Reflections on pain, from the burn unit

Deep frying: even more hazardous to your health than I realized.

Yesterday marked the end of my 18-day stay in New York Presbyterian Hospital’s burn unit, where I landed after accidentally overturning a pot of hot cooking oil onto myself. I ended up with second- and third- degree burns over much of my legs, but after skin graft surgery and some physical therapy, I can walk again, albeit unsteadily, and I have skin on my legs again, albeit ugly skin.

I learned a lot during my hospital stay. Unfortunately, nearly all of that hard-earned knowledge was in very specific topics – the ideal cocktail of pills, the least-uncomfortable position to sleep in, etc. – which will neither be applicable in other contexts nor interesting to other people. But I did leave with one realization about pain, and how we experience it.

I wasn’t in constant pain for the entire 18 days, by any means, but every day featured at least a few painful experiences, from the minor (frequent shots) to the major (scraping the dead skin off the burns). I tried a handful of methods to deal with it. Deep breathing helped a bit, as did pulling my own hair. One friend suggested I try imagining myself existing at a point halfway across the room; that helped a little, but only because our philosophical argument over whether it was even possible to pull off such a mental stunt briefly distracted me from my throbbing legs.

But the one thing that did seem to dramatically affect my pain level was my belief about what was causing the pain. At one point, I was lying on my side and a nurse was pulling a bandage off of one of my burns; I couldn’t see what she was doing, but it felt like the bandage was sticking to the wound, and it was agonizing. But then she said: “Now, keep in mind, I’m just taking off the edges of the bandage here, so this is all normal skin. It just hurts because it’s like pulling tape off your skin.” And once she said that — once I started picturing tape being pulled off of normal, intact skin rather than an open wound — the pain didn’t bother me nearly as much. It really drove home to me how much of my experience of pain is psychological; if I believe the cause of the pain is something frightening or upsetting, then the pain seems much worse.

And in fact, I’d had a similar thought a few months ago, which I’d then forgotten about until the burn experience called it back to mind. I’d been carrying a heavy shopping bag on my shoulder one day, and the weight of the bag’s straps was cutting into the skin on my shoulder. But I barely noticed it. And then it occurred to me that if I had been experiencing that exact same sensation on my shoulder, in the absence of a shopping bag, it would have seemed quite painful. The fact that I knew the sensation was caused by something mundane and harmless reduced the pain so much it didn’t even register in my mind as a negative experience.

Of course, I probably can’t successfully lie to myself about what’s causing me pain, so there’s a limit to how directly useful this observation can be for managing pain in the future. But it was indirectly useful for me, because it proved to me something I’d heard but never quite believed: that the unpleasantness of pain is substantially (entirely?) psychologically constructed. A bit of subsequent reading led me to some fascinating science that underlines that conclusion – for example, the fact that the physical sensation of pain is processed by one region of the brain while the unpleasantness of that sensation is processed by another region. And the existence of a condition called pain asymbolia, in which people with certain kinds of brain damage say they’re able to feel pain but that they don’t find it the slightest bit unpleasant.

The relationship between pain and unpleasantness is a philosophically interesting one, in fact. Unpleasantness is usually considered to be built into the very definition of pain, so it’s quite confusing to talk about experiencing different levels of unpleasantness from the same level of pain. And it’s even more confusing to talk about experiencing no unpleasantness from pain, as people with pain asymbolia do. The idea feels almost as incoherent as that of being happy but not enjoying it, or doubling a number without making it any bigger.

But observing my own experiences of pain a bit more closely has made it a little easier for me to wrap my mind around the idea. I really did feel, when the nurse informed me that she was pulling the bandage off of intact skin rather than burned skin, like the pain was the same but the unpleasantness was lessened. It’s harder to imagine pain with no unpleasantness, but perhaps my shopping bag example sheds a little light: I felt the sensation of something cutting into my shoulder, but it didn’t bother me. So maybe someone with pain asymbolia would experience a cutting sensation as if they’re just carrying a heavy shopping bag, with no “Warning!” and “This is awful!” alarms going off in their mind.

I’ll have to think more about the relationship between pain and the experience of pain, because it’s still confusing to me, but at least I can feel like I got some new philosophical food for thought out of my 18 days at NY Presbyterian. Not to mention the very practical, un-philosophical lesson: don’t leave your giant pots of oil near the edge of the stove.

(ETA: I completely forgot, while writing this, that Jesse had touched on this very subject last month! Wow, Jesse — in retrospect, that’s an eerily prescient post.)