In an impromptu meeting outside a school, a group of mothers and fathers discuss their children’s low tolerance for pain. After a few minutes there is a quorum: their children are much more whiny. Do the experts agree with the diagnosis? Has the pain threshold changed since generation Z (those born between 1997 and 2012)?
Specialists believe not. Although a study published in Science in December 2022 analyzes generational differences in the condition, the general opinion is that the main change has occurred in the way of dealing with pain. “Now when we feel a little pain we run to the doctor and we want to solve it. But that’s good,” highlights María Madariaga, president of the Spanish Pain Society (SED), “since pain can be an indicator of other things,” she adds.
“Possibly the new generations visit us more frequently, but theirs are not imaginary pains, but it hurts them,” points out this anesthesiologist. “Their parents, on the other hand, think that some small pains are not so important and that they just have to wait for them to disappear, but that is because they have much more experience,” she notes.
If in the 20th century bone fractures and acute pain took the cake, in the 21st century emotional pain seems to have taken over. “Pain – Carlos Goicoechea, professor of Pharmacology and vice president of the SED, intervenes – has two parts, one sensory, which is how the stimulus is transmitted, and another emotional, which is how we respond to it.” In the sensory part there do not seem to be differences: we all, more or less, have the same information transmission system. As for the emotional part, it determines the importance that each person gives to pain and their way of experiencing it, something that is usually personal and non-transferable. “We tend to think that previous generations were more resilient, but this also happens because we selectively forget,” says this professor ironically.
“We are in the generation of immediacy, of wanting everything now!”, agrees Elisa Gallach, a clinical psychologist who works in the Pain Unit of the Hospital Universitari i Politècnic La Fe in Valencia. “Today our well-being means being perfectly well, which is quite unrealistic because we are never completely like that,” she admits.
“I’ve been working with people in pain for 15 years and patients keep coming back, more or less, for the same reasons. I detect, however, a change in attitude,” says Gallach. In this regard, “the culture of body worship” and greater hypervigilance “is favoring the appearance of nonspecific and erratic discomforts, which sometimes just as they come, they go away,” he adds.
“Lately,” this psychologist continues, “we have some hypochondriacal patients who interpret their pain as if something very serious was happening to their body.” However, to a large extent, they are pains without a physical correlate that justifies the discomfort described by the patient. Because, what happens when the cause does not appear? The response of the specialists is that in this case there is no choice but to continue investigating.
Pain, experts explain, is difficult to objectify. It is not like an analysis in which it is possible to define, for example, blood cholesterol levels and conclude a figure. However, since there is no number with pain, a visual analog scale is usually used to approximate what the sufferer feels. But, even so, pain remains as difficult to ponder and calibrate as joy or sadness can be. With an added difficulty: the pain threshold does not remain stable, but changes throughout the day and over the years.
The intensity of pain can also vary depending on whether you live in the city or the countryside. Even religious factors come into play (a study indicates that those who pray feel less pain) and cultural factors, not to mention the importance of a sense of humor when dealing with blows. In relation to this issue, it is estimated that in Western countries there is a variability of up to 20% in the perception of pain, mainly due to the weight of emotions. The more restlessness a patient feels before a surgical operation, for example, the more pain they experience postoperatively.
Today, one in four Spaniards with pain suffers from anxiety, depression or some emotional imbalance. Patients with chronic pain have also increased and now represent 26% of the population, that is, almost 9 million people, according to the latest Pain Barometer promoted by the SED and the Spanish Multidisciplinary Pain Society (Semdor). A striking fact is that in 27.1% of cases it is unknown what causes the pain, something that makes the therapeutic approach difficult.
What can be done, then, with pain, whatever its type? Correct answer: Investigate until you find its origin since, regardless of personal tolerance, it is rarely faked. Pain is not something normal that should be normalized, although not all pain should be treated pharmacologically, but rather addressed through physiotherapy or psychological therapy.
Although until recently pain was just a symptom, in 2020 the International Association for the Study of Pain changed the definition to include the subjective nature of the painful experience. In that same document it is stated that “the story of a person in pain should be respected.” Something that, without a doubt, is appreciated by all those who fight to legitimize their suffering. “When the head is silent, the body speaks,” summarizes Gallach.
For all these reasons, if it comes to deciding what to do when a daughter or son expresses pain, the recommendation is to go to the doctor as soon as possible and, in any case, get involved in the treatment (and this applies to both the children and the parents…), instead of waiting for the specialist to solve everything.
The alternative is much worse: according to a study by the Chair of Childhood Pain at the Rovira i Virgili University carried out among young people between 12 and 18 years old, “catastrophic thoughts”, that is, the adolescent making a mountain of what is happening to them, to think about possible future repercussions or to show distrust in their own ability to cope, only lead young people to perceive their pain as much more intense and to abuse the medication.
