Unlocking Pain's Secrets

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beachhead in the Pacific. He was scared to death. Heavy enemy fire was killing his buddies all around him. When a shell burst near by, he felt an excruciating pain and the sensation of blood pouring down his leg. There was a call for a corpsman, and he was carried to a medical station, where doctors discovered he had indeed been hit—on his canteen. They sent him back out. More shells, more bombs.

Suddenly, he felt a sharp pain in his head, hit the sand, rolled over and ran his hand across his forehead. Sure enough, there was blood. Again they carried him to the medical station. The doctor took some tweezers, picked out a few fragments of metal from his face, slapped on some adhesive bandages and sent him back to fight once more. By then, almost his entire company had been wiped out. For the third time, a shell burst near him. It tore off his leg. He did not feel a thing.

The young G.I. who told this story to Dr. Raymond Houde some 40 years ago declared that the worst pain he had ever felt was when his canteen got hit. The second worst: surface wounds on his face. "What pain signifies makes a big difference in how it is perceived," explains Houde, now chief of pain drug research at New York City's Memorial Sloan-Kettering Cancer Center. Fear, anxiety, stress, the expectation of disaster can make pain seem much worse than it is. For cancer patients, he explains, pain is often magnified because it is interpreted as "a signal of the disease having recurred, or some terrible complication setting in, or worse, that you are dying." Hope and encouragement can, on the other hand, make pain seem less than it is. During World War II, pioneer Pain Researcher Henry Beecher found that soldiers wounded during the bloody battle at Anzio needed far less morphine than did civilians with similar wounds. The presumed reason, now known as the "Anzio effect," was that for civilians the wounds were a source of anxiety; for soldiers they meant going home.

In many cases of chronic pain, the patient has something material or psychological to gain from suffering. Seattle Psychologist Bill Fordyce cites the case of a woman who developed lower-back pain when her physician-husband retired, perhaps so that he would still have someone to treat. Studies have shown that individuals with a pending lawsuit seeking compensation for injuries rarely get better until the suit is settled.

But when there is a powerful motivation to get well, pain can fade into the background. Dr. Jon Levine, of U.C.S.F., describes a woman whose hands and knees are swollen with arthritis but who continues to manage a San Francisco clothing store and has even run in the city's 7.6-mile "Bay-to-Breakers" road race. "I feel sure that she is experiencing the physiological impulses of pain," says Levine. "When you push her, she'll admit that there are certain things she tends not to do; for instance, she can't lift big bundles of clothing any more." But, he says, she refuses to use the word pain.

Some physicians are convinced that there are distinct characteristics that make some people more susceptible to chronic pain. Drs. David Richlin and Leonard Brand of Presbyterian Hospital in New York City list the following traits: low motivation, poor self-image, lack of pride in accomplishments, dependency on others.