didn’t see any reason to sound an alarm.
But the next time Moseley was out in nature, his brain was on high alert. The trauma of the near-fatal snake bite made Moseley aware, consciously or not, of a danger that he had never known about before. As a result, when Moseley experienced something that faintly resembled the traumatic incident, his brain overreacted with a false alarm.
Something similar happened with the two nails: when the worker saw the huge nail sticking through his boot, his perception of danger was so acute that his brain produced pain to motivate him to get to safety. But Patrick Lawler was not aware of any danger when the nail gunshot a nail into his head, and he even saw physical “proof” that no harm had come to him. Believing he wasn’t in danger, and perceiving no evidence to the contrary, Lawler experienced almost zero pain.
Pain Isn’t Imaginary, But It’s More Controllable Than You Think
These findings excite me because they open up a world of possibilities. So much of life involves pain management, whether it’s chronic pain, pain from an injury, or pain from a surgery. While there’s no magic wand that makes pain disappear, there are patterns and trends that we can harness to lessen and control the pain in our lives.
Stay tuned for my upcoming articles: I’m going to unpack some of these patterns and show you how you can reap the benefits.
Nir Eyal is a former Lecturer at Stanford and is the bestselling author of Hooked: How to Build Habit-Forming Products and Indistractable: How to Control Your Attention and Choose Your Life. Indistractable won numerous honors and was named one of the Best Books of the Year by Amazon.