The Way of Pain

What is pain, when is it not, and what does the way we hurt say about the way we endure?

Original image by Sigueme.

“Pop,” I heard. “Crap,” I thought. The pain followed a split second later and tasted like a high-voltage arc. My hand shot out to grab my toe, presumably to keep it in place and/or the pain from spreading.

“And this little piggy slammed into a bookcase.” I had become a statistic, just one of the millions of people (I’m assuming) around the world whose toes fall victim to unfortunately positioned furniture every day. And although I had escaped with my life, I knew immediately I would not be “toeing” the start line of the race I had coming up.

Sitting on the floor with one hand still clutching my rapidly swelling and reddening toe, I reached for my phone to tell it what had happened. The browser opened to the race website. Sigh. I typed in my new reality. There were 279,000,000 search results for “broken toe.”

“Usually heals within six to eight weeks” (yep, there goes the race). “Usually doesn’t need treatment.” Advice included rest, buddy taping with a neighbor toe, and seeing a doctor if the injured digit was crooked or bent at an unnatural angle. I didn’t think mine was, although at this point it was more convincing as a strawberry than a toe, so it was hard to tell.

Despite what I used to think when I was eight, injuries aren’t cool. That said, some are cooler than others. Kicking a rock while going full speed down some scenic technical trail would’ve made for a better story than my foot missing the empty space in my own living room.

For the record, I did consult a doctor. She agreed—kicking a rock would’ve been way cooler. Also, the toe was broken in two places. You should see the other guy.

Not one to let a good bone fracture go to waste, I wondered what I could do with all that free time and energy I’d reclaimed when I liberated myself from the full use of my foot. This seemed like the perfect opportunity to work on those things we runners tend to neglect—you know, strength training, mobility, anything to do with the upper body.

Instead, I decided to practice the splits: an absolutely useless skill that made for a fun challenge and didn’t require bending or putting weight on my toe. The next day, after a seated/supine warm-up, I got into a side split position and began counting out 15 breaths. Phew. Got up, rested, went down again, a little lower this time. On the third rep, I hit my end range, where the discomfort in my inner thighs intensified into a burn. I got through the count by rubbing and scratching my legs, which seemed to ease the pain for some reason.

Wait, what was the reason? Was it the same reason I had clutched my hurt toe? Massage my temples when I have a headache? Rub my elbow when I hit my funny bone?

It was the same reason. Apparently, 60 years ago, a pair of scientists named Ronald Melzack and Patrick Wall came up with “a new theory of pain mechanisms,” which explained how non-painful sensations (such as touch or pressure) could override painful ones. They called it Gate Control Theory.¹ In trying to learn more about it, I quickly discovered I lacked a basic understanding of how pain itself works, which was an equally fascinating topic. If only I had the time to explore it in depth… Oh, right.

what a feeling

How real is pain? For anybody in pain, it’s the realest. Depending on its intensity, it can seem like the only real thing in the world. Yet, the more I read about it, the more unreal it got—starting with the mildly disorienting fact that my broken toe actually didn’t hurt at all. Apparently, a toe can get damaged and strawberry-like, but it takes a brain to do all the hurting.

This is because the thing we call pain can only be recognized by the brain—and only certain parts of it. For the rest of the body, it’s an electrical signal generated at the site of potential damage when pain receptors (nociceptors) detect harmful stimuli.

The signal itself doesn’t hurt. It doesn’t feel like anything until—look out, it nears the spinal cord! Nope, no pain yet. Next stop: the thalamus! Still nothing—until the signal finally reaches the regions of the brain that can decode it. Then the brain goes, “Oh no, what did she do now?” and scrambles to piece together the sensory, emotional, and cognitive aspects of the pain. It constructs it. Now it hurts.

Injuries may not be cool, but pain kind of… is? It’s not merely a sensation we passively feel, but a complex experience contained entirely within the brain that creates it. This means that no two people hurt the same way (nor do two injuries, for that matter)—and that’s even before accounting for individual pain tolerance.²

Here comes the coolest part: The experience isn’t final. As we know from aspirin, pain can be dampened (it can also be amplified, as we know from that race where we had to listen to one dude complain for two hours straight while we were dealing with a nasty cramp). But it’s not just drugs that can turn the pain signal down—our body comes with built-in dimmer switches (more than one!). Let’s start with the one that got me into this rabbit hole in the first place.

​

gate control theory: a tactile takeover

I’d always imagined rubbing pain away as somehow dissolving a gooey blob of it into a cloud that dissipates through the tissues. But, as I was able to confirm through hours of painstaking research, pain is not a blob. It’s a ghostly, disruptive presence that the brain whips up into existence from raw data.

But what if the data never gets to the brain?

Let’s say you bump your knee. A chain of neurons (nerve cells) transmit the pain signal along their axons (nerve fibers) from your knee through your spinal cord to your brain. If you then start rubbing the sore spot, the touch signal will follow a similar chain-like path, also entering the spinal cord before ascending to the brain.

Both signals pass through a region in the spinal cord called the substantia gelatinosa. This is where the “gate” is located. Now, the most important thing to know is that—despite the name of the theory—there is no actual tiny door there. I, for one, was disappointed. Instead, the touch signal, which travels along thicker, faster-conducting nerve fibers, activates inhibitory interneurons in the substantia gelatinosa. Those release chemicals (GABA, glycine) that make it harder for the pain fibers to transmit their signal further up the spinal cord and to the brain. And if it’s not in the brain, it’s not pain.

It’s like a neuronal relay race, except the faster team steals the slower team’s baton mid-race, so the slower team doesn’t even get to finish. Or, if we’re sticking with Melzack and Wall’s boring metaphor, it’s like (yawn) “closing the gate” for the pain signal.

This was bad news going up. Next: good news going down.

​

descending inhibition: a calculated response

Remember how I said the brain constructs the pain experience? Well, it can just as easily choose not to construct it. Our survival depends not just on the ability to feel pain, but on the ability to feel it when it’s appropriate to do so. In a fight-or-flight situation, for example, our brain might decide we don’t need any of that pain nonsense until we’ve escaped or neutralized the threat.

This is descending inhibition at work: a process in which some aggressively Greco-Latin–named structures (three words: paragigantocellularis reticular nuclei) send signals from the brain down the spinal cord to reduce the activity of pain-transmitting neurons. This is where you’ll find the magic endorphins (and other natural opioids). If you’re a runner, I know you’ve heard that word. And yes, exercise-induced pain relief is another example of descending inhibition. If that bumped knee still hurts as you head out for your workout, the pain may well vanish once you get moving. Not only that, but if you bump it again, while exercising, with the exact same force as before, it would likely hurt less than it did at rest.

So, one system inhibits pain signals from going up, the other sends relieving signals down. Neither will repair any damage you might’ve caused with your going around bumping your knees everywhere, but they can act to remove the pain from it.

Which illustrates that most unreal thing about pain: It’s not an inherent property of tissue damage, like color is of blood, or smell is of rubbing alcohol. Nor is tissue damage a necessary precursor to pain (think phantom limb pain). We can have one without the other.

Ultrarunners have long taken that to mean “If we can deal with one, we can ignore the other.”

what the way we hurt says about the way we endure

As the days passed, along with learning a lot about pain (and a little yet entirely too much about lobotomies), I made steady progress with my splits. The healing toe changed colors to mark the time, like leaves do. Fortunately, it didn’t fall off like they do. It was sometime during the yellow-and-green days that I achieved my all-time personal best in both the front and side splits.

I see you’re understandably unimpressed. Moving on then.

Everything I learned about the way we experience—or don’t experience—pain also shed new light on our ability to endure it during training and racing:

Ultras hurt. Training for them often hurts. But if some biological mechanism can influence how much it hurts, what does that say about that mental toughness we runners are always on about?

I’m going to make the argument that mental toughness is more of a mental skillfulness.

We know that pain is subjective—it differs from person to person. We also know that it’s not passive—not merely received from sensory input but actively constructed by the brain. And finally, we know that the construct we end up with is heavily influenced by context—thus, pain also differs from situation to situation.

“Context” here is short for “everything we feel, believe, expect, remember, are, and are doing in the moment of pain.” When we start hurting during a race, the brain factors in all the available information to create the pain experience.

Including that arguably most relevant piece of context: We signed up for this. Our desire to be there sends a clear message to the brain that there must be something meaningful to be gained from this experience. And because it interprets pain as part of a worthwhile effort, it quietly makes it that little bit less awful—with us never the wiser. Looks like badassery, is neurological prioritization.

To claim that this makes the race easy would be an insult to cramping and blister-footed runners everywhere. But the fact is that physical strain we find meaningful is easier to endure than physical strain we don’t. After all, the treadmill’s grim origins trace back to Victorian England’s prisons,³ where, reportedly, “[o]ne could not fail to be struck by the air of languor, and almost misery, which always marks labour not lightened by reward.”⁴ A reward—this is what makes an ultramarathon not like a nineteenth-century prison. Also the food, I guess.

It’s not just perceived meaning that can affect the pain experience. Just as ultras have many ways to cause pain, they’re also full of things that can cue the brain to dial it down (a timely snack, an enthusiastic pacer) or even up (uncomfortable underwear, an enthusiastic pacer). Running an ultramarathon means doing an objectively hard thing’s entirely subjective, context-bound, one-time-only version.

Being mentally tough, then, isn’t just about how much pain we can take, but also how well we can influence our brain’s interpretation of it—that subjective, context-bound, one-time-only interpretation.

In other words, our ability to endure involves both willpower and skill. And I would argue the one that matters more is the one that’s less of a finite resource. Hint: it’s the latter. Knowing how to focus our attention away from the chafing wedgie beats just gritting it out; learning to regulate our emotional reactions beats suppressing them; being able to reframe difficulty as growth or a challenge beats blindly white-knuckling through it.

In addition to being more sustainable, skillful endurance has a higher ceiling than brute willpower. Mental skills such as attention control, emotional regulation, and cognitive reappraisal are remarkably trainable (such as through mindfulness practice, visualization, self-talk, and running in the rain now and then). The more we practice conscious pain management, the more we strengthen the biological pathways that manage pain automatically. Over time, the brain changes how it interprets pain and becomes better at regulating it on its own—a phenomenon known as “your fifth 100k hurts less than your first.” Because neuroplasticity.

And guess what—those skills extend beyond physical hardship. Certainly beyond running. Absolutely beyond self-imposed adversity. Developing them will make us more resilient, less governed by impulse, more in charge of our own motivation.

In short, the pain will still be there—we’ll just be better at hurting.

And we’ll also be better at quitting. It sounds like the wrong thing to strive to be good at, but:

First, abandoning a goal brings with it a different, psychological type of pain. Raw willpower won’t get you through the grief and disappointment. But skill can.

And second, while willpower is a bit of a runaway train, mental skill is strategic and protective. Knowing when to stop pushing is very much a skillful aspect of mental toughness. Because the goal should be abandoned if there’s reason enough to do so; the goal is not to endure the pain until something snaps and then endure some more. Unless you’re David Goggins, probably, in which case I can’t hurt you, I mean help you.

​

A Reading Recommendation in a Single Quotation with No Further Explanation

❝Maybe it’s simply that things have meaning because we decide they have meaning. We stick with something because we believe it will be meaningful, and sometimes it becomes meaningful for no other reason than the fact that we stuck with it.

—

Brendan Leonard

, Ultra-Something

As always: Thanks for reading, and please consider sharing this post or leaving a like or a comment.
As just this once: Make your favorite breakfast from your childhood and have it for dinner.

​

1. Ronald Melzack and Patrick D. Wall, “Pain Mechanisms: A New Theory,” Science 150, no. 3699 (November 19, 1965): 971–79, https://doi.org/10.1126/science.150.3699.971.

2. Not to be confused with pain threshold. While the threshold for pain receptors to respond to harmful stimuli is relatively consistent among individuals, pain tolerance varies wildly from person to person.

3. These devices were actually more similar to the StairMaster—they forced prisoners to climb an endless series of steps on a rotating wheel.

4. Jill Evans, “On the Treadmill: Hard Labour at Gloucester Prison,” Gloucestershire Crime History, April 3, 2014, https://gloscrimehistory.wordpress.com/2014/04/03/on-the-treadmill-hard-labour-at-gloucester-prison/.