When we hear “pain,” most think about something physical—an aching back, a broken bone, or surgical discomfort. Our concepts are concrete —a place we can point to on the body, something we can see on a CT scan, or a rating on a scale from 1 to 10.
But for people facing serious illness, pain is rarely just physical. It is layered, complex, and often touches every part of life. It affects not just bodies but emotions, relationships, finances, faith, and identity. It changes what people hope for, fear, and how they see themselves in the world.
In palliative care, we recognize that suffering often comes from multiple sources. To care well for patients and families, we must understand how illness can hurt — not just the pain we can measure with numbers, but the quieter, heavier kinds of pain that don’t always have a name.
I learned to think about pain in four dimensions: physical, psychosocial, financial, and spiritual. Each dimension is essential for holistic care.
Let’s take a closer look.
Physical Pain: The Pain We Can Feel
Most people think of physical pain first. It’s the bodily discomfort caused by disease, injury, or treatment. Pain can be sharp and sudden following an injury or dull and relentless, like the ache of arthritis that worsens every month. It can come from surgeries, broken bones, pressure sores, chemotherapy side effects, or simply the progression of an illness itself.
Treating physical pain is foundational in palliative care. We have powerful tools to help: medications, nerve blocks, radiation therapy, physical therapy, and complementary therapies like massage and acupuncture.
But even physical pain is rarely just physical. It can shape how a person feels emotionally — leading to fear, anger, depression, or hopelessness. It can change how someone moves through the world — making them withdraw from the things and people they love.
Physical pain matters deeply. But it’s just the beginning.
Psychosocial Pain: The Pain We Carry Inside
Illness hurts more than just the body—it can also break the heart, the mind, and the web of relationships around a person. Psychosocial pain includes the emotional and social struggles that come with serious illness. Feelings of anxiety, sadness, guilt, loneliness, anger, and grief often surface. People may worry about becoming a burden to their families. Friendships may drift away. Old conflicts may reemerge just when support is needed most.
Relationships change when someone gets sick. Patients may want to talk about their illness and what it means for their family and caregivers, or they could deny the gravity of their illness when partners want to plan for the future because their own emotions may not allow them to face the reality of a serious illness. Family and caregivers can also be on each side of this spectrum—wanting to talk vs. denying reality and everything in between.
Supporting psychosocial pain means listening, validating, and creating spaces for people to tell the truth about their suffering without fear of judgment. Often, counseling, peer support groups, family meetings, or a steady, compassionate presence at a time when so much feels uncertain will help.
Financial Pain: A Hidden Weight
Few openly discuss financial pain, but it is a valid and stressful worry. Medical bills, insurance complexities, out-of-pocket expenses, travel for treatment, lost wages, and job loss can all create enormous stress. Even for families with good insurance, the financial ripple effects of illness can last for years.
Financial pain adds to emotional pain. It can limit access to care, affect treatment decisions, and deepen a sense of helplessness or injustice.
In palliative care, we work alongside social workers, financial counselors, and patient navigators to help families anticipate and address these struggles. Sometimes, just naming the financial fears out loud — acknowledging that they are real and valid — can be a relief.
Spiritual Pain: Important, yet often forgotten
Serious illness can shake us to our core.
Spiritually, suffering causes us to face the deep questions of life:
“Why me?” “Where is God in all of this?” “What is the meaning of my life now?”
These questions are not limited to religious people. Anyone can experience spiritual distress, the pain of feeling disconnected from oneself, others, meaning, and hope.
Spiritual pain can manifest as anger, despair, loss of identity, or a profound sense of loneliness. It can also be visible in words, silence, or a person’s changing view of life.
Addressing spiritual pain doesn’t always mean providing answers. Often, it means sitting with the questions — honoring the mystery, validating the struggle, and offering companionship on the journey.
In palliative care, chaplains, spiritual counselors, and attentive clinicians help patients and families explore these tender places, making room for whatever needs to be said, asked, or grieved.
A Full Picture of Pain — and Care
The physical, psychosocial, financial, and spiritual dimensions offer a window into a person’s total suffering. They are often interconnected. To treat physical pain, we must acknowledge and help emotional pain. Financial burdens deepen emotional suffering. Spiritual distress can increase both physical and emotional pain.
True healing requires seeing the whole person and the landscape of pain.
Over the next several posts, I’ll explore these types of pain more closely. We’ll explore what they are, how they appear in people’s lives, and how patients, families, and healthcare teams can work together to address them.
Pain is more than what hurts the body. It weighs on the heart, clouds the mind, burdens the spirit, and impacts the future.
Recognizing the full scope of pain is the first step toward genuinely healing care.
I hope you’ll join me as we walk through these four dimensions — one by one — together.