What is Pain?

Pain is a subject that pretty much everyone has some experience with. We have been experiencing pain since before our earliest memories. It is also a subject familiar to medical doctors, most of whom spend a significant portion of their time trying to manage pain in their patients. The current epidemic of opioid addiction is a tragedy for many people and their loved ones, and a hardship for countless more. This post will begin by discussing physical pain, and then move into a discussion about the analogous subject of emotional guilt.

What Is Pain? And What Good Is It?

Pain is an indication of tissue damage, a warning that the physical body is injured or in danger of injury. When a mechanical force exceeds the strength of the body’s tissues, news of the resulting injury is transmitted to the brain through peripheral nerves and the spinal cord, allowing the central nervous system to change the body’s behavior in order to avoid or minimize further tissue damage.

I have had a few patients with limited ability to feel physical pain, and these unfortunate people tend to injure themselves frequently in everyday situations. One of my patients often burned herself in the shower, until she purchased a shower head which changed its color to indicate the temperature. The ability to feel and respond to pain is critical for survival, and is one of the most important functions of the nervous system.

Neuropathic Pain

pain pathways
Schematic showing the difference between tissue pain and neuropathic pain. (Composed using public domain images from Gray’s Anatomy, downloaded from Wikimedia Commons)

But what happens when the nervous system is the source of the pain? This is a condition called neuropathic pain, and I have had many patients over the years with various neuropathic pain syndromes. Peripheral nerve diseases, primary headaches syndromes, spinal cord injuries, thalamic pain, and more mysterious diagnoses like fibromyalgia and complex regional pain syndrome can all fall under this category. In these conditions the pain is caused by dysfunction or damage of the pain circuits themselves, rather than damage to other tissues. In a neuropathic pain syndrome the pain signals are not simply relayed through the nervous system, they are generated within the nervous system.

These conditions can sometimes be very difficult to treat, and can be quite disabling to patients who cannot find adequate relief of the pain. The goal of treatment in a chronic pain syndrome is not to completely remove the pain, because usually that cannot be done anyway. Instead, treatment focuses on taking the edge off of the pain so that patients can cope with it better, with the goal of improving quality of life.

Pain and Guilt

As explained by Elder David A. Bednar, the emotion of guilt is very similar to the sensation of physical pain, and serves a similar purpose. In fact, the scriptures often refer to pain as a metaphor for guilt (Examples: here, here, here, here). A guilty feeling is a warning that your actions have been inconsistent with your innate sense of right and wrong, that your behaviors have violated your personal moral code. There are three principal responses to guilt, and we have all used some variation or combination of them at various times in our lives:

  1. Ignore it. This works in the short term, but guilt tends to resurface and intensify over time unless the underlying cause is resolved.
  2. Change your moral code so that your behavior is no longer in violation of it. This approach includes a broad spectrum of cognitive behaviors ranging from rationalization all the way to revision or even wholesale rejection of previously held beliefs.
  3. Change your behavior so that it is no longer in violation of your moral code. In other words, repent.

Note that it is hard to do #1 without also doing a bit of #2, and vice-versa. The third option has the advantage of leaving your moral code intact, and is the preferred method for managing guilt if you are confident in the truth of your belief system. In my experience it is also by far the most effective of the three methods at definitively and permanently resolving guilty feelings.

One of the most dramatic repentance experiences was described by the prophet Alma in the Book of Mormon. He described the intense guilt he experienced when he came to recognize his sins, but he called upon Christ, pleading for mercy. “And now, behold, when I thought this,” he reported, “I could remember my pains no more; yea, I was harrowed up by the memory of my sins no more” (Alma 36:17-21). Receiving forgiveness from Christ, and having my guilty feelings swept away, has been one of the sweetest experiences of my life.

“Moralopathic” Guilt

Just as neuropathic pain is caused by damage or dysfunction of the pain pathways, there exists a “moralopathic” guilt caused by problems within a person’s sense of what is right and wrong. For instance, victims of abuse often harbor terrible feelings of guilt, even though the bad behavior was entirely on the part of the abuser. The manipulation, deception, and betrayal involved in abusive relationships can cause severe distortions in the victim’s sense of morality. As incredible as it may appear to an outside observer, women who have been terribly misused by their husbands for decades can feel a terrible sense of guilt at the thought of leaving their abuser.

Belief in false doctrine is another common cause of moralopathic guilt. Latter-day Saints believe that God is willing to, and in fact continues to, reveal absolute truth. For instance, it is easy to infer from the Bible, and it is made very plain in the Book of Mormon, that baptism represents a voluntary commitment made by someone who wishes to follow Jesus Christ. There is no support for the practice of infant baptism in the Bible, and this practice is roundly denounced in the Book of Mormon, and clarified by the doctrine that “little children are alive in Christ,” and that “little children also have eternal life.” But parents who believe in the practice of infant baptism could feel intense inappropriate guilt if their little child died without first being baptized.

Another example of moralopathic guilt from belief in false doctrines is the prevalent idea that we are saved by our works. The word of God is clear: we are saved by the grace of Christ, and nothing else can save us. Essential gospel ordinances, such as baptism, are required demonstrations of our willingness to accept his grace. Our good and charitable deeds are not the means of our salvation, but are an indirect measure of the effects of his grace in our lives, and are a means of expressing our gratitude for it. Those who try to “earn” their salvation through righteous works will fall far short of the Lord’s standard of perfection, and will experience unnecessary guilt from their shortcomings. But the follower of Christ who correctly relies upon his grace will feel encouraged to continue their imperfect efforts to live like he did, trusting that his mercy, and not their works, will save them.


Identifying the cause and nature of pain leads to correct treatment and correct expectations for the outcome of treatment. It is similarly important to identify the cause of guilt, which will lead to its proper management. In all cases, seek to correctly understand what the Lord teaches and do your best to align your behavior with what you know to be right.

Alan B. Sanderson, MD is a member of The Church of Jesus Christ of Latter-day Saints and is a practicing neurologist.

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