The Psychology of Pain: It’s Not What You Think


What would you do if you learned from this moment until you died you would be in pain? Not something mild like an occasional headache, but something that overwhelms every one of your thoughts, feelings, and actions.

For those who are willing to think about this very uncomfortable possibility, your answer might be based on a theoretical, religious, or spiritual conviction. You might think about something you’ve read or a workshop you attended where it was asserted that with enough focus, the mind can reduce the severity of pain, or even eliminate it. And in looking back at your past, you may find instances of being able to do just that.

I recently read a book written by a well-known awareness advocate who wrote that with sufficient focus on the present, a person could separate him/ herself from the pain that was being experienced. In another book, a religious writer wrote about the redemptive value of pain as if it was in the same category as a confession. The problem with many of these books on pain management and acceptance is that it presents a picture of what someone who is experiencing pain should be able to do. Often in these books pain is described as something that is static and bounded by specific borders (i.e., in pain and out of pain).

As someone who routinely sits with people suffering intense suffering at the end of their life, I’m constantly amazed by the discrepancy between what many writers describe that the mind is capable of doing and what I see it doing. It’s analogous to looking at a 1930’s map of Los Angeles and trying to find a road in a section of the city that didn’t exist until 1960.

I’ve always found more truth in what I experience rather than what I find in theories. And that’s the case with pain. As I recover from a successful total hip replacement, I’m trying to understand the psychology of pain. Both from my perspective and those of the people who I serve as a hospice volunteer, who knew that although the palliative medicines (pain reduction) they received made the pain “tolerable,” it would remain present until they died, which for some was measured in months. For those with chronic illnesses, the time frame was years.

So what follows is a personal perspective, devoid of theories, concepts, or even the latest research on pain management. It’s a view of pain that I think will resonate with those who experience it, provide a roadmap for those who will eventually experience it, and hopefully help family and professional caregivers who are responsible for loved ones and patients living with it.


If you view yourself as a compassionate human being, don’t ever try to convince someone who is experiencing pain that there is much to be learned from it. Yes, it can be instructive, as I am sure it was for an Abbess of a northern California Buddhist monastery who was dying from cancer accompanied by intensive pain, and thanked the Buddha each evening for one more day to achieve enlightenment. I think most people who experience pain would prefer a lucid conversation with a friend over a bottle of 30-year-old rum. Pain is a sharp point of living that you may not be able to run away from. But it shouldn’t be romanticized.


There is no question that meditation can reduce the pain associated with some things like a headache, sprained ankle, or localized pain associated with the healing of surgical sutures. But once we go beyond these types of pain, we enter into a very different world.

A few years ago, I was rushed to the hospital because of intense chest pains. I was unable to use any of the meditative techniques that had been successful after a past surgical procedure. Was it because my skills as a meditator dwindled? No. The pain was so intense that there was no room for anything else in my consciousness. Not my practice, not what I thought I would experience before I died.

Fortunately, it wasn’t anything serious. But, it definitely was a “teachable” moment that made me realize the discrepancy that exists between what we think we are capable of doing and what we can do in the presence of excruciating pain, may be unbridgeable.

Think about a child’s teeter tooter. If both children weigh approximately the same, the slightest amount of added weight on either end will pull that side down to the ground. A little more focus, and the pain can be minimized. But what happens when the child at one end weighs twice as much as the other child. Or three, or four times the amount? A little more focus may have no effect on reducing the pain other than making us feel guilty about not being able to endure or control it. I think it might be similar to a husband telling his wife who is in labor how important it is to relax.


When most people think about the pain, they’re thinking about a specific time period—when it’s happening. But pain has porous boundaries. For example, after my surgery I knew that once my non-operated leg was in bed, I would have to lift the operated one. And while I wasn’t feeling any pain at that moment, I anticipated what I would be shortly experiencing. And the reverse happened when I got out of bed. The actual pain lasted only a few seconds. But the anticipation of it continued as long as I thought about it.

Pain is not confined to just when it is experienced. Sometimes the dread of  anticipating it is more debilitating psychologically than the pain itself. Imagine being faced with making a decision to do something you know will cause you immense pain, but something you know has to be done. And if you had to make that decision, as people with chronic and terminal illnesses do every day—maybe dozens of times a day—how much would that change you? It’s not only pain that changes personalities, but also the anticipation of it.


A hospice patient once said to me that she had learned to live with her pain. What caused her the greatest problems was not knowing how long it would last, or once relief came, how soon it would leave. With pain often comes uncertainty. How intense will it be this time? How long will it last? How much will I be able to endure?

I don’t think my personality changed during the first three weeks of recovery. Even though I asked myself the above questions every day, I knew the pain would eventually cease. But what would have happened if this was just the beginning of a chronic pain disorder, rather than the end of a successful recovery? I believe the longer someone suffers with pain, the more likely there will be changes in their personality. As a friend, or caregiver you need to be prepared to accept the changes and understand that the person you knew before the acute pain began may not be the same person you are caring for.


Without getting into the intricacies of palliative medicine, let me say that I’ve found the fear of becoming addicted significantly outweighs the likelihood of it happening. And doctors who are palliative care experts are very adept in managing it. Although many people react differently to pain medications, here are some generalities that may help you understand it. But of course, discuss these recommendations with a physician.

1. Increasing Pain. As the pain increases, more or stronger medication is needed.

2. Subjectiveness of Pain. The widely used pain management system (numbers 1-10) is subjective. What someone says is their pain number should be accepted. The person who is not experiencing pain is not in a position of telling someone who is that they’re exaggerating. The correct pain number is what a person who is experiencing says it is. Period!

3. Keeping Pain Manageable. Don’t wait until the pain is unmanageable. There’s no place for a stiff upper lip in pain management. And current research indicates that adequate pain management positively affects healing. It’s much easier controlling pain that’s less severe. Another way of deciding whether it’s time to use medication is being aware if the pain remains at the same level or is trending up. It’s important to stop the acceleration.

4. Don’t Wait. The longer you wait in a pain cycle to begin medication, the longer it will take for it to be effective, and the more you’ll need.

5. Palliative Intervention. Think of palliative intervention not only as a way of combating pain, but also preventing it before it becomes intolerable.


I know many of fellow Buddhists believe that awareness and living in the present is important. Logically, that would mean that those who are in pain should focus on it to overcome it, but it’s been both my personal experience and experience with patients in acute pain that the opposite is more successful. For me, it’s either playing my flutes or listening to a Brahms Sonata. For one of my patients it was the TV Soaps. For another, his pain diminished when I read to him.

Although it’s possible to go into a long discussion on the physiology of distraction, it makes more sense knowing that it works.

We don’t like thinking about acute pain. And definitely reading about it doesn’t rank very high. Yet, millions of people experience it every day and have trouble understanding why others react to them in a way that questions the legitimacy of their feelings. Hopefully, this article will shed some light on this misunderstand area of a part of life.

About the Author:  Stan Goldberg is a cancer survivor, hospice volunteer (Pathways Home Care and Hospice), husband, father, Professor Emeritus at San Francisco State University, and devotee of the shakuhachi (Japanese bamboo flute) and Native American Flute. In 2009, Stan was named by the Hospice Volunteer Association “Volunteer of the Year.”

This article was posted previously on: Aging and Illness and was reposted here with the author’s permission in July of 2012.

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Stan Goldberg, PhD

Stan Goldberg is a cancer survivor, hospice volunteer (Pathways Home Care and Hospice), husband, father, Professor Emeritus at San Francisco State University, and devotee of the shakuhachi (Japanese bamboo flute) and Native American Flute. In 2009, Stan was named by the Hospice Volunteer Association “Volunteer of the Year.”


  1. Dear Mr. Goldberg, thank you for sharing! It is a great article!

    Bob Marley said: ‘One good thing about music is, when it hits you, you feel no pain.’ I wish to say I fully agree! Still, I have experienced already, that if that hit of some music is strong enough on me, and is varied and surprising enough, it CAN ADD to your point on palliative intervention and in some cases did replace a medical solution in my case:

    I am another volunteer to explore what can I do myself to live a life with chronic pain as good as possible. I am a caucasian age 39 female, facing chronic developing pain from unbalanced hormone system, in and around the feminine organs from age 12. In the past 2 years chronic migraine in 50% of my time including night hours. In the last 4 years I am also in nearly unbearable emotional pain as well: endless insecurities of being able or not to have a child.

    Every human being, when facing chronic pain, shall explore for him/herself what the best solution for him/her is, because of the various factors that influence the level of pain we face. For example, just the emotional bit itself makes it already so very different for everybody!

    I developed a toolkit that works for me, so I share it here, maybe it helps some people.

    1. Physical tools:
    – Water, water, water and water, if possible non-stop. Sometimes a liter water in the morning changes 1-2 levels of pains for me!! Every level is so valuable, right?
    – Stretching=yoga, whatever moving is possible and when it is possible, but never never never skip it. Extremely careful and slow stretching helps through the pain period too. E.g. with migraine I stretch all my neck and all facial muscles, very very very slowly, but still. Again, can help 1 whole level of pain!
    – Enough fruits, vegetables and nuts – NO strict diet bs, that is another limitation only… We have enough with the pain itself! E.g. with migraine I start with an orange, sometimes I can skip a pill with just doing this!
    – Painkiller exactly when you need it – this is the point I really have to develop still, and a lot. To find the right moment before I go over the bearable point/ hurt the people nearest to me, unwillingly by being rude/impatient because of my pain… Anyone developed a good system on this one? Would mean a lot to me!

    2. Tools to influence my feelings:
    – Connect with others! It does not make me happy that other women face similar issues, but it does make me stronger that I feel less alone with pain!!!
    – Art, music, meditation, guided meditation and any hobby that motivates you from within= distraction that amazes you, influences your emotions, your feelings, charges you with unknown energies – whenever you have time for, if no other time, then read on the toilet or when in bed from that pain!
    – Stop the fear that is building up: by studying what happens to you: physically, psychologically, emotionally. E.g. in my case with the hormons I look up possible influencing factors on how ladylike is my lifestyle and can I add anything to it. Meaning maybe developing my creativity could help my health on the long run? This is a lifetime experiment, I could share them decades later only. But as long as my feelings are influenced positively by doing so, I am a ted better already in the present! 🙂 Be careful though to avoid going too much back into the past and simply stay focused on facing your chronic pain the best possible.
    – Stop blaming anybody, also not yourself! Nobody is to blame for my pain. Instead, just do what you can: back to point nr.1. and on to nr.3.!
    – Celebrate your every achievements in this pain management workflow, every little step.

    3. Steps towards higher effectivity:
    – Understand yourself and also work on understanding the people around you, who are also effected by your chronic pain.
    – Flexibility is the best solution for enormous challenges.
    – Adjust your agenda! Pain takes time, so plan the pain into your time management, reschedule your life in full: private-social-work.
    – Share your situation with the closest people around you – build a communication system on your pain status that could work for them too. Talk about best solutions and keep checking them on their feedback about this system.
    – Subscribe onto any training that might be necessary for such steps.

    4. Share your experiences:
    – The big picture in people about pain can change only on the long term. Sharing experiences and information on how to get to solutions can help many others like yourself, with their private, social and work lives!
    – This can happen only by the SHARING personal words of mouth or medical innovations you find.
    – Maybe an online forum with free access to anybody with chronic pain to be made? Maybe I just need to search this one up still. This is going to be my next step in my own process.

    Best of luck with yours!

  2. Thanks for this article. I have had many types of pain; stress induced neck pain & headaches, reactive arthritis, pain associated with chemotherapy & medically induced menopause for Tx of breast cancer.
    I have found ‘curious exploration’ and then refocusing to a valued/creative activity helpful with some types. As you say, other types are just not manageable through the mind alone. I was so grateful to my surgeon who put me on a medication for neuropathic pain post mastectomy. I think I took it for 6-8 weeks and fortunately don’t have any long term pain associated with that.

  3. Though I’m not a palliative patient (though sometimes it feels like it!) I’m a 31 year old female suffering from chronic pain due to a car crash I was a passenger in at age 16. I’ve done mindfulness, meditation, CBT, TENS, PT, acupuncture, biofeedback, breathing, probably tried about 80 meds… Luckily I have an amazing pain dr and GP who take me seriously (the MRI’s help, I admit). But my friends (and for a bit, my family, though that’s changed recently) just told me “it’s all in my head” (I have a pain Doctor at a renowned teaching hospital tell her students that. I broke down in tears). I’m grateful for your writing.. It’s true. Pain is subjective. My advice when doing the “pain scale” is to say “I’ve suffered X years, a good day for me is a 4, and 10 is when I pass out from pain [which has happened a number of times]) it helps give context. And doctors/practitioners/teachers need that context.

    For chronic pain I wish people would stop saying “it won’t always hurt like this”. I know they mean it won’t always be so bad, but hearing from someone who occasionally sprains an ankle “it won’t…” Makes me want to walk out. I go to sleep knowing I’ll hurt (if I even can sleep) and when I wake up I’ll hurt. I’ve lost friends who think I’m just taking drugs. Depending on medications (and non-pharmaceutical tools) isn’t fun. I don’t want to get high. I want to be able to stand up to use the restroom. And there are days I can’t even do that.

    But your writing talks about the subjectivity of pain, and the need to acknowledge our experiences are not others experiences. I hope you keep writing. Advocating. Discussing. Because people like me can’t convince others… They’ve made their judgement. I’m so grateful for your points to remember. I’m sharing this post — it’s a gem. Thank you so much!

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