Pain as a Contextual Experience

Erik Peper, PhD

Pain is not simply a neurological or biological experience, it occurs in a context. Imagine two scenarios. In one, a child falls, hurts his knee, the mother kisses the knee, and the pain disappears. In the other, an old man lies awake at two in the morning with throbbing pain, wondering if the pain will ever go away.

Similarly, consider the case of an eventful heart attack. Before the attack a man may experience chest pain and simply ignore it. (Historically, men are conditioned to ignore pain, and may even be hardwired with this predisposition.) Once the heart attack is identified that same level of pain may be terrifying, because it raises the possibility that he could die. Later, following bypass surgery the pain could actually be worse, but now it is reframed. Pain is associated with hope because the patient realizes that he has survived the heart attack and the surgery, and he sees the possibility of healing. The pain may be horrible, but the experience has a different quality. It represents hope: I will survive. It is no longer colored by negative images. If he is in a medical environment that he respects, he also feels safe and trusting, and that sense of safety tends to make the pain more tolerable.

The experience of pain is defined by the entire context in which the pain occurs. This is a critical aspect of the phenomenon. The pain of childbirth, for example, may be extreme, but it is understood that the pain is normal and that it will end. This may also be nonverbally communicated by a supportive midwife or doula, especially if she is a mother herself. Without words she is saying, “This is an experience that you can transcend, just as I did.” Psychologically, the pain serves a higher purpose, to deliver a child into the world, and in a sense this may also make the pain more bearable.

Personal Insight on Pain

As a researcher in human physiology and performance, I have studied pain periodically over the past 30 years. Here I would suggest that how we interpret the stimuli affects the quality of our experience. Physiologically, there are two components of pain. 1) Pain is a sensory experience and, 2) it is also a reflection of activation in the brain. If we do not attend to that experience, do not put any labels on it, then it is simply sensation.

Several years ago, I observed, monitored, and physiologically recorded the experiences of a Japanese yogi who performed various forms of piercing (piercing his tongue and neck with unsterilized metal skewers) (Peper et al, 2005; Kawakami, Peper, & Kakigi, 2015). Although most of us find it painful to even look at the photos, the physiological data of his pulse, brain waves, and breathing patterns made it clear that he was not experiencing pain per se.

Physiologic Data:

Responses to Piercing

A yoga master was psychophysiologically monitored while he pierced his neck and tongue with skewers to demonstrate control of pain and bleeding. Measurements included respiration rate (RR), heart rate (HR), diaphragmatic and thoracic breathing, electrodermal activity (EDA) and electroencephalography (EEG) from Cz and Fz. The yogi reported no pain during piercing and no bleeding was observed. In general he had elevated HR and low unresponsive EDA throughout the session. His respiration rate averaged 7 bpm during the slow breathing meditation prior to and following the piercing. His EEG showed predominate alpha of 10 Hz during meditation. Alpha, SMR, and beta elevated at Cz during piercing with no change in delta or theta. Alpha and beta elevated at Fz during piercing with no change in SMR (sensory motor rhythm), delta or theta. While he stayed in alpha during the piercing, there was broader alpha activation ranging from 10 to 14 Hz. This demonstration suggests a finding of conscious self-regulation, as opposed to disassociation, for controlling attention and responsiveness to painful stimuli. It could be hypothesized that clients with chronic pain could be taught how to control pain using the mind/body interface. (Peper, Wilson, Gunkelman, Kawakami, Sata, Barton, & Johnston, 2006).

These findings were reiterated when I had the opportunity to observe, physiologically record, and film the context of pain with a group of Sufi initiates in Amman, Jordan and during presentations at a scientific meeting (2012, 2013). These individuals, led by a spiritual master, take part in a ceremony that involves drumming and chanting, and at the end of that ceremony they pierced their bodies with unsterilized skewers (typically in the face, neck, arms, or chest). Like the Japanese yogi, participants exhibited no experience of pain. There was no bleeding, and the tissues seemed to heal almost instantaneously.

What decreases the experience of pain and promotes rapid healing with the absence of bleeding? In the case of the Sufis, this occurred in a setting in which the piercing was experienced as a totally normal, spiritual phenomenon, one which occurs in a setting of religious faith and trust in the leader. The Sufis reported that they had permission and support from their master, Sheikh Mohammed Abdul Kareem Kasnazani. Thus they felt entirely safe and protected; they had no doubt they could experience the piercing with reasonable composure and that their bodies would heal completely. This was not simply a matter of brief; they knew that healing would occur because they had seen it occur at piercing rituals many times in the past. The faith that healing would occur rapidly was transmitted as a felt sense in the group, the sense that pain would not occur, but if it did, it was not to be feared but embraced. The experience may be modulated by the psychological context of the group, the drumming, and the chanting. (If this seems beyond belief, consider the firewalk which is frequently included in motivational group experiences, filmed and posted for viewing on YouTube.)

My work frequently involves biofeedback measurement of human physiology. At this point I have participated in more than 100 research papers, so I am highly attuned to the phenomena of sympathetic and parasympathetic activation. In the initial Jordan experience, I videoed the ritual of piercing with non-sterilized skewers and knifes but did not employ instruments to monitor brain waves, muscle tension, skin conductance, or heart rate. Based on observation, I saw no evidence of sympathetic activation (stress response) in any members of the group. As a scientific outsider, I noted that none of the participants in the Amman demonstration showed any pain behavior or reported pain, there was no bleeding, and for each participant, the tissue seemed to heal almost instantaneously.

The experience was so normalized that when asked if I wanted to experience the piercing, I agreed to participate. I was in a relaxed, peaceful frame of mind. I also continued to be a scientific observer, and I directed a colleague to make a video recording of me as I experienced piercing for the first time in my life. This, in part, is an account of my own personal experience.

At the moment when the stimuli occurred, when I was pierced, my brain did not anticipate nor evoke any sensation of pain, nor did I experience a sense of stress (sympathetic arousal). I had a sense of safety, because I had observed others in the group, one by one, experiencing the piercing without any sensation of pain or distress. Consequently, the experience did not evoke anxiety, fear, or concern. Although I remained an observer, I felt peaceful and entirely safe. I did not anticipate pain and had no concern that the piercing would be dangerous, and in fact, I experienced no pain. Unlike most of the other individuals there, about two drops of blood formed on the surface of my cheek as the skewer was removed, whereas the others had none. In my case, the wound closed totally within a minute, and an hour later there was no evidence of the piercing. The only sensation I experienced was a slight electrical tingle.

Throughout most of the evening, my role in the group was as outside observer: I monitored a video camera, recording the experience of numerous people being pierced. I did not chant, and I was simply present in their world, so my experience of safety may have occurred as a result of mirror neurons. In that context, it can be proposed that pain is not only a personal experience, it is a social experience. Essentially, there are a number of reasons why I did not experience pain or discomfort, which reflect the contextual nature of pain.

At a later date, we had the opportunity to repeat the piercing demonstrations with the Sufis at a scientific meeting and record their physiological responses. The most impressive finding was that the physiology markers (heart rate, skin conductance, and breathing) were normal and there was no notable change (Booiman, Peper, Saleh, Collura, & Hall, 2015; Peper & Hall, 2013). The QEEG did show significant differences indicating the inhibition of pain (Collura, Hall, & Peper, 2014).

Thoughts on Pain

If you can isolate pain, the pain has no meaning. This is clearly demonstrated in research involving placebos. We also know that soldiers surviving battle may suffer horrific pain; but typically, they require less pain killer than would be anticipated. In this context the pain is an indication, “I have survived.” Whether they were terrified or heroic, they now feel safe.

On the other hand, an isolated individual, alone at night with only the physical sensation of pain, may find the pain tremendously stressful, which can intensify the experience. In this situation there are concerns about the future, “This is going to hurt, it’s going to be painful, I’m going to die from this, maybe I’ll die alone,” and the worry continues. Focusing on the pain alone intensifies it. If one can let go of these thoughts and breathe through the pain that gives hope.

What to Do While Waiting for a Diagnosis…

What are the implications of these experiences in clinical situations in which the patient is in constant pain and yet has not received an accurate diagnosis? Or in cases in which the patient has a diagnosis such as fibromyalgia, but treatment has not reduced the pain significantly? Experiencing pain or illness that goes undiagnosed and is not acknowledged can increase the level of stress and tension, which contribute to pain and discomfort. Acknowledgement validates the patient’s experience and confirms that the pain is not psychosomatic (imagined), because that simply makes the experience of the pain worse. Once the patient has a more accurate diagnosis, focused treatment may be possible.

When one has chronic pain, the question is, what can be done? The first steps are for the patient to acknowledge to oneself that unrelenting pain evokes hopelessness, and to remind one’s self that this does not mean the situation is unsolvable. With what little energy one has, it is important to focus on other options for diagnosis and treatment. With that limited energy, one needs to also include activities that reduce the pain. In my own work I have seen that activity that is creative, that is emotionally expressive, can reduce pain. The case comes to mind of a woman who had excruciating chronic pain and became a painter. During those moments of painting, when she activated her creativity and her curiosity, the pain and dysfunction took a backseat. In a sense her experience of pain simply was not registering.

There are many strategies to control pain which range from hypnotic induction, self-healing visualizations, changing conditioned response patterns, having one’s attention captured by other multisensory experiences, breathing exercises such as exhaling during the experience of pain, and being totally in the present and experiencing the pain just as sensation, and others. Yet there are many components that are unknown.

Overall, pain appears to be reduced when a person can accept without resignation what has happened or is happening. Pain is often aggravated when the person is resentful or wishes that what has occurred could be different. If the patient can accept and then look towards something that has purpose and meaning, pain may still occur; however, the quality is different. As long as one is angry or resentful of the pain, or of circumstances believed to have caused the pain, the pain is often worse. In other words, chronic sympathetic arousal increases sensitivity to pain and also reduces healing potential.

A working hypothesis is that if one is sympathetically aroused for too long, then the system becomes exhausted. A fairly good measure of this is heart rate variability. People whose heart rate does not vary (low heart rate variability) are at significantly greater risk for numerous illnesses. If they are exhausted for too long a period of time, they have difficulty mounting a sympathetic response to a stressor. Secondly, people who respond with a primal “freeze reaction,” also tend to have lower heart rate variability.

The challenge is to understand what occurs in experiences such as those of the Sufis and how to translate this into clinical practice so that suffering can be reduced. We propose that the first step is to create an atmosphere of safety, trust, and hope. In that context yoga practices to increase slow diaphragmatic breathing while maintaining alpha EEG would teach clients somato-cognitive techniques to refocus their attention during painful stimuli (mindfulness) (Pelletier & Peper, 1977). Using slow breathing as the over-learned response would facilitate recovery and regeneration following painful situations. This approach could also act as structured desensitization to painful stimuli and might be a complementary clinical technique for voluntary pain control. To develop mastery and be able to apply this type of skill under situations of stress requires training and over-learning. Yoga masters over-learn these skills with many years of meditation. With mastery, patients may learn to abort the escalating cycle of pain, worry, exhaustion, more pain, and hopelessness by shifting their attention and psychophysiological responses.

The major lessons I learned from studying the yoga master and the Sufis are that a client has to feel totally safe and accepted. It is clear that components of that experience include trust, hope, and faith, qualities that the industrial-medical complex has pushed aside because they are not billable. Yet these qualities form the foundation of humanistic, holistic medical care and are often covert reasons why people are frustrated by their experience with medical care and seek complementary and alternative medicine.

Erik Peper, PhD

An internationally known expert on holistic health, stress management, and biofeedback. Erik Peper received his BA from Harvard University in 1968 and his PhD in psychology from the Union Graduate Institute in 1975. Since 1976 he has taught at San Francisco State University (SFSU), where he has been instrumental in establishing the Institute for Holistic Health Studies, the first program in holistic health at a public university in the U.S. President of the Biofeedback Federation of Europe and former president of the Biofeedback Society of America, he has written more than 200 journal articles and nine books, including Make Health Happen, Biofeedback Mastery, and Fighting Cancer: A Nontoxic Approach. In addition to teaching, research, consulting, and travel, he maintains a biofeedback practice in Berkeley, California. For additional information, see www.biofeedbackhealth.org and his blog site, www.peperperspective.com.

Erik Peper, PhD,

Institute for Holistic Healing Studies

Dept. of Health Education, San Francisco State University

1600 Holloway Avenue, San Francisco, CA 94132

Tel: 415.338.7683

Email: epeper@sfsu.edu

Web: www.biofeedbackhealth.org

Blog: www.peperperspective.com

Contributors

I thank Mitsumasa Kawakami, Sheikh Mohammed Abdul Kareem Kasnazani, and Safaa Saleh for their generous participation in this research, and I thank my research collegues Annette Booiman, Thomas Collura, Howard Hall and Jay Gunkelman for their support and collaboration.

Resources

A link to the Sufi website that has numerous pictures and descriptions is available at: http://www.kasnazan.com/article.php?id=1820

Editorial

A writer and editor in San Francisco, Ms. Faass has worked on the development, writing, and editing of more than 45 books for publishers that include Elsevier, Harper, McGraw-Hill, North Atlantic, and others. Director of the Health Writers’ Group, she also works collaboratively on articles, white papers, and writing for the Web and can be reached at info@HealthWritersGroup.com

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Bibliography

Booiman A, Peper E, Saleh S, Collura T, Hall H. Soefi piercing een andere kijk op pijnervaring en pijnmanagement. 2015. Available for downloaded at: https://biofeedbackhealth.files.wordpress.com/2011/01/soefi-en-pijn-management-08-12-20131.pdf

Collura TF, Hall H, Peper E. A Sufi self-piercing analyzed with EEG and sLORETA. Applied Psychophysiology and Biofeedback. 2014;39(3-4):293-293.

Hall H. Sufism and healing. In Neuroscience, Consciousness and Spirituality. Netherlands: Springer; 2011:263-278.

Kawakami M, Peper E, Kakigi R. Cerebral Investigation of a Yoga Master during Meditation: Findings from Collaborative Research. Fukuoka, Japan: Showado Publisher 2015:1-8.

Pelletier KR, Peper E. Developing a biofeedback model: Alpha EEG as a means for pain control. International Journal of Clinical and Experimental Hypnosis. 1977;24(4):361-371.

Peper E, Wilson VE, Gunkelman J, Kawakami M, Sata M, Barton W, Johnston J. Tongue piercing by a yogi: QEEG observations. Applied Psychophysiology and Biofeedback. 2006;34(4):331-338.