A day against pain

September 11 is Global Day Against Pain. A Chennai company is using the opportunity to promote its already famous pain balm. In fact, the balm can do little to treat the kind of pain that this day commemorates.

Patrick Wall, considered the world's foremost authority on pain, did much of his work at Columbia University. The neuroscientist wrote at least three books considered path-breaking by his peers. He had a personal interest in the subject: he suffered from cancer, and it hurt.

I picked up Pain: The Science of Suffering, which Wall published in 2000, at a sale in Bangalore. It offers fascinating case studies. When a farmer's hand accidentally got trapped in an agricultural machine, he chopped it off with his other hand and carried it to a neighour. He later said he had felt no pain. Wall uses such instances to illustrate that pain is not a “simple signaling system” that switches itself on and off in response to injury. The mind plays a big role in the way pain signals are processed.

In 2004, my aunt was run over when she was crossing the tracks at the city railway station. I know she must have suffered the most extreme pain, but she wasn’t crying when I rushed to where she lay. She was unconscious, but drank some water. She died about an hour after the accident. Some weeks later, I developed severe pain and burning first in my legs and then all over my body. I had suffered no physical injury.

What is the connection between pain and the mind? Doctors, philosophers, scientists, and even lay people ask themselves that question. I owe my interest in Wall's book to the chronic pain that seized me in 2004. The problem took me to doctors and healers of all kinds, and to books such as V S Ramachandran’s Phantoms of the Mind. Ramachandran has cured soldiers and accident victims suffering from phantom pain (pain in a limb that has long been amputated) by tricking the brain with a mirror!

As I look for relief, it occurs to me that pain, or for that matter any illness, could actually be interpreted in multiple ways. The principle of "one truth, many paths" applies to the diagnostic sciences. Or if you were cynical, you might say doctors fit an illness to whatever limited tools they have acquired. For instance, doctors have said my symptoms were caused variously by diabetic neuropathy, nerve infection, fibromyalgia, nerve entrapment, and so forth. A healer from a wrestling family believes the pain is caused by poor blood circulation in my back.

Pain is the subject of much philosophical debate. Philosophers make a distinction between pain and suffering. Pain is neuron-related, Meera Baindur, who studies environmental philosophy at National Institute of Advanced Studies, once told me. Suffering is not.

“If suffering were limited to the pain generated by neurons, we won't be able to say trees and plants suffer and so one has to be kind to them," she said in the course of an impromptu Gmail chat. “To shift ethics from humans to nature, we have to see what suffering is common to all creation.”

A Tibetan Buddhist doctor I know tells his patients their pain would ease if they could see it as part of the larger suffering of the world. Pain isn't just a physiological problem: it has psychological, philosophical dimensions.

Wall’s book puts it this way, “Pain involves our state of mind, our social mores and beliefs, and our personal experiences and expectations.”

The World Health Organisation came up with the idea of a Global Day Against Pain in 2004 to draw attention to the plight of cancer and HIV Aids patients.

To desire freedom from pain is perhaps as futile as desiring freedom from death. But let us hope the world will do what it can to treat the pain of those chronic sufferers. Pain is difficult to understand, but it is even more difficult to live with.