PAIN
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At BMR, the first thing the doctors, nurses, and techs ask patients when they interview them is "Do you feel any pain?" And they want you to quantify it on a scale of 1-3-5 / small-medium-big.
What is pain? Physical, mental?
I tend to think of it rather as Sanskrit duḥkha (/ˈduːkə/ दुःख) than as English "pain", because the former is more all encompassing (corporeally, spiritually) than the latter, which I feel is more physical.
pain
From Middle English peyne, payne, from Old French and Anglo-Norman peine, paine, from Latin poena (“punishment, pain”), from Ancient Greek ποινή (poinḗ, “bloodmoney, weregild, fine, price paid, penalty”), from Proto-Hellenic *kʷoinā́, from Proto-Indo-European *kʷoynéh₂ (“payment”) (whence also Proto-Slavic *cěnà (“price”)).
Doublet of peine. Compare Danish pine, Norwegian Bokmål pine, German Pein, Dutch pijn, Afrikaans pyn. See also pine (the verb). Partly displaced native Old English sār (whence Modern English sore).
Duḥkha (/ˈduːkə/; Sanskrit: दुःख, Pali: dukkha) "suffering", "pain", "unease", or "unsatisfactoriness", is an important concept in Buddhism, Jainism and Hinduism. Its meaning is context-dependent: it may refer more specifically to the "unsatisfactoriness" or "unease" of craving for and grasping after transient 'things' (i.e. sensory objects, including thoughts), or expecting pleasure from them while ignorant of this transientness.[1][2][3][4][note 1] In Buddhism, dukkha is part of the first of the Four Noble Truths and one of the three marks of existence. The term also appears in scriptures of Hinduism, such as the Upanishads, in discussions of moksha (spiritual liberation).
While the term dukkha has often been derived from the prefix du- ("bad" or "difficult") and the root kha ("empty", "hole"), meaning a badly fitting axle-hole of a cart or chariot giving "a very bumpy ride", it may actually be derived from duḥ-stha, a "dis-/ bad- + stand-", that is, "standing badly, unsteady", "unstable".
Etymology and meaning
Duḥkha (Sanskrit: दुःख; Pali: dukkha) is a term found in the Upanishads and Buddhist texts, meaning anything that is "uneasy, uncomfortable, unpleasant, difficult, causing pain or sadness". It is also a concept in Indian religions about the nature of transient phenomena which are innately "unpleasant", "suffering", "pain", "sorrow", "distress", "grief" or "misery". The term duḥkha does not have a one-word English translation, and embodies diverse aspects of unpleasant human experiences. It is often understood as the opposite of sukha, meaning lasting "happiness", "comfort" or "ease".
Etymology
Axle hole
The word has been explained in recent times as a derivation from Aryan terminology for an axle hole, referring to an axle hole which is not in the center and leads to a bumpy, uncomfortable ride. According to Winthrop Sargeant,
The ancient Aryans who brought the Sanskrit language to India were a nomadic, horse- and cattle-breeding people who travelled in horse- or ox-drawn vehicles. Su- and dus- are prefixes indicating good or bad. The word kha, in later Sanskrit meaning "sky," "ether," or "space," was originally the word for "hole," particularly an axle hole of one of the Aryan's vehicles. Thus sukha … meant, originally, "having a good axle hole," while duḥkha meant "having a poor axle hole," leading to discomfort.
Joseph Goldstein, American vipassana teacher and writer, explains the etymology as follows:
The word dukkha is made up of the prefix du- and the root kha. Du- means "bad" or "difficult". Kha means "empty". "Empty", here, refers to several things—some specific, others more general. One of the specific meanings refers to the empty axle hole of a wheel. If the axle fits badly into the center hole, we get a very bumpy ride. This is a good analogy for our ride through saṃsāra.
'Standing unstable'
However, according to Monier Monier-Williams, the actual roots of the Pali term dukkha appear to be Sanskrit दुस्- (dus-, "bad") + स्था (sthā, "to stand"). Irregular phonological changes in the development of Sanskrit into the various Prakrits led to a shift from dus-sthā to duḥkha to dukkha.
Analayo concurs, stating that dukkha as derived from duḥ-sthā, "standing badly", "conveys nuances of "uneasiness" or of being "uncomfortable". Silk Road philologist Christopher I. Beckwith elaborates on this derivation. According to Beckwith:
… although the sense of duḥkha in Normative Buddhism is traditionally given as 'suffering', that and similar interpretations are highly unlikely for Early Buddhism. Significantly, Monier-Williams himself doubts the usual explanation of duḥkha and presents an alternative one immediately after it, namely: duḥ-stha "'standing badly,' unsteady, disquieted (lit. and fig.); uneasy", and so on. This form is also attested, and makes much better sense as the opposite of the Rig Veda sense of sukha, which Monier-Williams gives in full.
(VHM: This is a perfect analogy for my own primary suffering here at BMH, which is caused by the insertion of a Foley catheter into my body at a particular point [a small hole], also my wobbliness when standing.)
Afterword
téngtòng 疼痛
(VHM: I'm not sure how this common disyllabic "Mandarin" term (supposedly for "pain") relates to my own medical condition [see below].)
Pronunciation 1
|
(it) hurts; love fondly; ache
|
||
|---|---|---|
|
|
ache; pain; sorrow | ||
|---|---|---|---|
| simp. and trad. (疼痛) |
疼 | 痛 | |
| alternative forms | 疼疼 (thông-thiàⁿ) 痛疼 (thàng-thiàⁿ) 痛痛 (thàng-thiàⁿ) |
||
-
- Mandarin
- Cantonese (Jyutping): tang4 tung3
- Southern Min
- (Hokkien, POJ): thông-thiàⁿ / thn̂g-thòng / thàng-thiàⁿ
- (Teochew, Peng'im): dong3 tong3
Adjective
疼痛
Noun
疼痛
Pronunciation 2
|
(it) hurts; love fondly; ache
|
||
|---|---|---|
|
|
ache; pain; sorrow | ||
|---|---|---|---|
| simp. and trad. (疼痛) |
疼 | 痛 | |
| alternative forms | 痛疼 痛痛 |
||
Verb
疼痛 (Southern Min)
-
- to love dearly
- (Zhangzhou Hokkien) to take care of; to show care to
Synonyms
-
- (to love):
References
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- “疼痛”, in 教育部臺灣台語常用詞辭典 [Dictionary of Frequently-Used Taiwanese Taigi] (overall work in Mandarin and Hokkien), Ministry of Education, R.O.C., 2026.
Selected readings
- "The pain of forgetting one's mother / father tongue" (9/4/21)
- "Prescriptivist pain"
- "Sour waist" (12/4/20)
There's another word in Sinitic that means "ache; pain", viz., tòng 痛, which can also mean "hate". Curiously, the same word can convey the sentiment of "love dearly; have tender affection for". Selectively continuing a very long list of different definitions for the same character, we have "painful; sad; grieved; sorrowful" and "very happy; delighted", as well as "harsh; bitter; severe", and so forth and so on. Cf. téng 疼 which can mean "ache; pain", but also "love dearly; dote on". This is why, when you read Chinese texts, you have to be on your toes and pay keen attention to context and what you think the author is really trying to convey.
Scott P. said,
April 10, 2026 @ 7:34 am
When Spock mind meld with the horta and cries out "Pain, Pain" he's not saying the horta is suffering physical pain.
David Marjanović said,
April 10, 2026 @ 8:42 am
Why is there only an English pronunciation given instead of Sanskrit [dʊhkʰɐ], Pali [dʊkʰːɐ]? Is the term used that much in English?
So irregular I have a really hard time imagining them. But I know very little about any Prakrit; does anybody here know how this is supposed to have worked?
Victor Mair said,
April 10, 2026 @ 9:15 am
"Is the term used that much in English?"
Yes.
Peter Grubtal said,
April 10, 2026 @ 11:58 am
Won't you be up against it in any language with terms relating to pain or unpleasant physical discomfort etc.?
In my English interpretation "pain", "ache" are different perceptions although the words are glossed together in the OP, and we have as well "soreness" or "it hurts" – and probably others which don't occur to me right now. Mapping these to other languages I've always found very difficult.
Yves Rehbein said,
April 10, 2026 @ 3:15 pm
Perhaps it is unwise to argue the first two noble truths of the Buddha according to Sideshow Bob of the Simpsons: "One, existence is suffering. Two, the cause of suffering is desire".
Shower thought: is desire related to sore or dus-? Actually, possibly yes.
I mean, the nurse has asked how much attention the case will need, in pragmatic terms. A scale of one to five seems inappropriate, though I am not a doctor. Yes, no, maybe?!
Philip Taylor said,
April 10, 2026 @ 4:36 pm
(in response to David's question and Victor's reply) — I confess that I had never before encountered duḥkha, and the LPD offers no guidance as to how it should be pronounced, but the OED (sorry, David) does admit of its existence and gives quotations going back to the 1880s —
David Marjanović said,
April 10, 2026 @ 5:46 pm
Thank you!
Lars Skovlund said,
April 10, 2026 @ 8:53 pm
@Yves Rehbein: Since it happened in the shower, the answer is probably dusch.
Philip Taylor said,
April 11, 2026 @ 5:39 am
Yves — when (quite a few years ago) I had occasion to telephone my gastroenterologist in the middle of the night (I was passing a gall stone at the time), he asked how bad the pain was, on a scale of one to ten (I replied "nine"). So a scale of one to five would seem quite modest in comparison.
David Y. said,
April 11, 2026 @ 10:33 am
I've always hated that numeric scale, but it's become more meaningful to me over time. It's all relative, though.
When I was in my thirties I had my first kidneystone episode. It was the worst pain I'd ever felt: I'd never had a traumatic injury or any other pain condition besides (non-disabling) migraines, which I thought of as being around a 5. I said the kidneystone pain was an 8, because I could imagine worse.
A bit later I said that it couldn't have been an 8 because now I was at an 8 and the earlier number should have been around 6. I could still imagine worse.
Not long after that I was so unfocused and shaking so violently I couldn't answer the question. In retrospect, a 9, I guess? And the earlier numbers should have been 7 and 4-5, with the worst headaches at a 2-3.
Years later I had shingles, which was probably a 6-7 more or less constantly, and a 8-9 if I brushed the rash the wrong way.
I've started to answer new pain questions that way. Physical therapy for a shoulder issue? Well, it's like a 3, but that's on a scale where 9 is a large kidneystone or shingles. I still can't compare to a traumatic injury (fortunately!).
I also think of it in terms of focus. Anything over a 3 is too distracting to be productive on serious work. Anything over a 6 makes it hard to focus even on entertainment or conversation. Anything over an 8, I'm having trouble paying attention to the doctor or can't answer.
So too with spice, actually. If I'm at an Indian restaurant, with my white skin, my food is likely to be underspiced by default. But I also don't want it too spicy. So if I'm worried I'll say that I've spent a lot of time in India, and I'd like the food to be medium by Indian standards.
katarina said,
April 11, 2026 @ 2:37 pm
Recently I read a general saying: "My soldiers are not afraid of dying, they are afraid of pain."
stephen said,
April 11, 2026 @ 6:28 pm
Why is pain the French word for bread?
Victor Mair said,
April 11, 2026 @ 8:17 pm
See "Portuguese words in Japanese, and beyond"
Chas Belov said,
April 11, 2026 @ 11:01 pm
¿1 to 5? ¿Is that a mid-Atlantic thing? I've always been asked on a scale of 0 to 10.
Philip Taylor said,
April 12, 2026 @ 2:29 am
Correction to my earlier comment, in the light of Chas' more recent one — my gastroenterologist used a scale of zero to ten, not one to ten as I earlier wrote.
Andreas Johansson said,
April 17, 2026 @ 6:37 am
As I understand it, when they ask you to quantify you pain on a five, ten, or eleven point scale*, they're not so much interested in the absolute value as in how it changes over time. Alice's nine might be Bob's five, but if they report five and two the next day, both have significantly improved.
* Between chronic migraine and IBS, I've been asked to quantify my level pain more than probably most people. Around here an eleven point scale is the standard, with zero defined as no pain and ten as the worst you can imagine.
Tom said,
April 20, 2026 @ 8:29 am
Andreas is correct.
@Phillip – I also had gallstones. A nurse who had had both gallstones and given birth said passing the gallstone was worse than giving birth.