Most people are familiar with the experience of physical pain. However, there are also non-physical 'pain' components that contribute to suffering.
Imagine this scenario:
You are an avid runner who is training together with your fitness crew in order to participate in a marathon. One day, you sustain a serious leg injury that prevents you from running for a couple of months.
The pain results in you having to withdraw from the marathon (physical pain). Due to the pain from your ankle, you put your regular workout sessions with your fitness gang on hold and miss out on the regular social interactions (social pain).
Working out and meeting your friends have previously been the highlight of your week and a chance for you to de-stress from work. Now that this avenue is unachievable, you feel a lot more high-strung because you are unable to do what you love (psychological pain).
You have a lot more time on your hands but you are frustrated because you are unable to achieve the goals that you find meaningful. There is a pervasive sense of aimlessness as you feel that you have accomplished nothing significant over the past few months. You wonder what your identity is now that 'runner' is removed from the occasion (spiritual pain)...
What is total pain?
The concept of total pain was first described by Dame Cicely Saunders, a key player in the establishment of modern palliative care. Total pain encompasses four different dimensions of suffering:
An individual can experience pain in each domain with varying severity.
In the medical field, pain is defined as an unpleasant sensory and emotional experience that is associated with actual or potential body tissue damage. Following a pain-causing event, the actual or potential damage to our body is detected by nerves and the information is relayed to the brain which perceives it as pain.
Psychological pain is an intense and unpleasant emotional state. In the context of terminal illnesses, psychological pain can come in the form of:
Anxiety: the state of expecting that unpleasant things are about to happen. They may be anxious about when they may start to experience more physical symptoms, about when they may lose more of their independence, and about whether death will be painful.
Bitterness: they may face difficulty accepting the situation they are in and perceive it as unfair
Regret: they may experience a deep sense of regret over lost opportunities and/or decisions they have made in the past
Hopelessness: the belief that nothing can be done to improve their situation
The complications of diseases and treatments can lead people to feel that they have
Lost the role they used to play in other people lives: it could be that pain, fatigue, and/or other symptoms impede their efforts to be the parent that they want to be; or cause the breadwinner or a family to give up his or her job; or affect their emotional capacity to be a pillar of support for their friends;
An overall reduction in the quantity of social interactions: disease symptoms, risk of acquiring infections, decreased energy, changes in appearance, and low mood are all factors that discourages people from socialising;
Difficulty connecting and engaging with people: this could be because the circumstances that they are in are so drastically different from the people around them/
Social isolation and disengagement can also contribute to psychological pain.
Spiritual and religious beliefs can affect how a person interprets and manages their pain.
Punishment: some people may perceive that their physical suffering is a form of punishment from a higher power. They may respond to this by accepting the suffering as a form of payment for their past sins. Others may be fearful that the pain experienced at the end of life is a prelude to more suffering in the afterlife.
Disillusionment/abandonment: some people may feel that they have been abandoned by their God and feel betrayed
Confusion: some people may struggle to make sense of their situation and wonder what their mission is supposed to be
Why is it important to understand total pain?
Taking appropriate pain killers can help to alleviate physical pain but it may not completely treat the other non-physical components of pain that also contributed to overall quality of life.
Identifying that there are problems causing psychological, social, and spiritual pain can go a long way in relieving suffering.
(Outside of the context of terminal illnesses, we can also attempt to use the same framework to become aware of "pain points" in our own lives so that we can actively address them.)
Psychological, social, and spiritual pain are not as tangible and obvious as physical pain and can be easily overlooked. If left unaddressed and allowed to fester, it can slowly eat away at a person's mental health.
However, if acknowledged and properly addressed, it can be an opportunity to gain self-understanding and inner peace.