A Painful Description

I have often wondered about how to describe Ayurveda in a clear and concise manner. My current conclusion is that the description depends on how we observe it. So far my best attempt is to say it is a system that promotes healing by self-regulation (the body’s innate intelligence to heal and repair) through autonomic nervous system control. 

This autumn I joined a two-year master’s program at UCL for pain management. I am delighted to have found a cutting-edge course that teaches me everything there is to know about this familiar phenomenon, but, I was surprised to realise that there is no consensus between the scientific community about how to define pain. It appears that the description of pain is as difficult as a comprehensive description of Ayurveda.

I started connecting the dots, not for the first time though! I have been a keen enthusiast and observant of autonomic nervous system control in my work for years, particularly from the polyvagal theory perspective. This theory has been the bridge between eastern and western healing modalities and it allows me to confidently explain the healing principles of Ayurveda in Western Scientific terms. The theory has provided robustness in my practice as a consultant, therapist and teacher as it explains how a feeling of safety is the most fundamental element of healing.

The current description of pain by International Association for the Study of Pain (IASP) has made attempts to describe pain and has managed to create something that by itself feels rather painful. Since 1979 IASP has been trying to complete this task. The current version, from 2023:

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,”

The description is followed by a bulleted list of factors that need to be considered such as:

• We feel pain differently and in different intensities in varying contexts of life.
• Pain is mostly in our heads. Like colour, the brain receives signal that is transcribed to a sensation and this can be independent of a stimulus. Pain can originate just by thinking about it.
• Pain behaviour is learned. There are differences between age, genders and ethnicities. Some are more stoic than others.
• There is no way to measure pain. Pain specialists have to trust the word of the patient. It is, in fact, impossible to feel other people’s pain except by empathy and then be moved by compassion. The problem is that compassion is selective and there are inequalities between the above-mentioned categories. Minorities’ (such as black and Asian) pain is often underrated but unfortunately, they are the ones that suffer more and struggle getting proper help.
• The danger of pain helps us to behave in an environment in an adaptive way, however, pain and especially fear of pain often limits our interaction with the environment. A potential threat can create hypersensitivity and inability to adapt in the end.

Pain creates a challenge for diagnosis and prescription as peoples’ description of pain vary depending on their stoicism. Factors like catastrophising and emotional intelligence are variables that interfere with pain perception and they also vary through time.

Stress and self-control can vary significantly depending on the contextual safety or threat of an underlying disease, psychological state, social and living environments.  Therefore, pain is also described as a biopsychosocial experience where verifiable factors such as disease or genetics (e.g. scoliosis), psychological states such as anxiety and depression, and social interactions can on their own or together amplify or dampen the intensity of pain.

If you are familiar with Ayurvedic practice, we are connecting a lot of dots here through a holistic understanding that everything can be a source for pain: our body and the environment it lives in, the past experiences and future worries included.

Pain is undefinable. It is an energy, a force that drives our behaviour, similarly to the mind. We cannot define the mind but we know it exists. Pain’s existence can be verified by the fact that it creates a feeling and feelings create emotions, a change in physiology.

Ayurveda is fully based on feelings, or better, measuring feelings such as heat or cold. To some point heat is pleasant until it becomes unpleasant like when sunbathing. Cold can equally be pleasant but at some point intensively painful such as brain freeze by ice cream. Ayurvedic healing modalities aim to keep us in the comfort zone between a spectrum of two opposite feelings. Not too dry, not too moist, not too heavy, not too light. Everyone’s preferences change with context and therefore the role of the pain specialist is to educate patients how to navigate life within at least relative comfort.

This blog entry is part of the assignments of my first module. Apart from understanding the different facets of pain I am also delighted to have learned how the NHS is moving towards holistic, integrative, multidisciplinary approach for pain management.

Management is the key word especially as regards chronic pain and Ayurveda has an arsenal of tools to improve quality of life of the sufferers, like me. I live with pain without much suffering.

Based on this and what I’ve learned so far at UCL I am adding a new description for Ayurveda to the list of many: Ayurveda is pain management.