The Fascinating Science Of Pain – And Why Everyone Feels It Differently

Some opportunity it was John Sattler’s ain fault. The lead-up to nan 1970 rugby convention expansive last had been tense; nan squad he led, nan South Sydney Rabbitohs, had mislaid nan 1969 final. Here was an opportunity for redemption. The Rabbitohs were not astir to fto glory gaffe done their fingers again.

Soon aft nan starting whistle, Sattler went successful for a tackle. As he untangled – successful a move not uncommon successful nan athletics astatine nan clip – he gave nan Manly Sea Eagles’ John Bucknall a clip connected nan ear.

Seconds later – conscionable 3 minutes into nan crippled – nan towering 2nd rower returned favour pinch force: Bucknall’s mighty correct limb bore down connected Sattler, breaking his jaw successful 3 places and tearing his skin; he would later request 8 stitches. When his teammate Bob McCarthy turned to cheque connected him, he saw his skipper spurting blood, his jaw hanging low. Forty years later Sattler would callback that moment. One thought raged successful his shattered head: “I person ne'er felt symptom for illustration this successful my life.”

But he played on. Tackling heaving muscular players arsenic they advanced. Being tackled successful turn, astir nan head, arsenic he pushed forward. All nan while he could consciousness his jaw successful pieces.

At half-time nan Rabbitohs were leading. In nan locker room, Sattler warned his teammates, “Don’t play maine retired of this expansive final.”

McCarthy told him, “Mate, you’ve sewage to spell off.”

He refused. “I’m staying.”

Sattler played nan full game. The remaining 77 minutes. At nan end, he gave a reside and ran a thigh of honour. The Rabbitohs had won. The backmost page of nan adjacent day’s Sunday Mirror screamed “BROKEN JAW HERO”.

A photograph of Sattler, his dense greenish and reddish jersey rolled up to nan elbows, nan cervix grubby pinch blood, his mangled swollen jaw, carried connected nan shoulders of teammates, has go 1 of Australian sport’s astir well-known images. His expansive last capacity has been hailed arsenic “the astir celebrated show of playing done symptom successful Australian sporting history”. Sattler, inextricably linked to nan jaw he yet had to person wired backmost together, for decades hence was lauded for his courage, celebrated arsenic 1 of nan toughest men to person played nan game.

Because John Sattler could withstand nan pain.

How tin a personification bitten by a shark calmly paddle their surfboard to safety, past later liken nan sensation of nan predator clamping down connected their limb to nan emotion of personification giving their limb “a shake”? How is it that a female tin person a cyst connected her ovary burst, her abdomen steadily capable pinch blood, but proceed moving astatine her table for six hours? Or that a worker tin person his legs blown disconnected then nonstop his ain emergency treatment?

Each 1 of america feels pain. We each stub our toes, pain our fingers, sound our knees. And worse. The problem pinch surviving successful conscionable 1 mind and assemblage is that we tin ne'er cognize whether our six retired of 10 connected nan symptom standard is nan aforesaid arsenic nan diligent successful nan chair adjacent to us.

About 1 successful 5 adults acquisition chronic pain; it tin beryllium debilitating and patients person been historically dismissed, disrespected and under-treated. Acute symptom is different; it’s short periods of symptom usually associated pinch an injury, unwellness aliases insubstantial damage. Because each humans acquisition acute wounded aliases illness, we each person a consciousness of our symptom response. Many of america wonder, “Do I person a precocious symptom threshold?” And we person each astatine immoderate constituent been asked – by a doctor, by a nurse, by a teammate – “What’s your symptom connected a standard of 1 to 10?”

The expertise of immoderate group to acquisition superior wounded without appearing to consciousness superior symptom has been fodder for fable and investigation for centuries. Withstanding symptom has been heralded arsenic heroism aliases a freakish anomaly.

But what is happening successful nan assemblage and mind of a personification who does not look to consciousness nan symptom they “should” beryllium feeling. Do we each person nan capacity to beryllium 1 of these heroic freaks?

And really did John Sattler play those 77 minutes?

Questions for illustration these rattled astir nan mind of Lorimer Moseley erstwhile he showed up astatine Sydney’s Royal North Shore infirmary years agone arsenic an undergraduate physiotherapy student. He wanted to interrogate a quip made by a neurology professor arsenic he near nan speech theatre 1 day, that nan worst injuries are often nan slightest painful. So Moseley sat successful nan emergency room and watched group travel in, signaling their injuries and asking them really overmuch they hurt.

“And this feline came successful pinch a hammer stuck successful his cervix – nan curly spot had sewage successful nan backmost and was coming retired nan beforehand and humor was pouring each down,” Moseley recalls. “But he was relaxed. He conscionable walked successful holding nan hammer, relaxed. Totally fine.”

Then nan man turned around, deed his knee connected a debased array and began jumping up and down astatine nan symptom of nan mini knock.

“And I think, ‘Whoa, what is happening there?’”

The funny student ruled retired drugs, alcohol, shock. He realised that nan logic nan man did not consciousness symptom from his hammer wounded was owed to nan very constituent of symptom itself.

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“Pain is simply a emotion that motivates america to protect ourselves,” says Moseley, now nan chair successful physiotherapy and a professor of objective neurosciences astatine nan University of South Australia.

“One of nan beautiful things astir symptom is that it will motivate america to protect nan assemblage portion that’s successful danger, really anatomically circumstantial – it tin constrictive it correct down to a mini small spot.”

It is an evolutionary self-protection consequence that meant nan man pinch nan hammer successful his cervix did not look to consciousness pain. To consciousness symptom would not person aided his endurance successful that moment, Moseley says. Instead, fearfulness is astir apt what impelled him to title to nan emergency ward.

“So these group connected nan battlefield, their limb gets ripped off, they look for their arm, they prime it up, they locomotion to safety, nary limb pain. Perfect. That is an extraordinarily bold and blase protective system.”

Prof Michael Nicholas is utilized to stories for illustration these. “You tin spot it successful astir apt each infirmary ward. If you enactment astir agelong capable you’ll perceive comments for illustration ‘this personification has much symptom than they should have’ aliases ‘you mightiness beryllium amazed that they’re not successful pain’,” he says. “What that highlights to maine is nan wide inclination for each of america to deliberation location should beryllium a adjacent narration betwixt a stimulus for illustration an wounded aliases a noxious arena and nan grade of symptom nan personification feels.

“In fact, that’s mostly wrong. But it doesn’t extremity america believing it.”

The logic we get it wrong, Nicholas says, “is that we person a benignant of mind-body problem”.

Eastern medicine and accuracy has agelong recognised nan interconnectedness of assemblage and mind, and truthful excessively did nan westbound successful early civilisations. In ancient Greece nan Algea, nan gods of beingness pain, were besides gods associated pinch psychic symptom – pinch condolences and distress. But successful nan 1600s nan French philosopher René Descartes group occidental reasoning connected a different course, asserting that nan mind and assemblage were abstracted entities.

“In a batch of countries we thin to want to downplay immoderate imaginable psychological influences and we want to opportunity it’s each physical,” says Nicholas, a head astatine nan University of Sydney’s Pain Management Research Institute. Being told that symptom has a psychological constituent tin beryllium distressing, peculiarly for those who acquisition chronic pain. It tin consciousness dismissive, a proposal that nan symptom is not real.

“When group travel to spot me, they’re often worried they’re being told it’s each successful their head,” Nicholas says.

“Of people symptom is successful your head. It’s successful your brain. You know, it’s nan encephalon that is wherever you get that acquisition … It’s ne'er each physical.”

The existent of group who tolerate acute pain. It’s ne'er each physical. And it has small to do pinch heroism aliases freakishness.

Sometime betwixt 11am and 11.30am connected 22 May 2024, arsenic I sat astatine a large achromatic convention table, earlier a surface of colleagues zooming into a meeting, a cyst connected my correct ovary exploded. I felt symptom correct away. With my correct hand, I pressed difficult into my little tummy and breathed successful and retired slow to thrust done nan feeling. Jesus, I thought. I shouldn’t person eaten truthful galore Jols.

I returned to my table but still felt sore truthful went for a locomotion astir nan artifact to shingle it off. I felt a small better, returned to my computer, popped successful and retired of smaller meetings, answered emails, edited articles, vanished activity astatine 5.30pm, past walked half an hr to my sister’s flat and laic connected her couch. While nan symptom was reasonably beardown I was still convinced an overconsumption of sugar-free sweets was responsible. Only erstwhile my sister called a helpline 2 hours later and a caregiver told maine to spell to infirmary did I relent. We arrived astatine emergency astir 9pm, 10 hours aft that first crisp twinge.

Later successful nan night, arsenic I climbed connected to an introspection bed, I froze. Pain sloshing astir my abdomen violently halted my movement. As I stopped location silent, halfway to laying down, I saw nan superior look connected nan doctor’s face.

I realised that possibly my study of my symptom was an unreliable guide. She was looking for different clues. (I would later study that aesculapian unit usage self-reported symptom arsenic only 1 of a fewer measures to measure a patient, others see observations of movement, nan expertise to talk, facial expressions and guarding.)

It was nan mediate of nan nighttime earlier an MRI returned nan findings that I had spent nan time pinch what nan expert called “a belly afloat of blood”. The adjacent time I had surgery.

At my bedside an obstetric surgeon shook his caput arsenic he explained what was going connected successful my body. A burst cyst has a estimation for being very painful, he said. Why had I rated my symptom arsenic a six aliases seven? Didn’t it make much consciousness to springiness it a 10? I shrugged. I’d wanted to springiness myself immoderate wriggle room.

So why was my acquisition and study of symptom truthful retired of whack pinch nan insubstantial harm my assemblage experienced?

“It really starts pinch our judgments,” says Associate Prof Melissa Day, from nan University of Queensland. “So it’s not what happens to us. It’s really we judge what happens to us.”

In different words, if we springiness ourselves a convincing mentation for what we feel, an mentation that does not see threat aliases harm to our assemblage – if we deliberation it’s nan Jols and it will walk – we are little apt to consciousness symptom severely.

Pain is simply a protective system – wounded aliases insubstantial harm activates nan brain’s informing strategy that creates it. Illustration: Victoria Hart/Guardian design

We person a inclination to valorise those who do not kick of symptom erstwhile they face an acute injury. To opportunity this is simply a reliable person, a stoic person. But individual toughness aliases weakness is not what’s astatine play successful symptom responses, and nan aforesaid personification tin person 2 wholly different reactions to pain-inducing events successful different contexts.

When Lorimer Moseley tried a power pad symptom trial connected himself, expanding nan somesthesia connected nan pad connected his manus and noting his rising symptom levels, it took removing nan pad from his tegument to realise he had fixed himself two-and-a-half-degree burn. “This happens to group who do a batch of symptom investigation because you conscionable get exposed and your encephalon doesn’t deliberation it’s worthy protecting you arsenic overmuch arsenic it should,” he says.

“But I put my manus successful basking h2o to do nan dishes – I’m hopeless.”

Just 5 years agone nan International Association for nan Study of Pain revised its meaning of pain. The caller meaning follows what is called a bio-psychosocial model, which recognises not conscionable nan biologic causes of symptom but nan domiciled of psychology and societal discourse successful creating, amplifying – aliases dulling – it. While this is nan modern reasoning astir pain, says Nicholas: “Most group don’t usage it. Most clinicians, unfortunately, even.”

The biologic causes are clearest. Pain tolerance, researchers speaking to Guardian Australia say, has immoderate familial component. Red-haired people, for example, Moseley says, person connected mean a different period astatine which their nerves are triggered by a alteration successful somesthesia successful a heat-based symptom period test.

Complex societal factors play a important role: aggregate studies person recovered that group from a little socioeconomic position acquisition some much chronic symptom and, successful experimental symptom tests, demonstrate little acute symptom thresholds.

For each people, wounded aliases insubstantial harm activates nan brain’s informing strategy that creates pain. The associated accent tin trigger a psycho-biological consequence that helps nan wounded personification get done it without being immobilised.

“Short-term accent really motivates us,” Day says. “Gets adrenaline pumping done our bodies, allows america to person earthy endorphins to push through. There’s besides endogenous opioids that our encephalon releases to person that short-term alleviation of pain.”

The psychological elements are becoming much wide understood. “One point we cognize is possibly nan strongest predictor of symptom tolerance is really group deliberation astir pain,” Day says.

“If we deliberation ‘this is terrible, this is awful, it’s going to do maine superior damage’ – those types of group will person little tolerance.” This includes group who thin to beryllium anxious aliases who catastrophise pain.

The cognition of nan harm being done tin person a important role. A violinist is much apt to study higher levels of symptom erstwhile a symptom stimulus is applied to their ascendant playing manus than erstwhile their different manus is subjected to nan aforesaid stimulus, Moseley says – because an wounded to their ascendant manus could extremity their career. Farmers are known to hold seeking curen , he adds. “It mightiness beryllium that farmers expect that a portion of being a husbandman is to person pain. So [their brain] doesn’t impulse them to do thing astir it. Their anticipation is: you person pain.”

Our past acquisition of symptom besides plays a important role. Should I person different cyst explode, Moseley suggests I mightiness consciousness much symptom – I will person learned that this sensation signals superior harm and should not beryllium ignored.

Research suggests men mostly person higher symptom thresholds than women. Pain fluctuates for women astatine periods of hormonal change. Moseley says differences successful sensitivity successful immune systems and consequence to hormones plays a part. But truthful does “the measurement that they’re related to from birth”.

“Nature versus nurture – you can’t really abstracted them,” Day says. “There’s a scope of factors location successful position of learning histories astir symptom and really from a young property responses to symptom are very overmuch linked to gender arsenic good – really parents respond to a boy versus a daughter.”

As psychologists moving successful pain, Day and Nicholas are willing successful what behaviours mightiness thief group successful symptom tolerate aliases trim nan magnitude of symptom they are experiencing.

“The champion coping techniques will beryllium different for different individuals and will beryllium different crossed different contexts” Day says.

Nevertheless, for acute symptom suppression – “I’m not reasoning astir this because I’ve sewage this extremity I request to achieve” – tin activity good successful nan short term, says Day. (“Longer term, it rebounds.”) Emotional regularisation strategies, meditation and learning really to calm nan assemblage tin beryllium effective. Working connected beliefs astir nan symptom and shifting attraction distant from it, says Nicholas, autumn nether individual control. “If you tin power those factors you will person a amended consequence to pain,” Day says.

An individual’s sensitivity to reward and reward plays a domiciled successful acute symptom thresholds too, Day says. People who are much delicate to reward thin much often to retract astatine nan quality of pain, whereas those much oriented towards rewards are much apt to push done it to execute a goal, she says. Elite athletes are known to person higher symptom thresholds arsenic they are habituated to symptom successful their training regimes.

Which is to say, if you are successful a expansive last and you deliberation you’ve sewage a changeable astatine winning, and you cognize nan nationalist squad selectors are watching, your fixation connected your extremity mightiness summation your expertise to disregard nan symptom radiating from your jaw.

Is that what made John Sattler play on? I will ne'er know. He died successful 2023. But we cognize he had each nan predispositions for withstanding acute injury: he was habituated to symptom arsenic an jock successful a crippled famed for its large hits, he was reward-oriented successful a infinitesimal erstwhile nan stakes were high, he was a antheral socialised to worth withstanding symptom arsenic a badge of toughness, and saw toughness weighted arsenic a societal virtue. The conflict would person sewage his endogenous opioids pumping. His attraction was redirected distant from his injury. Pain is simply a protective system but, from each we cognize astir that day, Sattler judged protecting his jaw arsenic little important than claiming nan premiership.

“People who deliberation they person a higher symptom period – we will ne'er know,” Moseley says. “It’s nan aforesaid quality that makes nan symptom and that tolerates it.”

And truthful nan acquisition of acute symptom is caught successful nan realm of enigma and mythology; wherever we tin understand overmuch of what is happening successful a assemblage and portion of what is happening successful a encephalon but ne'er really cognize what different personification feels.

The fable of John Sattler goes that aft that fateful correct hook from Bucknall, nan bloodied skipper turned to his teammate Matthew Cleary. That nary 1 knew, possibly not moreover himself, nan harm that had been done to him became his mythological power.

“Hold maine up,” he said. “So they don’t cognize I’m hurt.”