Making sense of pain


It’s been said many times, so many times I can’t locate the originator of the saying “humans are meaning-making machines” – no more so than when a person experiences pain. Whether it’s a stubbed toe, sprained ankle, thundering headache – or, in my case, weird and ongoing widespread body pain AKA fibromyalgia – we would like to make sense of what’s going on. And mostly we tell simple stories about what we were doing, what happened to the body and that’s that.

In the case of weird or persistent pains the challenge becomes harder. The original story might not fit any more, or because of that story, we limit what we do in case we do damage.

Now philosophers and other commentators have taken up the matter of what this experience really is: sensation or perception? Frankly, I don’t think this matters a jot to the people I see who are trying hard to make sense of what their pain means to them. One person I’ve seen recently said “I feel adrift, like a pingpong ball bobbing on the sea” – life is what isn’t making sense any more. And life, dear readers, is not as simple as sensation or perception.

One of the concepts used to understand what constitutes health is the construct “meaning in life.” Meaning in life is associated with resilience, better health outcomes, and very importantly, recovery from Covid and dealing with the stress of how Covid and other world events have played out over the past few years (Arlsan & Allen, 2021; King & Hicks, 2021; Lin, 2021). But where meaning in life has been extensively studied is….chronic pain.

This makes sense to me! Chronic pain is known to disrupt “normal” life for the person experiencing it. Movements that used to be done without thinking are now etched into memory. Sleep isn’t the respite from world cares it was – now it’s endless hours of aching. Assumptions about how quickly a person should recover from injury are smashed. Chronic, persisting, ongoing pain can disrupt life as we know it.

Meaning in life is thought to comprise three facets: coherence, purpose, and mattering. Coherence is about comprehending or “making sense of the past, present and imagined future aspects of life, being able to integrate their life story into a coherent whole (King & Hicks, 2021).” Purpose is “a central, self-organizing life aim that organizes and stimulates goals, manages behaviors, and provides a sense of meaning (McKnight & Kashdan, 2009).” Mattering is about how a person believes their life counts – a sort of transcendence beyond self to a bigger world.

All three of these constructs contribute to an overall belief that life makes sense, and that we are effective agents that contribute over and above our lifetime. You can see how this can erode when living with a meaningless pain like neuropathic pain, or ongoing migraines, or low back pain that just doesn’t settle.

Where does that leave us, if we’re clinicians working with someone experiencing weird pain? I think one of the most important parts of our work is to help people achieve a sense of coherence – that despite pain, it’s possible to still be “me” and that while the future may be different from what was previously imagined, it can still fit into a coherent whole. What this means is helping the person to establish what matters in their life, then figuring out ways for the person to resume those things, whether pain is present or not. This might look like helping the person come up with a story about their pain – a narrative that moves from damage to perhaps recognising that we don’t know why they hurt, but that they know of various factors that influence the severity, frequency and interference of their pain (Hadley & Novitch, 2021).

I also think we need to recognise that people living with pain may also find their purpose is challenged – and some of our work is helping people recognise their purpose in life and find ways to keep moving towards what matters to them. This is the part where we recognise values and life direction – perhaps “occupational drive” or the things that people want and need to do.

Finally, throughout our work with people, we need to remember that mattering matters. That the person we’re working with isn’t “the wonky knee” or “the shoulder” or “the bad back.” Being willing to see the person behind the eyes, the talk, and the pained body. This takes time, and most of all – listening with heart and curiosity.

Arslan, G., & Allen, K. A. (2021, Jan 25). Exploring the association between coronavirus stress, meaning in life, psychological flexibility, and subjective well-being. Psychology, Health and Medicine, 27(1), 1-12. https://doi.org/10.1080/13548506.2021.1876892

Hadley, G., & Novitch, M. B. (2021, Apr 1). CBT and CFT for Chronic Pain. Current Pain and Headache Reports, 25(5), 35. https://doi.org/10.1007/s11916-021-00948-1

King, L. A., & Hicks, J. A. (2021). The science of meaning in life. Annual Review of Psychology, 72, 561-584.

Lin, L. (2021, May). Longitudinal associations of meaning in life and psychosocial adjustment to the COVID-19 outbreak in China. British Journal of Health Psychology, 26(2), 525-534. https://doi.org/10.1111/bjhp.12492

6 comments

  1. I so appreciate your writings Bronnie. This is another excellent article. I will be sharing it with my daughter who has Fibromyalgia. Healthcare needs more awareness when it comes to these concepts. Part of the challenge I have seen in the field is that many clinicians tie their identity around solutioning and being able to “cure” the patient. They get frustrated and dismissive of the patient’s pain and reality when they cannot progress them through their model of care. This, unfortunately, does not allow for the approach that you so eloquently describe: “helping the person to establish what matters in their life, then figuring out ways for the person to resume those things, whether pain is present or not.” The power of narrative should be part of our toolkit. Thank you again for sharing your thoughts and expertise.

    1. thank you so much Alexa, I appreciate it. You’ve struck on something important with the “many clinicians tie their identity around solutioning and being able to ‘cure’ the patient” – spot on! When we start to see that our job is to help the person find their own way through this, we are in a much better place to avoid that “hero” trap. I’m a cheerleader and a guide and perhaps a coach, but I’m not able to create results myself.

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