7 Types of Pain

不通則痛 通則不痛
“If there is no movement, there is pain.
If there is pain, there is no movement.”

Acute

Acute pain is sudden and, usually, intense. This is the pain of a sprained ankle, a broken bone, a migraine, or appendicitis. Injuries start as acute, but can become chronic if they do not heal properly. Internal issues often go the other direction, starting as chronic imbalances in muscles, blood flow, or nerve signalling, allowed to persist behind the scenes, until they burst out into acute symptoms (like appendicitis or an allergic reaction).

With acute problems, there are two rules:

1. Treat it quickly
2. Treat it completely

One of the lessons I took away from my time in China was the way many people did not let a health problem linger on and on. Small issues like waking up with a crick in the neck or a couple days of constipation would bring people straight to the acupuncture clinic. A couple of quick treatments and they go back to their daily life.

In the West, especially in the hectic rush of modern life, we shrug off small health problems. They get pushed down on our to-do list. Over months or years, that small problem snowballs into a collection of symptoms that all together dramatically affects quality of life. Over time and under stress, a simple symptom can snowball into a multi-system disharmony. Autoimmune diseases, fibromyalgia, chronic fatigue syndrome, chronic allergies, all tend to be the result of this kind of multi-system snowballing.

Acupuncture and herbal medicine are good at untangling these knots, but it takes a lot longer and requires a commitment to treatment and to changing unhealthy lifestyle habits.

Quick treatment of a small issue is wiser than waiting to see what happens. And I say this as someone who waited for years, watching as my own stress and poor lifestyle choices caused an inherited predisposition to snowball into ever more dramatic expressions of disease… but that’s a story for another time.

Full recovery is another aspect of acute pain that we rushed past. A broken bone is a good example. Let’s say you break your right shin just above the ankle. You go to emergency, get a cast, and go home. Come back in six weeks. In those six weeks, you put a lot of strain on your healthy leg, on your hips and your shoulders, as you try to live your life. Your whole body shifts to accommodate the healing process. This is good.

Then the cast comes off. The right leg is thinner, weaker. The right ankle looks different from the left one. You go back to your normal life, figuring that the leg will go back to normal soon too. Muscle mass comes back, but the ankle still looks a little misshapen. The muscles still compensating, one group is too weak, another too tight. Some of the small blood vessels don’t fully reopen with fresh blood and the skin is slightly discoloured. This doesn’t cause any pain, so you ignore it. You continue to favour your left side. Years later, your left knee starts bothering you. At first you only feel it after a long run, so you stop doing that. A year after that, your hips develop a stiffness until it feels like the stiffness is there more mornings than not. At some point along this trajectory, you experience a bout of dizziness. And then another. They come on with increasing frequency. During a stressful time in your life, your sleep goes off. You wake up 3 or 4 times a night. You used to have pretty bad anxiety and insomnia in high school, but it went away with medication and you thought it was behind you. Finally, you go see an acupuncturist for sleep and stress.

This problem started in the leg, then it spread first through structural imbalances in the skeleton, muscles and fascia, and then through functional imbalances in the circulatory and nervous systems.

I see stories like this often in clinic. Every system in the body communicates with every other system. Any time that one system screams loud enough, or for long enough, other systems will inevitably buckle under the pressure.

Chronic

Chronic pain is like grating, irritating background noise. Sometimes you can ignore it or forget about it for a little while, but it’s always there, just on edge of your life. And sometimes it comes to centre stage. At night when you are trying to go to sleep, at work when you’ve been sitting for five hours straight trying to hit a deadline, at home when stress and fatigue weigh on you like a thousand pounds and you just can’t anymore.

Chronic pain can come from an acute cause, like we saw above. It can also be caused by working (in the broadest sense of work) for too long and too hard without a break or support. (Emotional trauma can also create chronic physical pain—we’ll look at that in a bit.)

Treating chronic pain is rewarding. Small gains, like a few pain-free hours after treatment, feel like a huge relief. However, because this pain is burrowed deep into the nervous system, and often involves chronic inflammation, soft tissue damage and an emotional habit, it can be very stubborn.

Chronic pain is not too hard to improve, but it is difficult to treat completely. It takes time. It takes patience. It takes an understanding that there will be ups and downs along the way. But bit by bit, there is change. There are periods of life without pain. And with commitment and some luck, those periods grow longer and deeper. The path of healing from chronic pain is different for each of us. Sometimes it is easy, and sometimes it is challenging, but everything that has a beginning also has an end.

Recurring

Recurring pain is a issue of lifestyle, athletics and exercise, or work. Common examples are repetitive strain injuries like carpal tunnel syndrome, tennis or golfer’s elbow, and jumper’s knee. This is an injury that happens one time, recovers, then happens again, recovers a little less, then happens again, and so on.

Each time the injury is re-aggravated, it takes longer to recover. More inflammation lingers. The body remembers the injury and compensates to protect it, which can lead to left-right imbalances. Over time, scar tissue develops, which can restrict the fascia, pull along its planes, and cause pain in distant areas of the body.

With recurring pain, we are looking at healing the original injury, reducing inflammation and tissue damage from each recurrence, and also changing habitual patterns of use—the movement that is causing the injury. If the repetitive injury has been going on a long time, then this change in habitual patterns of use will feel pretty dramatic.

In these cases, acupuncture is well-assisted by physiotherapy, osteopathy, Alexander Techniques, occupational therapy. One of these modalities on its own may not be enough to treat the original injury, the chronic inflammation and the habitual misuse, so a combination treatment is ideal.

Internal

nternal pain is caused by problems in the trunk or head. Everything from menstrual cramps to headaches and stomachaches to appendicitis and heart attacks fall into this category.

Internal pain is a great example of the fact that the pain that you are feeling is not the real problem.

Pain is the body’s way of saying that something is wrong.

In the case of a heart attack, the Emergency Department physician is not concerned with reducing the pain of the person having a heart attack. This pain tells us that the heart muscle is not getting enough oxygen—the muscle tissue is suffocating and about to die. Tissue death means the heart cannot beat. And that is the real problem.

For internal medicine physicians, pain is a sign post, an exclamation point screaming “PAY ATTENTION!”

An acupuncturist has to be careful not to focus too much on reducing pain and risk missing the more important cause underlying this call for help.

External

External pain covers everything on the outside of the body, usually referring to the skin, muscles, tendons, ligaments and joints. This is a broad category of pain that includes traumatic injuries and reactions to environmental triggers and stimuli.

Environmental causes of pain can be seen in cases like allergic reactions that cause red irritated eyes or itching rashes. There are also plenty of examples of painful reactions to chemical substances, from headaches caused by perfumes to caustic liquids that burn the skin. Some of these reactions are simply a result of incompatibility (e.g. human skin is incompatible with lye), but other reactions are a result of hypersensitivity or a dysregulated immune system (e.g. human skin is not incompatible with poison ivy, but some people’s skin really, really does not like it.

Acupuncture can be useful in situations that call for more resilience to normal or mildly abrasive environmental conditions. The human body is designed to be able to thrive in a wide range of conditions, from hot dry desert, to freezing cold tundra, to tropical river deltas. And yet, many of us get thrown out of balance by humidity, pollen, air pollution, flu season, wheat, artificial scents, or even one of the four seasons that come around every year for our entire lives.

Without a doubt, these things may not make for a “perfect” environment. However, resilience is crucial to thriving on this planet, especially as climate change makes many environmental conditions more extreme, erratic and difficult for all of us to adapt to. Building resilience to external factors is sometimes a crucial aspect of acupuncture treatment.

Emotional

Pain can also come from that enormous part of human experience that we call ‘emotions’. There are some emotions that are healthy. In fact, there are some emotions that must be expressed for us to be healthy.

Anger, sadness, grief, joy, fear, fright are all important feelings in the right moment, in the right amount. Specific situations demand a specific emotional response. As long as the emotion that arises in reaction to your situation helps you either survive or thrive, and then fades away, then you are in good shape.

Dysregulated emotions, however, can create both physical and psychological pain.

An emotional imbalance can be too much or too little expression of a healthy emotion, like being unable to let go of anger for days after someone is rude to you, or, conversely, not once in your life yelling in anger at another person. An imbalance can also be an inappropriate emotion for the situation, like feeling fear despite being in a perfectly safe environment.

Being stuck in an emotional imbalance can create psychological pain with physical expression. Anger that feels like your blood is boiling or shakes your muscles. Sadness like a lead blanket. Grief that feels like a raw hole cut into your chest. These are the felt experiences of very real physiological changes. Emotional imbalances change blood pressure, blood circulation, heart rate, and respiration. They create muscle tension and chronic fatigue. They have specific neurological patterns in the brain and throughout the body that can become habitual. They can trigger stress hormones to flood your circulation, turn off the immune system, and prevent the healing of inflammation. All of this, in a dysregulated or extreme expression, can create a perfect storm for many different experiences of pain and illness.

Existential

Existential pain can be harder to pinpoint than emotional pain. It is bound up with the sense of self and one’s entire relationship to the experience of being alive. It can be the pain of facing death unprepared. It can be the pain of losing the motivation to live. It can be a deep sense of meaninglessness.

This kind of pain is sometimes called a spiritual crisis or a crisis of faith. When a part of your spiritual or psychological existence leaves your body, there is a profound sense of loss or confusion. Existential pain occurs when you become disconnected from any aspect of the psyche: imagination/inspiration, embodiment/physicality, cognition, will power, or the clarity of awareness.

If you lose your imagination/inspiration, you can no longer envision the path ahead of you; you do not dream, at night or during the day; you cannot be creative or inventive. If you lose embodiment/physicality, your body feels numb; foods lose their flavour, smells are all the same; you lack the strength to work or play. Loss of cognition creates confusion, worry, dwelling on things but not understanding anything clearly. Loss of will is loss of the primal survival instinct. This is “the will to live”. Without it, one merely waits for death, not through acceptance but from defeat. Loss of consciousness, in the existential sense, is death itself. This loss can be healthy of course—a good death. Dying well is just as important as living well. Everything that comes together must eventually come apart. But death can of course also be untimely, sudden, or violent. Sometimes this is out of anyone’s control. Other times, the will to live clings on desperately during a natural death, or something like dementia denies one the ability to understand and accept that one is dying.

Existential pain comes from an aspect of psyche unravelling, separating from the person, out of sync with the other aspects.

Existential loss can trigger emotional responses like fear, depression or sadness, but the pain itself is bigger. Emotions are momentary. We might hold on to a particular emotion for a while, but it is a conditional thing, like clouds in the sky. Emotions belong to the realm of humanity. In East Asian medicine, the psyche is also translated into English as “spirit”, and exists on the scale of stars and galaxies. The pain of an existential crisis touches on our connection to the never-ending process of life and death throughout the universe.

A side note: The classical Chinese medical and philosophical theories on spirit are truly brilliant. In Western traditions, the spirit, or soul, is something completely distinct from the body and anything physical, so it cannot be studied scientifically. In the Neijing tradition of classical Chinese medicine, the spirits are as much of a physical phenomenon as are the rain and stars. The way they influence our lives is analyzed using the same models used to explain embryology and star formation, i.e. physics and biology. This makes treating the imagination, cognition, will power, etc., a natural part of medical practice.