Pain

art and trouble happened. Muddies was full of X addicts, stick and polke tattoos, poets with their sketch pads, rappers and their skateboards, everybody falling in and out of love with one another, and almost nobody paying full price for the coffee. Sarah was one of the women who ran the place. She had long, messy raspberry colored hair, was part p J. Harvey, part Little Mermaid, and she tolerated zero insolence for many body, but if you got evicted

or fired or pregnant, she was supporting the storm. A lot of regulars Harvard crushes on Sarah. People respected her because she was clever and principled and brave, and she had this extra gravitas because we all knew that she was really, really sick and in a lot of pain. I became acutely aware of this mystique thing, like the

iconic sick white female. It always reminds me of little women that like tragically ill, pretty one who coughs up blood, talks really quietly, and she's sickly and everyone loves her. And I found it so irritating. Sarah was diagnosed with diabetes when she was eighteen months old, and with several autoimmune diseases after that. She ended up needing a bunch of surgeries. The extreme abdominal pain started when I was

probably sixteen. Eventually I got a diagnosis that kind of explained it, but there's no real treatment for it, so I was in just constant, pretty excruciating abdominal pain. To hurt is a private experience and difficult to discuss. I can't hold my pain up to the light for you to examine, or drape it around your shoulders to see how it might fit. Pain is a room for one only you can enter, and sometimes you can't leave. Also,

we don't have a great vocabulary for pain. We shave our perceptions of red into very fine slices for millions scarlet Crimson Maroons series, but we don't name discreete pain sensations in the same way. This is pretty graphic, but the only way I could ever think of describe it was that it felt like I was rotting in my mind. If you cut open my abdomen, you would find just everything infected and flamed, cramping and rotting. I felt like death,

but slow. But of course, no matter how vivid the description, the only pain you can know intimately is your own. So let's burn you, Okay, then let's burn me. That's Irene Tracy, a neuroscientist at Oxford. She studies exactly how humans perceive pain, which means she's often got to hurt them herself. We generally have a sort of torture chamber suite of every device man into man, where we can burn, or we freeze, or we poke, or we put like

either mustard oil on or chili pepper cream on. So what we have here is a little homebuilt device on the table between us. Irene's got a device about the size of a lunchbox. It's gray metal with dials and buttons, some duct tape and a long black wire comes out one side that's connected to like a little circuit board looking thing, a shiny square roughly the size of a postage stamp. Irene presses it against the bare skin on

the inside of my right forearm. So I can zip up thirty degrees in less than a second, and it'll be a lot of nobody's been scarred or blistering. Um, well, we've had the open I'm not gonna lie you know that. You get the old thing happened to be over twenty five years right, there'll be a lot of deep right, are you ready? I am? That hurts. So I would say that if one is just on the threshold of being codd is pain, I would say that was I don't know. Three okay, okay, So we can go up

a little bit more than which is always good. So we'll take it up just a wee bit. Okay, quick freeze frame Here for a comment on pain scales in medical environments, people are often asked to rank their pain on a scale of one to ten. You might have been asked to do it by your doctor, but here's Sarah on why that's a problem. Everyone's scale is different because your ten is always the worst pain you've ever had,

but it's not the worst pain you could have. So your ten changes over time, and over the course of ten surgery. As that ten, the bar for a ten got very high. You know. That's where I can't take a full breath, I can't cry, I can't talk, and then down to I can still live my daily life. And then sometimes I can't talk for thirty seconds because I'm in so much pain, but it's going to go away. I would give that four, but someone else might give it a seven because it is so painful in that moment.

Your standard for what's high changes. It's easy to see how this sort of variance and patient reports could pose a challenge for their health care. If my four is your seven, how is the doctor supposed to know what sort of pain killer we need and in what dosage? One of us might be grinding your teeth till morning. Well the other winds up loopy and flirting with the night nurse. Okay, back to the lab. Wow Okay, wow

was not the first word that came to mind. That is absolutely me trying to active in front of a microphone on the BBC. Well like experiencing an unexpectedly intense dose of pain which left to mark. But let zoom in on what exactly is going on inside the body at a moment like this. We come equipped with three distinct kinds of pain receptors, thermal, chemical, and mechanical. The

thermal receptors respond to temperature. The chemical ones sense harmful substances like the pepper cream that Irene uses, and the mechanical ones are for when you just cut or bang or smash yourself. When you get hurt, these receptors send off a distress signal, and the signals go whizzing in a long nerves in your arms or your legs to your spinal cord, which is this big sort of channel sending signals up to the brain. It's not till the brain gets those signals that pain emerges. Think of an

orchestral score. You've got a lot of notes on paper, but until they're sounded by an instrument m there's no music. My burned arm doesn't actually hurt directly. The nerve signals have to be processed by my brain. If it doesn't register in the brain, there is no pain. And her brains take a lot of artistic license and the interpretation of these signals if you're tired, the same signal might

be amplified to hurt more. If you're distracted, say by a pain researcher who is asking you to count backwards by sevens, you might hurt less. Let's see one, twenty one, one oh six. Distraction is great, and that's a big sort of free analgesia call pain relief you can get. So you've got these incredible systems in the brains them whose sole job it is is to communicate down to the bottom of the spain called where the signals are coming in, and just stop them at that point so

they don't come up. They don't come in the brain and feel pain. Distraction actually works chemically to turn down the perception of pain. Even the fact that we think something is going to hurt can affect how much it really does. Cooling expressional muses, you know, you get the pain you expect and you really do. To prove this point, Irene's done some very clever experiments with placebos. In one study, she recruited a bunch of research subjects willing to let

her inflict painful burns on their legs. She asked them to rate their pain and recorded all their answers. Then she gave them an opioid through an IVY drip, and as you'd expect, participants reported less pain while receiving the drug. If Irene stopped the IVY, the pain ratings went up again. But here's the tricky bit. Irene occasionally deceived her subjects so that they thought they were receiving an opioid when

really they were just getting saline. And lo and behold, when they believed they were on drugs, they really did feel less pain even though they were essentially just getting an armful of contact solution, and brain scans supported this finding, showing less activity in pain sensing regions of the brain when the participants were all plus e boat up. Irene's also tested the opposite scenario, where people who were receiving

the opioid were told they were getting saline. So you've got most powerful drug in two thousand years and in an instant, I can just manipulate their expectations, and by driving a negative expectance, if we can just have it override the brain. For fellow word nerds, that's called the no sebo effect. Hey, a lot of variables influence pain perception,

which means identical injuries do not necessarily hurt identically. If you and I got matching neck tattoos on the same day from the same artist, we might have totally different levels of pain, And if we returned in a week for a touch up, we might have completely different experiences than on the first visit. What the science has told us for twenty years is you cannot make a judgment call about what pain somebody should be having based on

what you can measure out in their tissue damage. What they say it is is one it is because it is this private subject of experience. So far, we've talked about acute pain, the garden variety that surges in whenever we damage our bodies somehow, but chronic pain functions differently. Historically, by ten fifteen years ago, we thought if we fixed the thing that calls the pain, then the chronic pain

will go away. And that model hasn't worked. Nobody is sure by some injuries just go on hurting and hurting for months or years. You can't predict who's going to go chronic or why. In the US, chronic pain affects something like one in five adults, just a huge number of people. So the pain field has sort of had a parallel shift in their thinking. Is that when somebody has, after three four months, gone chronic, so to speak, that's a whole new set of problems in its own right.

All your life's journey, all your bumps and scrapes and stresses and emotional experiences, the way that the environment changes and colors your genetics, so all that is changing, the way because your central livst in your brain is wildly developing throughout this period, you know, growing, worrying up different bits. Literally literally your life's jury changes your brain. My friends,

Sarah's pain confused her doctors for a long time. I think I had an experience that many women have that I was told that it literally was impossible that I was in pain because the disease i'd finally been diagnosed with doesn't cause pain. There's not like an m r I or a cat scan or a pet scan or anything that can point to what it was. But what it was I realized later it was an inflammation of my entire digestive tract from my throat all the way

down through my colon. Talking about pain is challenging because it's a private experience, and because we've got a poverty of language for it, but also it just sucks socially. There's a whole bunch of taboos around illness and speaking about it, even in your most intimate relationships. So there is pressure on the patient to pretend like they are okay, and there is pressure on the other people in the room two also pretend it's okay. Family and friends act weird.

Acquaintances treat you with kid gloves. Even rivals go soft when they hear you're in the hospital, and I'm like, dude, no, it's okay. Like if you hated me on Wednesday, you can hate me on Thursday. It's fine. The illness didn't make me a better person, So carry on with whatever your normal opinion of me was. I respect that some of my best philosophical conversations have been with you, and I wanted to know how pain affects cognition, because I

think that's something that bothers you more than most. Yes, I can't prove it, but I am distinctly dumber than I was. My brain is different ten years of constant adrenaline and cortis I'll do alter the way that you think it fries certain pathways. Sarah's brain hands down one are the best brains I know, and I hate the idea of its sizzling and all this suffering. Ah, we're gonna swivel to a researcher who studies pain from a very, very different vantage point. So let's fade up onto a

scene unfolding on the island nation of Mauritius. Or An anthropologist is standing next to a bed of coals, preparing to photograph a firewalking ritual, and at some point some of the locals they called me and they said, Dave Trius, we think you're now one of us. You should do the fire walking ritual just like we do. And my response to that was, well, look, I don't want to pretend to be one of you. I'm still a foreign

anthropologist who was here to do my job. I'm here to learn about your customs and it's very important for me to be able to observe what you're doing as you're doing it. They immediately said, that's fine, Okay, if God wants you to do it, then he'll do it. And I said, trust me, God does not want me

to walk on fire. Apparently I was wrong, because on the day of the fireworking ritual, somebody tapped me on the shoulder and I turned around, and I looked at the entire village looking at me, expecting me to walk on fire. Dmitris Lots has spent his career studying extreme rituals. And I decided it was either to humulation and the major disruption of the ritual or just going through with it.

And when I came out, people are actually asking me the same kinds of ethnographic questions that I were asking them. Demitris has traveled the world trying to understand why people voluntarily subject themselves to tortuous levels of pain. So, for example, you have in the Philippines you have Catholics who on Good Friday would nail themselves on crosses. Similarly, on the day of Assura, you have Muslims who will whip themselves with whips that have blades attached to them. Just reading

Demetrius's work can get pretty intense. At the Poquette Vegetarian festival, for example, celebrants pierced their cheeks, and some of these piercings are so long and heavy, so that the big skewers that might be three meters across that they will have to bite down on them at all times and hold them with both hands, because otherwise they might just rip their face off. Man. Okay, So I think for

a lot of us, the question is why. I have asked thousands of people why they perform the rituals, and the most common responses some kind of sense of puzzlement. They look at you and say, well, well, what do you mean. We just we just do them. That's what we do, that's who we are. At a firewalking festival in Greece, Demitrius asked a bunch of first time participants why they decided to remove their shoes and proceed barefoot over a bed of hot coal. Some of them reference tradition,

Some people explained they just had an urge. Some said they weren't really sure why. But when he asked people much later about why they had gotten involved at first time, they gave very specific motives. They'd been looking to be healed from some malady or to become fertile. Well, once you've done it, once you put a skewer through your cheeks, then you have to ask yourself, why did I do that?

This uh effort triggers a search from meaning, and this way we construct these post hoc justifications of our actions and our experiences. When we do something that's very taxing, that doesn't have need discernible benefit, we feel really uncomfortable about it, and to feel better we engage in what's called effort justification, where we retroactively deem the activity is meaningful or important. Do you think that there's potentially like a parallel to even the conversations that we have in

a daily basis. Right, if I talked to a friend like ten years after her divorce, well, I remember when she was getting that divorce, right, she turned herself inside out. She would have done anything to make that marriage work. But now ten years later she goes, oh my gosh, that was like the best thing that ever happened to me. I'm so glad Michael left. Absolutely, And this is something adaptive. It helps us cope with over their life, it helps us move on. Yes, we have a need to justify

our actions. Demitrius also suggests painful rituals confer real benefits. During the Cavety Festival and Mauritius, he measured the stress levels of participants who walked down nails, carried heavy loads in the hot sun, and pierced their bodies so times with hundreds of needles. As you might imagine, there's stress levels spiked, but a month later they reported feeling better

healthier than before the cavity. Things get more interesting when we look at who is performing the ritual and how so we see that people of low soci economic status, as well as those who suffer from chronic illness, are actually more likely to perform the ritual, and when they do, they will put more needles in their body and they will suffer more. He explains that extreme rituals provides social benefits. Getting involved demonstrates a commitment to the group and puts

you in better standing within the community. He thinks that's why people of low status are likely to participate enthusiastically. They could use the social boost. And don't be tempted to imagine that extreme rituals only happen in faraway places. Fraternity hazing, gang initiations, military traditions, lots of similar formulas.

In elementary school, I remember when kids used to pass around packs of big red gum and we'd all take a piece and then we would lick the foil wrapper, would stick it to our foreheads, and within a minute, the cinnamon flavoring would start to burn, and we sat there looking at each other with like garbage on our foreheads for as long as we could take the pain. Why because it was the thing to do in third grade and we were proving ourselves as baby badasses and

it made us giggle and feel connected. Everybody is suffering the same thing at the same time. So one thing you're doing there is you're advertising some individual qualities that have to do with your fitness. You're you're cool enough

to with something, You're strong enough to withstand this. At the same time, we're advertising your commitment to the group's norm, because, for whatever reason, if that becomes the norm, then doing something that requires you paying a high price to enforce that norm on yourself that means you're good and come a member of that community. Pain is often cast in a simple role, the character who enters to pull her hand away from the burning stove and then recedes into

the wings. But pain is larger and more complex, performing sometimes as antagonist sometimes ally. I'm glad to report that Sarah's life isn't as painful as it used to be. They're still hurt, fatigue, and nausea. I've seen Sarah vomit into an empty soda bottle and moving cars with the sniper's aim. But it's better still, the pain has changed her. What's the biggest single thing that pain has taken away? Uh,

it's a lot. A lot takes away your ability to be present to the people that you're fighting the illness to continue to be with. So it is a thief in that way. Is there anything that's given you any upsides? Yes, there's a lot. Actually, like a lot really? Oh yeah,

I remember after my first transplant. It was probably a year later, standing in line in the pharmacy, and all of a sudden, he said, tears streaming down my face because I realized it had been four years since I could stand in a line and not have to sit or lay down on the floor while I waited. I found. So, if you have chronic pain and it is a given and it's not negotiable, how do you want to live your life? And then how do you have to change your mind to meet the person that could live this

life and enjoy it? So like, how do you rise to the occasion of your own life and take joy in it? Yeah? I want to extend an enormous thank you to Sarah for being so candid and smart, to Demetrius for his time and insights, and of course to Irene Tracy, Queen of Pain, thanks for the hurts. You're welcome. Any that's such a long laugh. All good science stories should end with a cackle and a flesh wound. Next time, on Deeply Human, we're talking about lying why it's a

milestone for toddlers but a slippery slope for you. Deeply Human is hosted by Deessa and is a co production of the BBC World Service and American Public Media with I Heart and Me Yeah