better ourselves, and set benchmarks for future growth. We compete against others and we compete with ourselves, pushing through that extra repetition at the gym or trimming five seconds off our three-mile run. Pain is essential in honing our competitive edge. It tells us how far we can push and when to back off. When you feel the burn of lactic acid (inflammatory pain) during the last mile of your run or the last set of your workout, you know you are close to your physical limit. That sensation tells you that you can push just a little bit more before you rest in order to maximize the benefit of your training session. When you push yourself to the threshold of discomfort, your muscles tear microscopically. When you rest, they rebuild stronger than before. Pain is essential to this growth process.
The Golgi tendon organ is the sensory receptor that helps us know our limits when we stretch our bodies. Without it to warn us, we would extend our muscles beyond their limits, tearing them and even damaging our joints. Pain regulates both the stretch and the contraction, keeping us safely between both extremes. In order to see the benefits of stretching after a workout, you have to gently push against the limit set by pain. As Benjamin Franklin wrote in his classic essay, The Way to Wealth:
So what signifies wishing and hoping for better times? We may make these times better, if we bestir ourselves. Industry need not wish, and he that lives upon hopes will die fasting. There are no gains without pains.
Growth and gains come at a price through pain. The phrase “no pain, no gain” appears in many contexts, but above all in the realm of fitness.
In her book Unbroken about World War II prisoner of war (POW) Louis Zamperini, Laura Hillenbrand illustrates the remarkable growth that can accompany a willingness to embrace discomfort. Zamperini was born in America to Italian immigrants. As a boy, he was bullied and mocked for his English, so his father taught him how to box. Training in the ring with his dad involved a lot of discomfort and pain, but Zamperini wanted the bullying to stop, so he pushed through it and eventually began to defend himself successfully.
Zamperini’s older brother, Pete, encouraged Louis to start running track. To keep pace, Pete would run behind him and hit him with a switch if he slowed down. Pretty soon, Zamperini was breaking records. A naturally gifted runner, he went on to compete in the 1936 Olympics.
In 1938, Zamperini competed in the mile while at USC. Other runners singled out the Olympian in their midst for abuse, spiking him with the sharp edges of their shoes to hurt him and slow him down. Determined, Zamperini pushed through the pain to set a new record for the national collegiate mile: 4 minutes, 8 seconds.
Without pain or the fear of more pain driving him, Zamperini would never have achieved his amazing potential. Without achieving that potential, he never would have survived the challenges to come.
In 1941, Zamperini joined the Air Force to fight in the Second World War. His plane was shot down over the Pacific and he was captured by the Japanese after a long and arduous 47 days at sea in a raft. Near starvation, Zamperini was put into a POW camp, where he was beaten and tortured. At one point, he was forced to hold a steel beam over his head. Though weakened and pushed to his physical limits, he defied his captors by not succumbing to the pain.
After the war, Zamperini returned home, suffering from nightmares and what we might today call post-traumatic stress disorder (PTSD). He became an alcoholic, descending deeper and deeper into psychological pain. Eventually, however, Zamperini overcame the psychological trauma and alcoholism through a spiritual transformation. He became a Christian evangelist, forgiving his captors. Some of them even converted to Christianity after being embraced by their former prisoner. In a way, Zamperini’s remarkable resilience delivered a hopeful lesson to others about easing their own pain.
Pain is a metaphor that we can all relate to—it is especially valuable when it helps us remember a significant event, such as childbirth. Pain brings home the poignancy of the key events of our lives. Without pain, we would not appreciate the limits of our bodies and rally behind those who seek to test those limits. People facing physical challenges could not know their body’s limits without pain. By enduring the discomfort, victory is sweeter. We can all learn to better ourselves, through the embodied wisdom in pain, to become more resilient when faced with life’s challenges.
Pushing Through the Pain
Medicine is an art as well as a science. When it comes to the care of patients with maladaptive pain, there is a great deal of art involved because the science of pain is still very much in its infancy. Pain is both crucial and complex, nothing to be treated lightly. We must embrace what it tells us, because avoiding it completely simply isn’t an option.
“So what do I do when I get the pain?” asks Bob, a patient with spinal stenosis. “Stop and sit down until it gets better, or push through it?” Spinal stenosis is a narrowing of a region of the spine. In the lumbar spine region, it causes lower back pain and numbness in the legs when you stand or walk too long. Sit down, and the pain usually resolves within minutes.
“This is anything but a no-pain, no-gain situation,” I tell him. “Let your pain tell you when to rest and when it’s okay to get up again.”
Physicians are notorious for tolerating discomfort many others would not as they undergo the rigorous training and punishing hours of medical school, residencies, and beyond. How are we supposed to know when a patient is on the right path when we are treating their pain? Do we draw an arbitrary line somewhere in the sand?
In When Breath Becomes Air, Paul Kalanithi relates the pain he experienced from stage IV lung cancer, and how he pushed through that pain to complete his rigorous neurosurgical training at Stanford.
Though he was rapidly coming face to face with his own mortality, his desire to complete the path he was on was stronger than the pain, simple as that. Kalanithi’s book is a beautiful account of pain faced and overcome. Pain makes us present to our lives in a way that would not be possible without it. One passage illustrates the remarkable relationship between pain, suffering, and meaning:
A bevy of new pain medications was prescribed. As I hobbled out of the hospital, I wondered how, just six days ago, I had spent nearly thirty-six straight hours in the operating room…and even so, I had suffered excruciating pain…Yes, I thought, and therein was the paradox: like a runner crossing the finish line only to collapse, without that duty to care for the ill pushing me forward, I became an invalid.
Kalanithi’s mission to become a healer made it possible for him to accomplish anything in the face of extraordinary pain.
The Human Response to Pain
Humans remember painful things like nothing else. From hazing rituals and other rites of passage, to childbirth and injuries or illnesses, events involving intense pain are etched into our memories. Depending on the story we tell ourselves about our suffering, they are often remembered as transformative events, experiences that turned us into who we have become.
As I sat in the emergency room waiting for someone to stitch up my leg, I wondered what I could have done differently: pick up the bottles one by one? Take my time instead of rushing? Wear pants instead of shorts? A dozen thoughts went through my mind. It’s human nature to imagine alternatives when an accident occurs. We seek the lesson in the pain when it isn’t obvious.
Some patients are shocked when I tell them there is an upside to pain, but this mindset is crucial to our survival. The downside of having no pain is far worse, as we will see in Chapter 2. In Kelly McGonigal’s book The Upside of Stress, she makes a similar argument about stress. Using stress as a positive or adaptive force that pushes you to overcome the challenge ahead is far healthier in the long run than trying to avoid stress. We feel stress because what we’re doing matters to us.
There is something similar to be said about pain. In fact, stress can exacerbate pain and vice versa, but with the right mindset you can use these feelings as a catalyst to energize yourself, when you turn your thoughts towards the task at hand.
The concept of learning from our mistakes is in many ways about learning from our pain. Mistakes