Pain isn’t something most of us want to experience. We are hard-wired to avoid unpleasant conversations, experiences, and memories. And most of the time, this instinct serves us well.

But when it comes to recognizing risks — vulnerabilities and threats that could cause harm — avoiding pain is dangerous.

This is the first in a 3-part series about Pain and Decision-Making.

Part 1 | Part 2 | Part 3

In this post, I will review the basics of pain, our unique thresholds, corresponding fears, and how to evaluate and properly both pain and managing risk.

What is Pain?

We’ve all experienced various kinds of pain.

• Acute (intense, brief episode that subsides). This type of pain can be present in any body system. You have probably had at least one visit to the dentist where a cavity drilling didn’t go quite as planned. Some of us (up to 13%, according to Dental Phobia UK) would rather do just about anything than get their pearly whites drilled, and fear of pain is the #1 reason.
• Chronic (intermittent, persistent, lasting 6 months, of unclear cause). Like 49 to 71 percent of women worldwide, I suffered from debilitating menstrual pain as a young adult. Unfortunately, many intensely painful conditions are so embarrassing that we tend not to talk about them.
  Other invisible chronic conditions include:
  • Fatigue
  • Dizziness
  • Polycystic Ovarian Syndrome (PCOS)
  • Fibromyalgia
  • Back pain
  • Hip or knee bursitis
  • Crohn’s disease
  • Irritable Bowel Syndrome (IBS)
  • Rheumatoid & psoriatic arthritis
  • Sciatica
• Emotional and mental. Another type of suffering we rarely discuss is not related to a physical condition: the agony of feeling broken-hearted, seeing others suffer, or struggling with mental illness, either as a patient (experienced by at least 1 in 5 of Americans) or as a caregiver. People who suffer from mental illness are often told their pain is not real, when nothing could be further from the truth. Common mental disorders include:
  • Depression
  • Anxiety
  • Bipolar disorder
  • Schizophrenia
  • Autism
  • ADHD (Attention Deficit Hyperactivity Disorder)
  • Impulse Control like ODD (Oppositional Defiant Disorder)
  • OCD (Obsessive-compulsive disorder)
  • PTSD (Post-Traumatic Stress Disorder)

Three Types of Physical Pain

Each of us has unique a threshold for pain.

What might be perfectly fine for you (like a routine dental cleaning, for example) might be absolutely horrendous to someone with a low pain threshold, or for someone who suffers from dental anxiety. Our perception of pain is subjective, which means that it exists even if there is no explainable reason.

Physical pain can be divided into 3 different groups: Nociceptive, Neuropathic, and Combination.

• Nociceptive — pain caused by a normal nerve response to stimulus in body tissue (from the Latin nocere, “to harm or hurt”). It is split into two subcategories, Somatic and Visceral:
  • Somatic: detected by nerves in the skin, subcutaneous tissues, muscles, and joints; can feel sharp, dull, or burning.
  • Visceral: detected by nerves in the body’s internal organs; can feel dull and be difficult to locate.
• Neuropathic — pain arising from damage to the nervous system itself
• Combination — pain which occurs in neurological dysfunctions such as fibromyalgia, complex regional pain syndrome, irritable bowel disease, and nonspecific back pain

The 5 Types of Fear

What happens when we try to avoid feeling pain? Well, most of the time, avoiding all pain causes us to miss out on things. A single event that causes pain may stop us from participating in those activities. What used to bring enjoyment might now be a source of frustration.

Most of the time, when we avoid activities, objects, and people out of a desire to not experience pain, the root cause is actually fear.

There are 4 possible responses to fear: Fight, Flight, Freeze, and Face.

Out of these, Face is the most effective, because it allows us to see the situation objectively and calmly. In The Matrix, once the main character Neo faced his fears, he was unstoppable.

We also have 5 basic needs: Physiological, Safety, Esteem, Belonging, and Self-Actualization. When any of these are not met, it can cause us to feel tremendous pain as well.

Needs and fear are related. We can get in a fight-or-flight response simply when we expect something bad to happen, even if there is no logical reason for how we feel.

Here are the 5 types of fear and the corresponding needs:

• Fear: Extinction (Need: Physiological)
• Fear: Mutilation (Need: Safety)
• Fear: Ego Death (Need: Esteem)
• Fear: Separation (Need: Belonging)
• Fear: Loss of Autonomy (Need: Self-Actualization)

Assessing Pain

We can measure pain. One widely accepted method is the Universal Pain Assessment Tool, which uses the Wong-Baker FACES® Pain Rating Scale (as shown below).

This scale was originally developed by Donna Lee Wong, PhD, RN, PNP, CPN, FAAN (who sadly passed in 2008) and Connie Morain Baker, MS. Together, they created this tool with the help of children who needed to communicate their pain level. It uses a 0 to 10 pain intensity numeric rating scale (NRS) to pinpoint patient needs and provide the most effective treatment. The Universal Pain Assessment Tool is widely used by medical professionals around the world.

Using Pain to Evaluate Risk

Now that we’ve talked about the 3 types of pain, where it comes from, and how to measure it, let’s discuss risk.

Risk is simply:

the probability of uncertainty resulting in a positive or negative impact (waste, loss, fraud, or abuse) due to internal or external vulnerabilities.

To calculate a level of risk, we simply multiply Likelihood (the probability an event will occur) by the Effect (anticipated result).

RISK   =   LIKELIHOOD  X   EFFECT

We can evaluate risk using a measurement tool like this one:

Your tolerance for pain depends on how much discomfort you can withstand. The same idea applied to risk: our Risk Appetite is determined by the level of loss we feel most comfortable accepting.

The response will depend on the degree of potential loss:

• acute and intense
• chronic and intermittent, or
• emotional/mental and qualitative

And just like pain, we can divide risk appetite into the 3 types of pain as mentioned above:

• nociceptive (normal response from stimulus, for which we can analyze the root causes)
• neuropathic (loss arising from damage to the company’s strategic intelligence) and
• combination (loss that is due to an internal dysfunction like Corporate Ladder Bias or unHealthy Feedback Loops)

Like the Universal Pain Assessment Tool discussed above, we can evaluate risk using tools.

I really like the Risk Appetite and Tolerance Tool, which is a simple chart to evaluate whether a particular risk is one your company should tolerance, or whether it should be avoided.

What is Decision-Making?

So we have discussed pain and risk evaluation. How do these correlate to decision making?

Well, let’s first define Decision Making. It is:

The cognitive process of selecting a final course of action among alternate possibilities.

A basic Decision-Making Matrix includes 4 parts:

• High benefit with high confidence: High-Value (do it now)
• High benefit with low confidence: Secondary (do it next)
• Low benefit with high confidence: Insignificant (postpone it)
• Low benefit with low confidence: Wasteful (eliminate it)

Putting It All Together: Applying Pain to Decision-Making

When we go through an experience that is painful (intense, intermittent, or qualitative), instead of reacting to the pain with a fight-flight-freeze fear response, Facing it requires us to evaluate the potential loss and benefits.

Here is how I recommend using pain in decision-making:

1. Evaluate whether this event has the potential to maximize growth (which is how I define “health”).
Will this painful experience allow your company to reach new levels of success? Will your customers benefit? Will it cause you to be a better, more empathetic leader?

2. Identify which kind of pain you are feeling.
Is it intense pain from a one-time event? Is it ongoing, persistent pain? Or does it have an emotional component that may be causing an extreme reaction?

3. Find the root cause.
Where is the pain coming from? What is the root cause or main problem that is causing the discomfort? Is there a problem with your organization’s strategic plan? Do you have any leadership biases, blind spots, or inadequate feedback loops?

4. Make tough decisions.
Dealing with pain is really difficult. It can affect our perception of reality, especially if the pain is due to a combination of physical and emotional discomfort. Consider using a tool like the Decision-Making Matrix above, or simply write the pros and cons of your options. This allows you to see the problem objectively, and not based solely on an emotional reaction.

I hope this overview of pain points and decision-making has been helpful. Let me know which other tools you use to move your organization forward.

Check out 50 Ways to Accommodate Patients Who are Afraid of the Dentist

To find out how to leverage good and bad pain, check out Part 2.

Interested in hearing how to improve the value of your business? Find out more here.