If there was pain before the Fall, it was only good. That is implied,  I presume, in God’s calling his unfallen creation “very good” (Genesis 1:31), and in God’s promising that in new world there will be no crying “nor pain anymore” (Revelation 21:4). However, not many would use the word “pain” for something that is only good. It doesn’t appear that the Bible uses it that way either.

But pain in this fallen world is clearly bad and good. Reviewing a new book, Pain and Its Transformations, Philip Yancey questions whether pain originated with the fall: “The theologians blithely attribute pain to the fall, ignoring the marvelous design features of the pain system.” He documents the amazing benefits of various kinds of pain:

Every square millimeter of the body has a different sensitivity to pain so that a spec of dirt may cause excruciating pain in the vulnerable eye whereas it would go unreported on the tough extremities. Internal organs such as the bowels and kidneys have no receptors that warn against cutting or burning—dangers than they normally do not face—but show exquisite sensitivity to distention.

When organs such as the heart detect danger but lack receptors, they borrow other pain cells ("referred pain"), which is why heart attack victims often report pain in the shoulder or arm. The pain system automatically ramps up hypersensitivity to protect an injured part (explaining why a sore thumb always seems in the way) and turns down the volume in the face of emergencies (soldiers often report no pain from a wound in the course of battle, only afterwards).

Pain serves us subliminally as well: sensors make us blink several times a minute to lubricate our eyes and shift our legs and buttocks to prevent pressure sores. Pain is the most effective language the body can use to draw attention to something important. (Philip Yancey, “That Hurts,” in Books and Culture, May/June, 2008, 32-33)

But is it necessarily “blithe” to attribute pain to the Fall? Could God subject the creation to futility (Romans 8:20) in such a way that the physiological changes he brings about are designed so that there is something punitive and something profitable in them all? Could he intend that even in the physiology of judgment there is a witness to mercy?

I have just finished a book called Spectacular Sins and Their Global Purpose in the Glory of Christ. One of those sins is the Fall. If the sin of the Fall can be designed by God for the glory of the grace of Christ, it is a small thing that the physical consequence of the Fall also serve to point to God’s grace as well as his judgment.

Therefore it may be possible to “attribute pain to the fall” and not do it “blithely.” In any case, Yancey is surely right to point to the complexity of what pain is for the Christian:

For the Christian pain represents, at various times and from various angles, a design feature worthy of praise and gratitude, an affliction to be overcome, a potential vale of soul-making, and a spur to hope in a painless future.