16/05/2025
PAIN AND SUFFERING
A recently published 2025 study by Peter Stilwell and colleagues explored how people describe their worst pain episodes, not just the physical sensation, but what happens to the self when pain becomes overwhelming. The researchers interviewed adults living with long term pain, asking them to reflect on the moments when pain was at its most extreme. Many felt stripped of their identity, disconnected from their bodies, and lost in time. This was not just pain; it was suffering at a deeper level. Some described out of body experiences, feeling like a ball of pain, or becoming so overwhelmed that their thoughts and coping strategies simply vanished. Importantly, this suffering did not rely on narrative reflection, that is the ability to think about who you are or tell your life story drawn from your history and learning. It happened in the moment, disrupting what we call the minimal self, the basic sense of being here, in your body, now.
Traditionally, pain related suffering has been explained through the idea of the narrative self, the part of us that makes sense of life through memory, roles and purpose. This idea sees suffering as a disruption to who we are, what we do, and how we understand ourselves. But this paper questions whether that is the whole story. It introduces a second kind of suffering, rooted in the minimal self. This is your raw, moment to moment sense of being a body in time and space. When pain disrupts that, it can make you feel powerless, trapped, or even dehumanised. You might feel like you are no longer a person, just pain. This study shows that pain can overwhelm either the narrative self or the minimal self, or both. Understanding these differences, we can recognise the full experience of what suffering can be. Reasons for adding the minimal self is that the research argues that pain experiences are not just based on the narrative self as this suggests that those with dementias or infants with limited to no ability to create a story of their lives, can’t experience suffering. Adding that suffering, including suffering from pain, occurs in the moment and not just in the narrative self, helps appreciate the complexities of pain for everyone.
What this research helps us see more clearly is that suffering may actually be the larger and more complex part of the pain experience. When pain overwhelms the self, it can trigger a cascade of fear, anxiety, stress and low mood. These are not just emotional responses, they are deeply biological, activating the hypothalamic pituitary adrenal (HPA) axis, the body’s core stress system. This system releases hormones such as cortisol, adrenaline and noradrenaline, which increase physiological arousal and can drive systemic inflammation. Inflammation, in turn, sensitises the nervous system and exacerbates the perception of pain. This creates a vicious cycle, suffering feeds the body’s stress systems, and the body’s stress responses amplify the pain experience. In this context, the work of touch therapies is not just about easing tissues or releasing muscles. What we are really influencing is the emotional and perceptual experience of pain, and the suffering that surrounds it. Through calm, skilled, attentive touch, we help interrupt that loop. We support regulation, connection, and meaning. And in doing so, we may have a greater impact on pain than we ever could through physical techniques alone.
Sometimes a client seems distant, emotionally numb, or disconnected, and we may assume they are avoiding engagement. But the reality might be that they are overwhelmed. They could be in a state where the nervous system cannot self-regulate, and where their usual coping systems have collapsed. This matches with how pain affects brain networks like the default mode network, which handles reflection and identity, the salience network, which filters danger or safety, and the central executive network, which helps focus and problem solve. When pain disrupts these networks, people can feel lost, alone, and like their body is no longer their own. In these moments, our job is not to fix. It is to offer safe, grounding support. Touch can reconnect someone to their body and their sense of self. That is where our true value as therapists lies.
Read the paper here.👇
When pain overwhelms the self: A phenomenological study of a new mode of suffering, based on adults’ recollections of their worst pain episodes. https://www.jpain.org/article/S1526-5900(25)00640-6/fulltext
Additional paper👇
Towards a new model of understanding – The triple network, psychopathology and the structure of the mind https://www.sciencedirect.com/science/article/abs/pii/S0306987719306280