The Study of Pain

*This piece was originally written in April 2014 for a blog I had at that time exploring the intersection between sport, pain, and what it means to suffer.

Heading up the last climb of the Tour of the Gila on Sunday I made the conscious decision that I was not going to be able to keep up the pace of the lead group I was in and subsequently sat back in my saddle and drifted away from them. It is always a conscious decision to remove oneself from a painful stimuli (save for torture). The only other reprieve would be death and our brains will not allow for that. But, what elements were involved in my choice? Many. However, the primary ones form the framework by which we study and understand pain.

It is important to take a closer look at these different filters by which pain, in all its forms, is examined. Academics are always squabbling to prove their theories and more often, it seems, to disprove the others. However, it doesn’t take tenure to see that a bit of a Venn approach fits best. A phenomenon as dynamic and enigmatic as pain needs this broader perspective because the nuances of the individual experience might otherwise be overlooked.

The model I was taught in medical school is known as the bio-medical model. It examines how the nerves that sense pain talk to each other and in turn how those signals are interpreted by the brain. This is obviously a simplistic explanation of the model, but I won’t bore you with the details.

The discomfort in my legs as we ascended the category 2 climb came from the major disruption in my body’s equilibrium. Whether this discomfort is caused by lactic acid, decreased blood flow, muscle tearing, or some other mechanism (or combination thereof) is not completely understood. However, these initial triggers set off a cascade of signals to my brain saying, “What the hell happened to the massage we had last night! Let’s go back there cuz this place sucks!” or at least the biochemical equivalent of that.

A critique of the bio-medical model is its reductionist tendencies — pain is nothing more than nerves and neurotransmitters. The model doesn’t fully account for our different responses to pain. However, other models do examine this further. I want to emphasize though, that the authenticity of one’s experience is not diluted by the understanding of its origin.

A few months ago, I was in Tucson and riding up the infamous Mt. Lemmon for the second time that day. My tank was empty at that point and I struggled to continue. I don’t know if it was the song in my earbuds or the view, but I suddenly began to tear up. A new surge of energy came over me and I was out of the saddle again. But, as quickly as the tears had come they were replaced with anger, and I don’t know at what. I was legitimately pissed and cursing at nothing but the setting Tucson sun. Clearly, I was suffering and my responses to it were varied. I suspect, my emotions can be, in part, explained by the contextual model for understanding pain.

I am half Italian and half German so there is a frequent struggle between the stubborn strudel of a left brain and the passionate conglomeration of pasta for a right brain. I want to spend more time writing about these cultural differences because they are deserving of more explanation (in a later entry), but suffice it to say they do exist.

However, I have found that at a certain level of pain, of suffering, these responses become blunted. Pain mutes my emotions and I simply become flesh on a bike. I don’t think rationally, nor does the conjuring up of previously emotional memories have any impact on me. Honestly, I don’t like those moments. I want more control over my mind when that time comes. These are deeply personal experiences and how I alone react to them is my choice. It is this choice that I believe can be altered and I have found that my understanding of where I falter can be changed, my threshold can be moved.

The personal, subjective experience of pain is known as the phenomenological model. It is the most enigmatic, as we all relate to pain differently. Even the language we use to describe pain is different, a characteristic that makes its understanding all the more complex. An important concept that I have carried with me in medicine is the idea that there is nothing more objective than the subjective. Our personal experiences and emotions are entirely our own and no scientific explanation can take that away from us. As patient and athlete we have the ability to choose our relationship to pain for it is our own experience regardless of its etiology. This choice is by no means easy, but it is empowering once realized. Even within the past month of racing I have tried to recall this sentiment as I near my threshold. I chose to sprint one more time, to grab for that wheel again and it has led me to a better place athletically and mentally. I see that threshold moving, but I know it still has a ways to go because I’m not dead yet.