Pain is experienced in the brain. It is influenced not only by the nerve pathways from the skin and other structures, such as the spine (e.g. sciatica), but also from other parts of the brain, including the areas concerned with anxiety. There is abundant evidence that people who are anxious experience more pain than those who are calm, and treatments such as yoga and acupuncture probably affect these pathways more than the simple sensory ones. There are also cultural variations in the experience of pain.

Pain is a symptom, not a disease, and lends itself to a broad range of management approaches, most of which are not going to be discussed further here. Yet, where anxiety is a component, particularly when people are interpreting what pain might mean in terms of illness, the strategies described earlier in this handbook can be very helpful. In the traditional medical treatment of pain, relief of symptoms is achieved mainly by giving analgesics, such as aspirin and paracetamol, in the first instance, extending to much more powerful drugs, including opiates, when the pain becomes more intense. Much pain is short lived and relatively easily managed by this approach, but when it becomes chronic it is generally more difficult to explain, and it often becomes extraordinarily troublesome and distressing.

Many of the ways in which pain is treated medically have their limitations. Analgesics, however they are administered, nerve blocks, various surgical ablative procedures, and ‘TENS’ machines (which deliver small electrical pulses to the body via electrodes placed on the skin) are rarely completely successful, especially for chronic pain, and physicians prescribing them often do so with the caveat that they are of limited use or may only help some individuals. Many pain-relief remedies can be bought over the internet and sometimes offer more than they deliver.

The problem with many parts of medicine is that the role of specialist is to identify areas of pathology in which they have particular knowledge, but there is a danger that this knowledge can be used inappropriately to fit the experience of pain to their area of expertise. As Todd (1983) commented about one of the most common forms of investigated pain, usually called non-cardiac chest pain, ‘bogus cardiac diseases have been diagnosed on an enormous scale, mainly because attention has been concentrated on the cardiac manifestations, while the patient was ignored’.