Understanding Pain

Understanding pain from the inside and enduring it has been a practice I have undertaken with great interest since learning that my ACL (anterior cruciate ligament in the knee) was torn.  It has been a fascinating and fruitful search.

Fundamentally, physical pain is a signal and nothing more. It is a message from the body to the conscious mind [cerebral cortex] stating that something has changed. Quite honestly, in many circumstances a sensation of change can easily be interpreted as something other than pain — but that reinterpretation has to transpire at the level of the mind — that is, using frontal executive cognition, and repeating this until it becomes a habit, at which point the reinterpretation is automated within more central entrails of the limbic system and takes less energy to generate. By then, it is no longer a “re-“interpretation… it is THE interpretation.

This is essentially the story behind physical training of any sort. During the process of exercise, muscles undergo relative hypoxia, which is understood to be uncomfortable and demands a response. This all takes place without any intervention from the conscious mind. Simply, using channels of the autonomic nervous system, the diaphragm is triggered to breathe more rapidly, the heart pumps faster, and blood vessels increase tension, all with the purpose of delivering more oxygen to the starved muscle cells.  In any case, oxygen-depleted muscles hurt, but the process of practicing this increased oxygen delivery ultimately results in a more efficient cardiovascular system, as well as stronger muscles. Eventually, with repeated training, an athlete understands (through cognitive reinterpretation as described above) the sensations that accompany exercise to be positive rather than negative.  Whereas, under the full set of understood circumstances, the same sense signals from nerve endings that might accompany, say, a limb strangled by a python, are interpreted as being constructive (exercise) rather than deleterious or concerning (python).

Personally, having gone through this reinterpretation process enough times now, whether in the post-operative state of recovery or from intense workouts, I have gained a new respect for physical pain and learned some tactics for embracing it rather than fearing it.  Ultimately, the difference lies not in the sensation itself — as in whether or not pain is experienced — but in the question of “embrace vs fear.”

Turns out this very question became the essence of existence in the time that followed my knee injury.  I had surgery to reconstruct my ACL in February of 2020.  As I was learning to optimize strength and understand the difference between pains that could be constructive versus concerning, I recall sitting IN the physical therapist’s office watching the news of the oncoming pandemic, not knowing what would cause more pain on a grander scale: the morbidity and mortality of an unknown virus, or the social consequences of isolation as the entire world was forced to shut down.

The signal was sent and received. Something… no, EVERYTHING… had changed. What would we do, as a population? Embrace? Fear? What to embrace? What to fear?

The answer for most seemed to evolve into embracing fear. That never sat right with me, and still doesn’t.

They say when you’re a hammer, everything is a nail.  Turns out I have some special insights on conditions known as Depression and Anxiety, and have devoted countless hours of attention to learning the truth behind these problems so as to defeat them, both personally and professionally.

Whereas, I will beg your pardon as I present my biased declaration that the pandemic on the horizon — dare I say already present and yet to reach its climax — is not microbial, but rather psychiatric in origin.

The next few posts on this blog will be copied and pasted from the Archives. Several years ago I wrote a three-part series on Depression. I think these lay a basic foundation for what I will write about in upcoming new posts.

Given that I expect a minimal –if any– audience for these missives, this blog is mostly a challenge for myself to balance honesty with wisdom. Without the fear of widespread judgment and without hope for a barrage of “likes”, I feel some liberty to present my authentic perspective. But… just some liberty. Because, authentically, my personal business ain’t none o’ yours. That is: if you are reading this and happen to not be Me, Myself nor I.

But even for fellow seekers, I wouldn’t have to divulge details of my individual story to communicate that there is a common objective amongst those who intend to survive what is coming. I don’t believe the universe is binary by any stretch, but I believe the human mind operates most efficiently by awakening to tipping points in a binary fashion. Meaning: we like to choose between two things — it’s easier than having to process the whole big picture.

So the common objective amongst those who will survive and thrive, is to choose wisely at any given moment, under any given circumstances between the following:

Will I treat this message (i.e., a pain signal) as Concerning or Constructive?

Will I be a Worrier or a Warrior?

Will I be a Victim or a Victor?

In all cases… it is a choice. The conscious mind must be engaged to make the choice, and thinking/judging/deciding is hard. At least, it is harder than NOT engaging. Simple facts.

Whether you like it or not, a choice will be made. If you allow the choice to be made for you, chances are your tipping point will lean you in an undesired direction. Because… well… you elected to NOT make the decision in favor of what you desired.

But if you have desire, if you want to be on the winning side of any fork in the road, the hardest part of the decisions presented above is to BE THE ONE to decide. It takes frontal cognitive effort. In other words, yes it is hard. At the end of the day, being in charge of the unfamiliar circumstances that come at you involves taking the road less traveled, the difficult path. Otherwise, YES, those circumstances will GOVERN YOU.


Be advised: patients of mine are taught and encouraged to choose more difficult paths in the interest of their survival. If you are a patient seeking a PCP and that’s not what you’re looking for, feel free to move on to someone who won’t push you.

But me… I want my patients to live. If you want it, I will do my damndest to show you how to get it.

Or… let’s get real: I do a lot of geriatrics. In my line of work, often the question is not how to live, but how to die. My answer? With dignity. Which also involves making difficult choices, not just for the patients but for their loved ones. It isn’t fun. But this is what I do. It’s my job.

Nice to meet you. See you again after the aforementioned archives are re-posted.

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