She experienced extraordinary pain in her left leg. She thought she had pulled a muscle or twisted a nerve or something. Some hot pack, massages rest later the pain eased in a couple of days. One month later she again experienced the crippling pain. Since she could not move much the burden of the household work fell on other members in the house. This time her husband suggested seeking medical help. Numerous test, scans, consultation did not bring any clarity to the cause of her pain. The scans showed nothing wrong with her leg. The docs prescribed some medicines for alleviating pain. The cycle repeated every few months. Everyone came to the same conclusion - nothing wrong with her leg at all. “Your pain is imaginary”, “It is all in your mind”, “This is just pretending to avoid work”. Insults, insinuations came her way swiftly. She could not comprehend any of it. Nothing wrong with her leg but her pain was real. She actually felt the pain. How was that possible?
It is possible. It is very much possible to experience pain in parts of your body even when nothing is wrong with the part of the body. This is counterintuitive but real. Pain can flow from bottom to top and from top to bottom. Let me explain that.
When you experience a cut, hit your leg against the table legs, jam your thumb against the door the part of the body takes structural damage. Skin is torn, scrapped, bone is broken, muscle is compressed/stretched and the signal goes to the brain. Each part of the body is mapped to a specific area in the brain and that part of the brain associated with the damaged part activates the pain signal and you experience the sensation of pain. Let us call this is bottom-up pain.
In the case of the lady mentioned above and thousands of such instances, the part of the brain associated with the body part sends out the pain signal even though the body part is fine. This is the top-down pain. Although this seems mysterious, it is a reality for many people. The pain is generated in the brain with nothing being wrong with the body part.
The extreme cases of such phantom pain are discussed in VS Ramachandran’s classic book Phantoms in the Brain. Many people have had their limbs amputated due to war, accident, medical need etc. They do not have, say the right arm or the left leg. Yet these people can experience extraordinary pain in a part of the body that does not exist at all! There is no left leg yet the person feels pain in the left leg. That is the phantom pain. That is the pain flowing from top to bottom instead of the normal route of the bottom to top. This is not imagined pain. This is not “all in your mind’ pain. This is the ‘all in the brain’ pain. There is a huge difference between the two. This pain is not psychological, this is physical pain but not in the normal sense.
A better understanding of this form of pain will help us empathize with people who experience real pain with no real cause.