FOR several weeks after a Caesarean section, you aren’t allowed to drive. There is good reason: if you needed to stop suddenly for a child darting into the road, the pain felt from your seat belt crushing your surgical wound would prevent you from braking properly. Your brain, your unconscious mind, forces you to act to avoid your own pain – no matter the consequences.
You would think, given how important this sensory experience is for governing our behaviour, we would know more about it. The fact is, when it comes to pain, we have been muddling through for decades – made desperately clear by the 80,816 deaths in the US that involved opioid painkillers in 2021.
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Now, though, there are signs of change – and hope. As you can read in our special report, breakthroughs in pain research are coming along swiftly. We have a better understanding of how pain is processed throughout the body and brain (see “What is pain, how does it work and what happens when it goes wrong?“) and how to measure it (see “New ways to measure pain can help us communicate how bad it really is“). We have discovered important differences between three types of pain (see”We are only just beginning to understand what causes nociplastic pain“). We understand that chronic pain is its own condition (see”Viewing chronic pain as its own illness is providing better treatments“) and have pieced together the relationship between pain and conditions like depression and anxiety (see”Why emotions can feel so painful – and what it means for painkillers“), leading to better treatments (see “The new pain treatments that may finally stem the need for opioids“).
“We need to accept that subjective thoughts and feelings play a major part in pain”
But these advances come with a sting in their tail. If we are really going to win the war against opioids, we need to fight another battle: to broaden acceptance that subjective thoughts and feelings play a major part in our experience and treatment of pain.
Incorporating subjectivity into medicine has always been a challenge for doctors and patients alike. “It’s all in the mind” has historically been a way of dismissing someone’s pain. Now, we must embrace the idea that our mind has a vital role to play. With more than 30 per cent of the world’s population living with chronic pain, it is more vital than ever that we understand pain’s subjectivity. Lean into that and we may start making the progress we so desperately need.