Episode 7: Feeling Heard - Giving a Voice to Pain

Unlocking Pain Communication: Beyond Words and Numbers

In this episode of 'Mind Your Body,' Dr. Zev Nevo explores the complex relationship between mind and body in the context of pain. He delves into neuroception and the challenges of describing internal pain to others. Drawing on insights from thinkers like Federico Faggin, Dr. Nevo emphasizes the importance of creative language and vivid metaphors in effective pain communication. He offers practical advice for both those experiencing pain and their caregivers, highlighting the crucial role of validation and empathetic listening. By understanding these dynamics, we can enhance pain assessment and care, ultimately fostering a more compassionate world.

00:00 Introduction to Mind Your Body

01:26 Exploring the Pain Experience

02:13 Describing Pain: The Challenge

03:02 Federico Faggin and the Science of Consciousness

06:12 The Limitations of Pain Scales

07:38 Creative Language for Pain Description

09:18 The Role of Patterns and Triggers

10:51 Becoming a Better Pain Detective

14:33 The Power of Validation

18:12 Conclusion and Final Thoughts

About Dr. Nevo
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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Transcript

Episode 7 | Feeling Heard: Giving a Voice to Pain

Hello and welcome back to Mind Your Body, where we unlock the fascinating connections between well, your mind and your body. I'm Dr. Nevo and I'm so genuinely grateful you're spending this time with me today. Honestly, it's the highlight of my week to share these insights with you.

Now, we've been on quite a journey lately, diving deep into what I affectionately call the pain experience. We've explored that incredible concept of neuroception, that silent unconscious sentinel within our nervous system constantly scanning for whispers of safety or shouts of threat. It's happening inside our bodies, out in the world, and even in the subtle dance of our human interactions influencing our capacity for co-regulation.

This constant safety check plays a huge role in how we [00:02:00] experience and crucially how we express distress, including that notoriously elusive sensation that we call pain. Today, we're going to take that exploration up a notch. We're really going to zero in on the head-scratching challenge of describing that intensely private internal experience of pain.

And here's the kicker: How on earth do we help another person truly, deeply viscerally understand what we're going through? Because let's be real: it's one thing for your nervous system to silently register a threat or discomfort, say, "ouch!, I just bumped my funny bone." But it's an entirely different beast to translate that raw, primal feeling into something communicable.

Something shareable with another human being. It's like trying to describe the color ultraviolet to someone who's only ever seen the visible spectrum. [00:03:00] Tricky, right? This is where the insights of thinkers like Federico Faggin become incredibly relevant. Federico is the inventor of the microprocessor and the touchscreen technology, and he's been studying the science of consciousness for decades.

Now if you're picturing a brilliant mind pondering the very fabric of reality, you're on the right track. In his book "Irreducible", hedives into this idea that a feeling like pain isn't something you can point to on an MRI or dissect with a scalpel. 

It's not a solid liquid or gas. It's not sitting neatly in your amygdala, patiently waiting to be measured. Instead, he proposes that our feelings are part of a deeper, perhaps even quantum physical reality called "qualia". It's our consciousness, he suggests, that [00:04:00] applies meaning to these raw sensations. Then, to bring that incredibly private internal feeling out into our shared, observable physical world, we have to use symbols.

We're talking verbal symbols, like words, adjectives, the whole linguistic shebang and non-verbal symbols, facial expressions, gestures, how we hold our bodies, even our habits. We use language almost poetically, trying desperately to capture that internal reality. However, this process immediately hits some rather human limitations on our end, the sharer of the pain, we are constrained by our vocabulary, our choice of language, and our very human ability to select the best words to describe what's swirling inside. Have you ever tried to explain a truly bizarre [00:05:00] dream to someone? It's a similar struggle, isn't it? You know what you experience, but the words just feel inadequate.

And then on the receiver side, there are limitations too. Their ability to understand your internal feeling and experience based on your symbolic description is filtered through so many layers. Their own emotional intelligence, their knack for reading, both verbal and nonverbal cues. Some of us are better at this than others.

Their personal experiences of similar sensations. And even their memory and comprehension of how you've explained your experience before. Authentically internalizing what the experience must be like for you is a complex act of interpretation. And it's precisely this beautiful, messy complexity that creates so much potential for misunderstanding in [00:06:00] pain communication.

So given that inherent difficulty in translating a private internal quantum level feeling into shared understanding. How do we even begin? We often default to that familiar zero to ten pain scale, don't we? Zero is no pain, ten is the worst pain imaginable.

It's a quick tool and it certainly has its place, especially for tracking changes over time. But honestly, how often does a single number truly capture the essence of what you're feeling? Is a seven always the same for everyone? Is a seven the same for you every single day? Does it tell the difference between a sharp stabbing pain and a deep aching throb, or maybe that weird phantom sensation you can't quite pinpoint?

Not really, right? Think about it. We have this incredibly rich vocabulary for so many things. [00:07:00] We can describe the nuances of flavor and food with exquisite detail: smoky, bright, herbaceous, deeply savory. We have a vast spectrum of emotions, each with its own subtle shade: annoyance, frustration, exasperation, fury.

When it comes to pain, we often default to just a handful of tired descriptors: sharp, dull, burning, aching, throbbing. I guess they're a start, but they can feel quite limiting, like trying to paint a masterpiece with only five colors. This is where getting a little more creative with our language can really help.

Imagine someone trying to convey a specific type of nerve pain. They might struggle with typical words, but then they say, "It's not just pain. It feels like a thousand tiny electric eels, wriggling, and sparking just [00:08:00] under my skin, sometimes delivering a sharp, unexpected jolt." Now, electric eels isn't a medical term, but wow,

does it paint a vivid picture! It goes so far beyond burning or tingling and gives you a real palpable sense of the sensation's quality, its movement, and even its unsettling, emotional impact. For a moment, think about your own pain, past or present. What if your pain had a unique, bizarre, or even fantastical name?

What would it be? How would that change how you describe it? Using analogies and metaphors, drawing from our everyday experiences can be incredibly powerful tools. Is your pain like a tight band squeezing your head? Is it like a relentless drumbeat, thumping behind your eyes, or more like unpredictable lightning strikes that zap you out of nowhere?

Perhaps it's like a [00:09:00] toothache, but annoyingly in your back, or a constant dull throb that feels like a slow, heavy river flowing through your joints. These comparisons can help someone who isn't in your body get a little closer to understanding what it feels like to be in your body with that pain. It also immensely, It's also immensely helpful to describe how the pain behaves.

 Does it come and go like an unreliable guest? Does it flare up predictably at certain times of day or after certain activities, or perhaps even in specific social contexts?

What makes it better? Even just a tiny bit? A hot shower, a specific stretch, a calming cup of tea? And what makes it worse? This information about patterns and triggers is absolute gold, especially for healthcare providers who are trying to play detective and figure out the source of the pain and the [00:10:00] best way to approach treatment.

So if you're trying to communicate your pain, remember to move beyond just numbers. While zero to ten scales have their place try to expand, instead of just a seven, try a seven, but it's a sharp drilling seven, like a tiny jackhammer. Embrace metaphor and analogy. Is your pain like a heavy cloak, a jagged glass shard, or a buzzing beehive?

Get creative and always describe its behavior if you can. When does it appear? What makes it ebb or flow? What movements, activities or positions aggravate it or bring relief? Think of it like a weather report for your body. This brings us to the other side of the coin, becoming a better Pain Detective. If you are a caregiver, a family member, [00:11:00] a friend, or a healthcare professional, it's not always easy to truly tune in and interpret someone else's pain, especially when they're struggling to express it verbally or perhaps downplaying it because they fear becoming a burden.

Active listening is paramount here. It's not just about hearing the words: it's about listening with your eyes, your intuition, and your heart, too. Pay attention to facial expressions. Are they subtle shifts or obvious grimaces that tell a story? Look at their body language. Are they restless protecting a body part or are they unusually still, guarded, almost frozen?

Are there changes in their breathing or even their skin color? Think about a parent trying to figure out if their nonverbal infant is in pain. What do you do? You look for crying. Sure, but also changes in feeding habits, sleeping patterns, [00:12:00] fussiness, and how the baby holds their tiny body. Parents become incredibly attuned to those subtle nonverbal signals, almost like a superpower.

We need to bring that same level of attentive observation to adults who may have difficulty communicating whether due to age, illness, or other factors. Asking the right questions is also crucial instead of just "where does it hurt? or "what's your pain on a scale from zero to ten?" Try open-ended questions and invite a story:

"Hey, can you describe what the pain feels like to you right now?" "If your pain had a texture, what would it be? Rough, smooth, sandy, sticky." "What does the pain stop you from doing that you wish you could do? What makes it feel even a tiny bit better? Even for a moment? What patterns predictably increase your pain?"

Or a question I like to ask is: "How do you feel right now in your body?" These kinds of [00:13:00] questions invite a more detailed, personal and less clinical response, going far beyond the standard pain vocabulary. Now, imagine you needed to create this feeling of pain for someone, or even an AI that had no prior experience of it.

What would you do? What tools would you use? Would you describe it as a constant dull pressure, like a vice slowly tightening, or maybe a sharp hot jab, like being poked repeatedly with a glowing poker? Perhaps it's a deep vibrating ache, like a low frequency hum that resonates throughout your bones. This thought exercise of having to engineer the sensation forces us to be incredibly precise and creative in our descriptions, which is exactly what we're aiming for when we communicate pain.

So to be a better pain detective, listen with your whole self. Beyond words. Observe body language, [00:14:00] facial expressions, and subtle shifts. Ask expansive questions. Going beyond where and how much? Ask about textures, colors, sounds, or even how you'd create that feeling for someone else. If your pain had a sound, what would it be?

 And always look for patterns. When does it worsen? What brings relief? This is, as I said, diagnostic gold. But perhaps the most important tool in a Pain Detective's kit is something we simply cannot stress enough. Validation. 

 This comes up often and it bears repeating loudly and clearly. When someone is brave enough, vulnerable enough to share their pain with you, simply believing them and making them feel heard and listened to is incredibly powerful. You don't need to fully understand the sensation itself to believe that they are experiencing [00:15:00] it and that it's real and significant to them. Think about a time you were going through something difficult, maybe not even physical pain, but emotional pain or a tough situation at work. Did someone dismiss your feelings or try to cheer you up by saying "It's not that bad," or "Just think positively,

It'll pass." How did that feel? Probably pretty isolating and invalidating, right? Like you were being told your reality wasn't real. Now imagine someone simply saying, "Wow, that sounds incredibly difficult. I'm so sorry you're going through that." Or, "I can see how much this is affecting you." That simple acknowledgement, that validation, can be a lifeline for someone in pain.

It's the same with physical pain. Perhaps even more so because the pain is by its very nature, invisible to the observer. 

 When someone [00:16:00] expresses their pain, whether verbally or non-verbally, and the response is disbelief, minimization, avoidance, or indifference. A quick change of subject, a dismissive wave, it adds layers of emotional pain onto the physical pain.

It can lead to feelings of frustration, isolation, and even questioning their own reality. On the other hand, when a healthcare provider, a loved one, or even a casual acquaintance, takes the time to truly listen, observe, and say, "I believe you", or "That sounds incredibly painful," it can dramatically change the person's experience. How? It reduces the stress and anxiety associated with feeling unheard, which as we discussed with the mind-body connection, can actually exacerbate physical pain.

Validation doesn't magically take the pain away - if only - but it can make the burden of carrying that pain just a little bit lighter. It builds trust [00:17:00] and strengthens the relationship. Creating a safer space for the person to continue communicating their needs, knowing they won't be judged or dismissed.

Small acts of validation can make a huge difference. It might be a simple nod and eye contact while someone's speaking, a hand gently placed on their arm or simply repeating back what you've heard to ensure you've understood. Phrases like, "So, if I'm understanding correctly, you're saying the pain feels like..." insert their description "and it tends to get worse when you..." describe their trigger.

Or "I can see that moving your arm seems really difficult for you right now." These statements show that you're paying attention and genuinely trying to connect with their experience. It's a silent message that says, "I see you. I hear you. You matter. Your experience matters." 

Consider [00:18:00] this: When was the last time you felt truly heard, especially when expressing something difficult, what impact did that have on you? How can you offer that gift to someone else this week? Ultimately, effective pain communication is a two-way street. It's built on a foundation of trust and a genuine desire to understand.

It requires a person in pain to find ways, often creatively, to express their subjective experience, both verbally and non-verbally using whatever tools are available. Words, analogies, gestures, technology, body postures, facial expressions, and it requires the listener to be a skilled pain detective, actively listening, observing nonverbal cues, asking thoughtful questions, and most importantly, validating the reality of the other person's [00:19:00] pain. By becoming better communicators, and more empathetic listeners, we can dramatically improve pain assessment, strengthen our relationships, and ultimately provide better support and care for those living with pain. It's about giving a voice to that invisible adversary, and in doing so, making the world a little more compassionate. 

Thank you so much for listening. I hope this episode has given you some practical, palatable steps to make a difference in your life and the lives of those around you immediately and in the near future. See you next time, and until then, remember to always mind your body.