Which is worse: physical pain or emotional pain? And how does one tell the difference? At an earlier chat someone asked me to distinguish between physical and emotional pain. I gave a brief reply but upon reflection felt I had only scratched the surface of this tricky subject.

What is the difference between physical and emotional pain? An overly simplified answer is that physical pain has a physical cause and emotional pain comes from emotional distress. When pain is accompanied by physical injury or inflammation, dysfunction or disease, we usually declare it to be physical pain. It may not be so simple since emotions usually accompany physical pain and add an additional twist to it.

It would be easier to discriminate if there were a clear cut way to measure pain. There is no machine that gives a numerical pain reading. The only method available is to ask you. Pain must enter your mind to be experienced and this is where it must be measured. The most commonly used pain measurement is a scale from 0 to 10 where 0 is “no pain” and 10 is “the worst pain imaginable.” This is bad news for scientists, because it is subjective and unreliable, but good news for those doing the imagining. There are many mental techniques to manipulate and reduce pain.

There is a distinction between pain and suffering. Pain is a physical sensation and suffering contains all the feelings and interpretations we have about that sensation. This is a useful distinction because, while we may at times be unable to consciously control the sensation of pain, we do have the option of changing our interpretation to alter the accompanying emotions. There is an old saying, “Pain is inevitable, suffering is optional.”

There is also a difference between suffering and emotional pain. This may be merely a matter of degree. When we curse the pain we feel for destroying our lives, this is suffering, and usually it will increase the pain. As we dwell increasingly in pain-inflicted helplessness, we enter the realm of depression. Now changes in brain chemistry rob us of control over these deepening emotions. The pain of depression becomes dominating and relentless. Now it has become emotional pain as well.

Any strong negative emotion can be powerful enough to be considered painful. Sadness, anger, fear, shame, grief, disgust, desire, and stress can hurt us deeply when they are intense enough. Usually we know these are emotional, rather than physical, pains. These are intensely unpleasant experiences and we work hard to avoid them.

Where does emotional pain occur? Is it only in your mind? One tricky problem is that both physical and emotional pain are in the mind and the body. Emotions are our reactions to the things that happen around us. Sadness is our response to loss, anger our reaction to frustration or hurt. Each emotion is a mind-body reaction. Of course the mind plays a big part in the generation of emotions. We all know how quickly a thought about a particular person or event can launch a flood of emotions. It is our interpretation of our immediate world that triggers each emotion. When those interpretations are consistently negative, the dark side of our emotions become intense enough to hurt us.

We can turn emotional pain into physical pain. Sometimes we are successful in numbing ourselves to emotional pain by ignoring it or shutting it out somehow. Emotional pain is based on our interpretation that something in our world is dreadfully wrong. Unless you actually change that interpretation, the emotion has a way of lurking in the background and letting us feel the pain in some other way. I experienced this myself when my brother was losing his battle with a terminal illness. Months before his death I developed an excruciating and relentless pain in my back that was beginning to cause numbness in one hand. Various doctors had various diagnoses and corresponding treatments. Nothing brought relief. After my brother passed away, I allowed myself to grieve fully with my family. Lots of hugging and crying, and crying turned out to be the required treatment. The pain disappeared in relatively short order, much to my surprise.

When there is pain without a known physical cause it often is assumed that cause is emotional. Sometimes this is true and sometimes the physical cause has yet to be discovered. The assumption of emotional origin can also be a process of elimination when there is a failure to properly diagnose the problem. No physical cause can be found, so it must be emotional. When patients who have been told their pain is psychological are sent to me, I see a variety of reactions. Some believe that it may be true since tests have been negative and they do have alot of distress. Others don’t believe it but are open to the possibility and to treatment. Still others think emotions couldn’t possibly play any role and want nothing to do with psychological treatments. It is always good to explore the contributions of emotional factors to pain. At the least one can learn some useful things about oneself and perhaps even some psychologically based pain management skills.

One difference between physical and emotional pain has to do with attention. I mentioned earlier that pain must enter the mind to be experienced. In other words, pain must get our attention for us to be conscious of it. Normally, this is not a problem. Physical pain’s main purpose seems to be to grab our attention and it does this well. However, most sufferers of chronic physical pain have experienced times when their attention became absorbed in something other than pain and they, momentarily, forgot about the pain. Without attention, there is no conscious pain. It is similar to the puzzle, ”If a tree falls in the woods and there is no one there to hear it, does it make a sound?” If sound requires conscious perception, as pain does, the answer is no.

With physical pain several things determine whether we become aware: the intensity of the pain, the strength of our attentional focus in something else, and, perhaps, the physical area of the pain. Stronger pain has more pull on our attention. However, when attention is extremely absorbed elsewhere, even severe pain can go unnoticed. Consider the stories of athletes completing events with normally incapacitating injuries or soldiers saving others when then themselves have been maimed. We do not have to go to such extremes to develop the ability to powerfully focus attention away from pain. One can acquire this ability through the study of meditation or self-hypnosis, both useful pain management skills.

Pain location seems to make a difference also. Most people report more trouble distracting their attention from headache pain, perhaps because it seems to occupy the place our attention comes from. One seems to look out at the world through a curtain of pain. Headache pain has this common factor with emotional pain - both reside mostly in the head. The source of emotional pain lies in our inability to stop dwelling on thoughts that feed the emotions that pain us. These thoughts become almost obsessional taking possession of consciousness, and even though we may divert our attention briefly, we keep returning to the interpretations that something is dreadfully wrong with our world.

This obsessional quality can make it harder to divert your attention from emotional pain than from physical pain. However, the payoff is greater when you are successful. When you can keep you attention off the thoughts creating the emotional pain, there is no pain. With physical pain, whatever is wrong, remains wrong. The trees still fall down. With emotional pain, without conscious perception, the trees don’t fall.

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