The Mysteries of Pain

I had planned to follow up last week’s blog entry on pain ("An Epidemic of Pain"[1]) with suggestions about how to self-manage it. But my mother sandbagged me. She gave me a book called Phantoms in the Brain[2] by neurologist V.S. Ramachandran, M.D., Ph.D. [3] This book completely changed the way I think about pain.

Ramachandran’s research shows that all of our sensations are illusions. What we see, hear, and feel is not the same as what is in the environment or in our bodies. Instead, our brains create sensations from all kinds of input. The actual signals from nerves are part of the input, sure. But they get blended with other sense signals, with thoughts, feelings, and memories. Then the brain organizes all this data and tries to make sense of it.

Is Pain an Illusion?
Chronic pain[4] may be the classic case of a sensation manufactured by the brain. According to Ramachandran, “Pain is an opinion[5] on the organism’s state of health…There is no direct hotline from pain receptors to ‘pain centers’ in the brain. [Instead] there is much interaction between different brain centers, like those concerned with vision and touch.”

What this means is the exact opposite of saying pain is “all in your head.” It means that pain is a summary of all the data that come into your brain from your whole body, your environment, your relationships, feelings, and beliefs. If the summary says, “Things are not well,” you will likely feel pain.

Pain is one of nature’s great mixed blessings. If you couldn’t feel pain[6], you would have died long ago, because pain is our natural warning system. It tells you to stop doing something or change something. (“Pull your hand out of that fire, fool!”) But when pain is chronic, it can be very hard to figure out what to change. And even if you can understand the message, you may not be able to do much about it.

When the Brain Gets It Wrong
There are also times when the brain just messes up the data. Ramachandran’s specialty is “phantom limb”[7] pain. When people lose an arm or leg in an accident or surgery, about half of them will still feel the limb is there. About half of those people develop serious pain in the phantom limb. Obviously, this isn’t due to physical injury going on in the moment. It’s a misunderstanding by the brain of the signals it is getting and not getting. The brain figures the signals add up to something seriously wrong, so it sends out an urgent pain message.

The same thing applies to the chronic back and leg pain so many of us have. There may be a few pain signals coming up from the nerve endings toward the brain. Those signals go through nerve centers called “pain gates.” Those “gates” are where the signals are mixed with other sense data, feelings, and body states such as tension. In people with chronic pain, the gates amplify the signals over and over until the pain is severe. They do this because the brain thinks we need to be warned away from a real threat, like taking our hand out of the fire.

What Can You Do?
So what can you do if your body is feeling all this pain? Next week I’ll write about approaches to chronic pain and give you some resources for dealing with it. (Really I will.) We may be able to turn down those pain gates or retrain the brain to see things differently. The important thing to take away from this particular blog entry is that it’s not your fault. Just as people can have severe pain in limbs that don’t exist any more, it’s quite natural to have pain that can’t be explained by damage to the body.

In the meantime, you might want to check here[8] or here[9] for more information and support. I’ll have more next week. Please write me if you have any ideas or questions.

Sex Note
To all the people who wrote requesting tips on nonintercourse sex (see “Partners Speak Out About Sex”[10]), I apologize. It turned out to be much harder than I thought it would be. But I’m almost done with some pages, including illustrations. They should be helpful to anyone who is willing to try something different. I promise you’ll have them in two weeks.

  1. "An Epidemic of Pain":
  2. Phantoms in the Brain:
  3. V.S. Ramachandran, M.D., Ph.D. :
  4. Chronic pain:
  5. Pain is an opinion:
  6. couldn’t feel pain:
  7. “phantom limb”:
  8. here:
  9. here:
  10. “Partners Speak Out About Sex”:

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David Spero: David Spero has been a nurse for 40 years and has lived with multiple sclerosis for 30 years. He is the author of four books: The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Hunter House 2002), Diabetes: Sugar-coated Crisis — Who Gets It, Who Profits, and How to Stop It (New Society 2006, Diabetes Heroes (Jim Healthy 2014), and The Inn by the Healing Path: Stories on the road to wellness (Smashwords 2015.) He writes for Diabetes Self-Management and Pain-Free Living (formerly Arthritis Self-Management) magazines. His website is His blog is

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