VIRTUALLY every man has experienced pain and therefore knows just how it feels. But he cannot tell anybody else what it is really like. Pain cannot even be precisely defined. Lay and medical dictionaries alike offer essentially circular definitions of it as hurt, distress or suffering—pain is pain. Half the medical textbooks say little about it, except for extreme and uncommon forms, and doctors learn correspondingly little about it in medical school. The great British physiologist Sir Charles Sherrington described pain as "the psychical adjunct of an imperative protective reflex." More simply, pain is what the victim perceives in his mind after he has touched a hot stove—and reflexively pulled back his hand to guard against further burn damage.
Pattern of Responses. It is only since World War II that the investigation of pain has been pursued as energetically as the search for disease-causing microbes. One of the difficulties that must be understood, says University of Wisconsin Psychologist Richard A. Sternbach, is that pain is not a "thing," and certainly not a single, simple thing, but an abstract concept used by observers to describe three different things: "1) A personal, private sensation of hurt; 2) a harmful stimulus, which signals current or impending tissue damage; and 3) a pattern of responses, which operates to protect the organism from harm." Sternbach concedes that his use of "hurt" in the first part of his redefinition is circular, but insists that the important consideration is the total.
How a pain researcher views this pattern depends mainly on his specialty, Sternbach told a pain symposium last month at the City of Hope Medical Center in Duarte, Calif. Each investigator, he said, is "locked in" to thinking of pain in his own terms. Thus the psychologist views it as a basic, elementary sensation like sight or hearing. To the psychiatrist, it is an affect or emotion, like depression or anxiety; to the analyst, the product of an internal psychic conflict; to the neurologist or neurosurgeon, a pattern of neurophysiological activity. The biologist emphasizes its survival value. The existential philosopher, Frederik J. J. Buytendijk, regards pain as a potentially character-building phenomenon that unites an individual with the rest of humanity in its existential suffering.
Specialists in these related sciences have begun to seek a common language to describe the many varieties of pain, to chart its pathways from the burned finger or the stubbed toe to the brain, to assess its total impact, and to find better ways of relieving it. Mind doctors and body doctors are at last recognizing that in their evolving concern with pain they are really talking about the same thing in different terms. Increasingly, they realize that even the most obviously real and physical pain, as from a burn or a fracture, is processed in the mind. By the application of psychotherapeutic techniques, notably hypnosis, they are teaching patients to control their reactions to such pain.