Pain--it's all in your head: a philosophical essay

There are three levels at which a therapist may help a patient to deal with pain. One is at the level of peripheral nerve endings, where pain is triggered by a wide variety of physical stresses which have in common the fact that living tissues begin to be damaged. The therapist needs to accept the patient's evaluation of what hurts while using objective signs to keep track of inflammation in the tissues and modifying the stresses of treatment so as to minimize pain. Higher in the nervous system, but still below consciousness there is a level defined by Melzack and Wall as the Gate, where there is a sort of triage of sensory information entering the brain. Moderate pain messages are crowded out when there is heavy traffic of other sensations. Patients who keep busy find that sensory and other distractions relieve pain. It is in the cortex, in the conscious mind, that pain is recognized as pain, and it is here that it is often made worse by fear, by anger, or by a sense of isolation. The pain may be diminished if the patient understands the cause and loses his fear. This is a great opportunity for the therapist. To be a successful pain reliever, one needs to be relaxed, non-threatening, and open. Patients should feel free to express fears and to ask questions they were too shy to ask the doctor.