To describe the physiology of perceiving pain 🤕; we will trace the bodily reaction 🧍♂️ to tissue damage 🧬, as when the body receives a cut 🩹 or burn 🔥. The noxious stimulation ⚠️ instantly triggers chemical activity ⚡ at the site of injury 📍, releasing chemicals called algogenic substances 🧪 that exist naturally in the tissue 🧬. These chemicals—which include Serotonin, Histamine, and Bradykinin—promote immune system activity 🛡️, cause inflammation 🔴 at the injured site, and activate endings of nerve fibers 🧠 in the damaged region, signaling injury ⚡.
The signal of injury ⚡ is transmitted by afferent neurons 🧠 of the peripheral nervous system to the spinal cord 🦴, which carries the signal to the brain 🧠. The afferent nerve endings in a damaged region 📍 of the body that respond to pain stimuli 🤕 and signal injury ⚡ are called Nociceptors. These fibers have no special structure 🧬 for detecting injury; they are simply free nerve endings 🧠. They may be found in skin 👤, blood vessels 🩸, subcutaneous tissue, muscle 💪, joints 🦴, and other structures. When activated ⚡, these end organs, like other receptors, generate impulses that are transmitted along peripheral fibers to the central nervous system 🧠.
Pain Signal Transmission ⚡🧠
Pain signals 🤕 are carried by afferent peripheral fibers of two types 2️⃣: A-delta fibers and C fibers. A-delta fibers are coated with myelin 🧬, a fatty substance that enables neurons 🧠 to transmit impulses very quickly ⚡. These fibers are associated with sharp 🗡️, well-localized 📍, and distinct pain experiences 🤕. C fibers transmit impulses more slowly 🐌—because they are not coated with myelin ❌—and seem to be involved in experiences of diffuse dull 📉, burning 🔥 or aching 😣 pain sensations.
Signals from A-delta ⚡ and C 🐌 fibers follow different paths 🛤️ when they reach the brain 🧠. A-delta signals ⚡, which reflect sharp pain 🗡️, pass through specific areas of the thalamus 🧠 on their way to motor 🏃♂️ and sensory areas 👁️ of the brain. This suggests that signals of sharp pain 🗡️ receive special attention 👀 in our sensory awareness 🧠, probably so that we can respond to them quickly ⚡. On the other hand, C fiber signals 🐌, which reflect burning 🔥 or aching 😣 pain, terminate mainly in the brainstem 🧠 and lower portions of the forebrain, such as the limbic system 😢, thalamus 🧠, and hypothalamus 🧪. The remaining C fiber impulses spread to many areas 🌐 of the brain 🧠 by connecting with a diffuse network of neurons 🧠. Signals of dull pain 📉 are less likely to command our immediate attention 👀 than those of sharp pain 🗡️, but are more likely to affect our mood 😢, general emotional state 😰, and motivation 🎯.
Referred Pain 📍➡️
So far, the description we have given of physiological reactions 🧬 to tissue damage makes it seem as though the process of perceiving pain 🤕 is rather straightforward ➡️. But it actually isn't ❌. One phenomenon that complicates the picture 🖼️ is that pains originating from internal organs 🫁 are often perceived as coming from other parts of the body 🧍♂️, usually near the surface of the skin 👤. This is called referred pain 📍➡️. The pain people often feel in a heart attack ❤️💔 provides one of the most widely known examples of this phenomenon: the pain is referred to the shoulders 💪, pectoral area of the chest 🫁, and arms 🤲. Other examples of referred pain include:
- Pain perceived to be in the shoulder 💪 that results from inflammation of the diaphragm 🫁.
- Pain in the upper back 🦴 originating in the stomach 🤰.
- Pain in the ear 👂 or in the wrong area of the mouth 👄 that result from a toothache 🦷.
Referred pain 📍➡️ results when sensory impulses ⚡ from an internal organ 🫁 and the skin 👤 use the same pathway 🛤️ in the spinal cord 🦴. Because people are more familiar with sensations from the skin 👤 than from internal organs 🫁, they tend to perceive the spinal cord impulses ⚡ as coming from the skin 👤. Another issue that complicates our understanding 🧠 of pain perception is that people feel pains that have no detectable physical basis ❌, as the next section discusses.
Pain without Detectable Body Damage 🤕❓
Some pains people experience are quite mysterious 🔍, since they occur with no detectable "reason" ❓—for instance, no noxious stimulus ⚠️ is present. Most of these pain experiences belong to one of three syndromes 3️⃣: neuralgia, causalgia, and phantom limb pain 🦾. These syndromes often begin with tissue damage 🧬, such as from an injury 🤕, but the pain (1) persists long after healing is complete ⏳, (2) may spread 🌐 and increase in intensity 📈, and (3) may become stronger 💪 than the pain experienced with the initial damage 🤕.
Neuralgia ⚡🤕
Neuralgia is an extremely painful syndrome 😖 in which the patient experiences recurrent episodes 🔄 of intense shooting ⚡ or stabbing 🗡️ pain along the course of a nerve 🧠. In one form of this syndrome, called trigeminal neuralgia, excruciating spasms of pain 😖 occur along the trigeminal nerve 🧠 that projects throughout the face 👤. Episodes of neuralgia occur very suddenly 💥 and without any apparent cause ❓. Curiously, attacks of neuralgia can be provoked more readily by harmless stimuli ✅ than by noxious ones ⚠️. For instance, drawing a cotton ball 🧶 across the skin 👤 can trigger an attack 💥, but a pin prick 📌 does not ❌.
Causalgia 🔥🤕
Another mysterious pain syndrome is Causalgia 🔥, which is characterized by recurrent episodes 🔄 of severe burning pain 🔥. A patient with causalgia might report 💬, for instance, that the pain feels like "my arm 🤲 is pressed against a hot stove 🔥." In this syndrome, the pain feels as though it originates in a region of the body 🧍♂️ where the patient had at some earlier time ⏳ been seriously wounded 🤕, such as by a gunshot 🔫 or stabbing 🗡️. Curiously, only a small minority of severely wounded patients 🤕 develops causalgia—but for those who do, the pain persists ⏳ long after the wound has healed 🩹 and damaged nerves have regenerated 🧬.
Episodes of causalgia 🔥 often occur spontaneously 💥 and may take minutes ⏱️ or hours ⏰ to subside 📉, but may occur repeatedly 🔄 each day 📅 for years ⏳ after the injury 🤕. The frequency and intensity of the spontaneous pain-attacks may increase over the years 📈, and the pain may even spread to distant areas 🌐 of the body 🧍♂️.
Phantom Limb Pain 🦾👻
Phantom Limb Pain 🦾 is an especially puzzling phenomenon 🤔 because the patient—an amputee 🦾 or someone whose peripheral nervous system 🧠 is irreparably damaged ❌—feels pain in a limb that either is no longer there ❌ or has no functioning nerves 🧠. After an amputation 🦾, for instance, most patients claim to have sensations of their limb still being there 👻—such as by feeling it "move" 🔄—and most of these individuals report feeling pain 🤕, too. Phantom limb pain 🦾 generally persists for months or years ⏳, can be quite severe 😖, and sometimes resembles the pain produced by the injury 🤕 that required the amputation 🦾.
Although the pain tends to decrease over time 📉⏳, it sometimes gets worse 📈. Individuals with phantom limb pain 🦾 may experience either recurrent 🔄 or continuous ⏱️ pain and may describe it as shooting ⚡, burning 🔥, or cramping 😣. For example, many patients who feel pain in a phantom hand 🤲👻 report sensing that the hand is tightly clenched 👊 and its fingernails are digging into the palm 💅.
Why do people feel pain 🤕 when no noxious stimulation ⚠️ is present ❌? Perhaps the answer relates to the neural damage 🧠❌ that precedes the development of causalgia 🔥 and phantom limb pain 🦾—and perhaps even neuralgia involves neural damage ⚡, even though of a less obvious nature, such as from infection 🦠. But then why is it that the large majority of patients who suffer obvious neural damage 🧠❌ do not develop these curious pain syndromes 🤔? Although the puzzle 🧩 is far from being solved ❓, the explanation will almost surely involve both physiological 🧬 and psychological 🧠 factors.
The Role of the "Meaning" of Pain 💭🤕
Some people evidently like pain 🤕—at least under some, usually sexual 💑, circumstances—and are described as masochists. For them, the meaning 💭 of pain seems to be different from what it is for most people. Some psychologists 👨🔬 believe individuals may come to like pain through classical conditioning 🔔, that is, by participating in or viewing activities that associate pain 🤕 with pleasure 🙂.
Most of the evidence for the view that the meaning 💭 of pain can change 🔄 by its association with pleasure 🙂 comes from research with animals 🐕. For example, Ivan Pavlov 👨🔬 (1927) demonstrated that the dogs' 🐕 negative reaction ❌ to aversive stimuli ⚠️, such as electric shocks ⚡ or skin pricks 📌, changed if the stimuli repeatedly preceded presentation of food 🍖. Eventually, the dogs 🐕 would try to approach the aversive stimuli ⚠️, which now signaled that food 🍖, not danger ⚠️, was coming 🎯.
Physician Henry Beecher 👨⚕️ (1956) described a dramatic example 🎭 of how the meaning 💭 of pain affects people's experience of it. During World War II ⚔️, he had examined soldiers 🪖 who had recently been very seriously wounded 🤕 and were in a field hospital 🏥 for treatment. Of these men 🪖, only 49% claimed to be in 'moderate' or "severe" pain 🤕 and only 32% requested medication 💊 when asked if they "wanted something to relieve it."
Some years later ⏳, Beecher conducted a similar examination 🔍—this time with civilian men 🧑 who had just undergone surgery 🏥. Although the surgical wounds 🤕 were in the same body regions as those of the soldiers 🪖, the soldiers' wounds had been more extensive 📈. Nevertheless, 75% of the civilians 🧑 claimed to be in "moderate" or "severe" pain 🤕 and 83% requested medication 💊.
Why did the soldiers 🪖—who had more extensive wounds 🤕—perceive less pain 📉 than the civilians 🧑? Beecher described the meaning 💭 the injuries had for the soldiers 🪖, who had been subjected to almost uninterrupted fire 🔥 for weeks ⏳. Notable in this group of soldiers was their optimistic 🙂, even cheerful 😊, state of mind.... They thought the war ⚔️ was over ✅ for them and that they would soon be well enough to be sent home 🏠. It is not difficult to understand their relief 😌 on being delivered from this area of danger ⚠️. The battlefield wound 🤕 marked the end ✅ of disaster for them.
For the civilian surgical patients 🧑, however, the wound 🤕 marked the start 🚀 of a personal disaster 💔 and their condition represented a major disruption ⚠️ in their lives.
Personal and Social Experiences and Pain 👥🤕
Imagine this scene: little Steve 👶 is a year old and is in the pediatrician's office 🏥 to receive a standard immunization shot 💉, as he has done before ⏮️. As the physician 🧑⚕️ approaches with the needle 💉, Steve starts to cry 😭 and tries to kick 🦵 the doctor. He is reacting in anticipation of pain 🤕—something he learned 📚 through classical conditioning 🔔 when he had received vaccinations 💉 before.
Learning and Pain 📚🤕
We learn 📚 to associate pain 🤕 with antecedent cues 🔍 and its consequences, especially if the pain is severe 😖 and repeated 🔄, as it usually is with chronic pain ⏳. Many individuals who suffer from migraine headaches 🤕, for example, often can tell when headaches are on the way 🔮 because they experience symptoms, such as dizziness 😵, that precede the pain. These symptoms become conditioned stimuli 🔔 that tend to produce distress 😰, a conditioned response, and may heighten the perception of pain 📈 when it arrives.
Also, words 💬 or concepts 💭 that describe the pain people have experienced can become conditioned stimuli 🔔 and produce conditioned responses. A study of people who do and do not have migraine headaches 🤕 measured their physiological arousal ⚡ in response to pain-related words 💬, such as "throbbing 💓," "sickening 🤢," "stabbing 🗡️," "scalding 🔥," and "itching 🐛." Migraine sufferers 🤕 displayed much stronger physiological reactions 📈 to these words—especially the words that described their own experience with pain 🤕—than those without migraines did. Other findings 📊 indicate that people who suffer from chronic pain ⏳, such as headaches 🤕, show lower discomfort thresholds 📉 for pain and non-pain stimuli than others do. Perhaps they learn to notice 👀 and react more strongly 📈 to low levels of discomfort 😣.
Pain Behaviors 🧍♂️🤕
Learning 📚 also influences the way people behave when they are in pain 🤕. People in pain behave in characteristic ways—they may moan 😩, grimace 😖, or limp 🦵, for instance. These actions are called pain behaviors 🧍♂️, and generally, they can be classified into four types 4️⃣:
- Facial or audible expression of distress 😖, as when people clench their teeth 😬, moan 😩, or grimace 😖.
- Distorted ambulation or posture 🚶♂️, such as moving in a guarded 🛡️ or protective fashion, stooping while walking 🦴, or rubbing or holding the painful area 🤲.
- Negative affect 😠, such as being irritable 😤.
- Avoidance of activity 🛑, as when people lie down frequently during the day 🛏️, stay home from work 🏠, or refrain from motor 🏃♂️ or strenuous behavior 💪.
Pain behaviors 🧍♂️ are a part of the sick role 🤒, and people in pain may begin to exaggerate these behaviors 📈 because, they think 💭, "No one believes me 😞". Regardless of why the behaviors start 🚀, they are often strengthened or maintained by reinforcement 👍 in operant conditioning 🔔, as Wilbert Fordyce 👨🔬 has pointed out (1976). When pain persists ⏳ and becomes chronic, these behaviors often become part of the person's habits 🔄 and lifestyle 🌍. People with entrenched patterns of pain behavior 🧍♂️ usually feel powerless 😔 to change 🔄.
How Pain Behaviors are Reinforced? 👍🔄
Although being sick 🤒 or in pain 🤕 is unpleasant 😣, it sometimes has benefits 🎁, or "secondary gains." Someone who is in pain 🤕 may be relieved of certain chores around the house 🏠 or of going to work 💼, for instance. Also, when a person has a painful condition that flares up 🔥 in certain circumstances, such as when lifting heavy objects 🏋️, he or she may begin to avoid these activities 🙅♂️. In both of these situations, pain behavior 🧍♂️ is reinforced 👍 if the person does not like doing these activities in the first place: getting out of doing them is rewarding 🎁.
Another way pain behavior 🧍♂️ and other sick-role behaviors 🤒 may be reinforced 👍 is if the person receives disability payments 💳. Studies of injured 🤕 or ill patients 🤒 who differ in the financial compensation 💰 they receive have found that those with greater compensation 📈 tend to remain hospitalized 🏥 and miss work 💼 longer ⏳, report more chronic pain ⏳🤕, and show less success ❌ from pain treatments.
Placebos and Pain (Role of Cognitions) 💊💭
You have probably heard of physicians 🧑⚕️ prescribing a medicine 💊 that actually consisted of "sugar pills" 🍬 when they could not find a physical cause ❌ for a patient's complaints or did not know of any medication 💊 that would help. You may also have heard that this treatment sometimes works ✅—the patient claims the symptoms are reduced 📉. An inert substance or procedure that produces an effect is called a placebo 💊. Studies have shown that placebos can often be effective ✅ in treating a wide variety of ailments 🤒, including coughs 🤧, nausea 🤢, and hypertension ⬆️🩸, at least on a temporary basis ⏱️.
Placebos 💊 can also be effective ✅ in treating pain 🤕. They do not always work ❌, but they seem to produce substantial relief 😌 in about half as many patients as do real drugs 💊, such as aspirin or morphine. The effect of placebos 💊 depends on the patient's belief 💭 that they will work ✅—for instance, they are more effective:
- With large doses 💊—such as more capsules or larger ones 📏—than with smaller doses 📉.
- When injected 💉 than when taken orally 👄.
- When the practitioner 🧑⚕️ indicates explicitly and strongly that they will work 💪.
Unfortunately, however, the effectiveness of placebos 💊 in treating pain 🤕 tends to decline 📉 with repeated use 🔄.
Social Processes and Pain 👥🤕
People who suffer with pain 🤕 also receive attention 👀, care 🤗, and affection ❤️ from family 👨👩👧 and friends 👥, which can provide social reinforcement 👍 for pain behavior 🧍♂️. Researchers 👨🔬 have demonstrated this relationship with both child 👶 and adult 🧑 patients. Karen Gil 👩🔬 and her colleagues (1988) conducted a study of parents' reactions 👨👩👧 to the pain behavior of their children 👶 who had a chronic skin disorder 🤒 with severe itching 🐛 that should not be scratched 🙅♂️ since it can cause peeling and infection 🦠.
The researchers videotaped 📹 the behavior of each child 👶 and his or her parent 👨👩👧 in the child's hospital room 🏥. As you might expect, the parents paid attention 👀 to the scratching 🐛, perhaps because of the harm ⚠️ it can do. But what effect did the attention have? An analysis revealed that parent attention 👀 appeared to increase 📈 the children's scratching 🐛, rather than decrease it ❌, and paying attention to the children when they were not scratching seemed to reduce 📉 their scratching behavior.
Research has examined how family members' reactions 👨👩👧 affect pain behavior 🧍♂️. Studies have used questionnaires 📋 to assess how patients' pain behaviors relate to their receipt of social rewards 🎁, such as being able to avoid disliked social activities 🙅♂️ or getting from their spouses 👫 considerate care 🤗, that is, high levels of help 🤝 and attention 👀. Receiving higher levels of social reward 🎁 was associated with patients reporting more pain 📈 and showing more disability ♿ and less activity 📉, such as in visiting friends 👥 or going shopping 🛍️.
Research findings 📊 on parents' 👨👩👧 and spouses' 👫 reactions to chronic pain behavior 🧍♂️ and the social climate within the family system 👨👩👧 illustrate how each family member's behavior impacts on the behavior of the others 🔄. When families lack cohesion ❌ or the members are highly attentive 👀 to pain behavior without encouraging the patient to become active 🏃♂️, they are likely to promote sick-role behavior 🤒. These conditions can develop into a vicious circle 🔄—for example; solicitousness 🤗 may lead to more pain behavior 📈, which elicits more solicitousness 🤗 and so on.
Showing care and concern 🤗 when people are in pain 🤕 is, of course, important and constructive ✅. But the patient's diminished activity 📉 may then lead to physical deterioration 🦴, such as through muscle atrophy 💪📉, and lead to progressively more pain 📈 and less activity 📉. These social processes 👥 in the family system of pain-patients are gradual and insidious 🐌—they tend to increase the patients' dependency 🤝 and decrease their self-efficacy 💪 and self-esteem 😔. Self-efficacy is important because people who believe 💭 they cannot control their pain 🎮❌ very well experience more pain 📈 and use more medication 💊 than those who believe they can control it 🎮✅.
Gender, Socio-cultural Factors and Pain 👨👩🌍
Studies have found gender 👨👩 and sociocultural differences 🌍 in the experience of pain 🤕. Men 👨 and women 👩 appear to differ in the types of pain they experience and reactions to pain. Women 👩 have higher incidence rates 📈 of pain from arthritis 🦴, migraine headache 🤕, myofacial neuralgia, and causalgia 🔥; but men 👨 have a greater incidence 📈 of back pain 🦴 and cardiac pain ❤️.
Women 👩 tend to report more than men 👨 that pain interfered ⚠️ with their daily activities 📅. Surveys of adults 🧑 in different countries 🌍 who suffer from chronic low back pain 🦴 revealed greater work 💼 and social impairments ⚠️ among Americans 🇺🇸, followed by Italians 🇮🇹 and New Zealanders 🇳🇿, and then by Japanese 🇯🇵, Colombian 🇨🇴, and Mexican 🇲🇽 individuals. Research on the pain 🤕 experienced after dental surgery 🦷 by people from different ethnic groups in the United States 🇺🇸 found that blacks reported more pain 📈 than people of European 🇪🇺, Asian 🌏, or Hispanic 🌎 backgrounds, and women 👩 in each group reported more pain 📈 than men 👨. The reasons for these gender 👨👩 and sociocultural differences 🌍 are not clear 🤔, but they may include differences in the social support 👥 and financial consequences 💰 these people receive for being sick 🤒.
Emotions, Coping Processes and Pain 😢🤕
People in chronic pain ⏳ experience high levels 📈 of anger 😠, fear 😱, and sadness 😢. Pain 🤕 and emotion 😢 are intimately linked 🔗, and cognitive processes 🧠 mediate this link 🔄. In a study of these relationships, Gerry Kent 👨🔬 (1985) had dental patients 🦷 fill out a brief dental anxiety scale 😰 while waiting for their appointments 📅. Then they rated the pain 🤕 they expected in their visits. After the appointment ✅, the patients rated the pain they actually experienced 🤕, and rated it again by mail 📧 3 months later ⏳. The results revealed that anxiety 😰 played a role in their expectations 💭 of pain and in their memories 🧠 of it 3 months later ⏳. The patients with high dental anxiety 😰📈 expected and later remembered four times as much pain 🤕 as they experienced. In contrast, the low-anxiety patients 😌 expected and remembered less than twice as much pain 🤕 as they experienced. These findings suggest that high-anxiety patients' 😰 memories 🧠 of pain are determined more by what they expect 💭 than by what they feel 👁️.
Does Emotion Affect Pain? 😢➡️🤕
A study of emotion 😢 and pain 🤕 compared the anxiety 😰 and stress levels 📊 of children 👶 who suffered from migraine headache 🤕 with those of their best friends 👥, and then had the migraine sufferers keep diaries 📓 of their headaches over the next 4 months ⏳. Although the scores on tests 📊 of anxiety 😰 and stress 😰 were about the same for the two groups and were within the normal range ✅, migraine sufferers 🤕 with high levels of anxiety 😰📈 had more frequent 🔄 and severe 😖 headaches than those with lower anxiety 😰📉. Other investigations 🔬 using self-report methods 📝 have found that migraine 🤕 and muscle-contraction headaches 😣 tend to occur after periods of heightened stress 😰📈 and that Type A individuals 💼 have more frequent 🔄 chronic headaches 🤕 than others do. These studies clearly indicate that stress 😰 and headache 🤕 are related 🔗. Has any research shown that stress 😰 causes headaches 🤕?
Convincing evidence 📊 that stress 😰 can cause headaches 🤕 comes from a study with adults 🧑 who suffered from either chronic headache 🤕 or only occasional headaches. Before testing a subject 👨🔬, researchers attached sensors 📡 to the person's body to take several physiological measurements 📊, such as of heart rate ❤️ and electrical activity ⚡ of muscles 💪. A researcher also told the subjects that they "might or might not" experience headache pain 🤕 in the procedures and that they would rate their perception of pain 📊 several times during the study. After sitting quietly 🧘♂️ for 15 minutes ⏱️, they were given a stressful task 😰—calculating arithmetic problems ➕➖, such as 349 + 229, every 15 seconds ⏱️ for an hour ⏰—and told that a buzzer 🔔 would sound if their performance fell below a norm. Actually, the buzzer 🔔 sounded periodically regardless of their performance. Then the subjects sat quietly 🧘♂️ for 10 minutes ⏱️. How did they react to these conditions? More than two-thirds 📊 of the chronic headache sufferers 🤕 and only one fourth 📊 of the occasional sufferers reported developing headaches 🤕 during the stress task 😰. Ratings of headache pain 🤕 increased throughout the stress condition 📈, and decreased later 📉 while they sat quietly 🧘♂️. The headaches tended to resemble tension-type headaches 😣 and be preceded by sustained physiological arousal ⚡. These are important findings 📊 that indicate that stress 😰 can cause headaches 🤕.
Emotions 😢 are also related to other kinds of pain 🤕, but whether emotions cause the pain is still in question ❓. Research has demonstrated, for instance, that the amount of pain 🤕 people with sickle cell disease 🦠 report increases with the amount of stress 😰 they experience each day 📅 and with increases in stress during the preceding 2 days ⏮️. But although people with recurrent low back pain 🦴 report higher levels 📈 of anxiety 😰 and tension 😤 than pain-free control subjects do, these mood states 😢 do not worsen in the day or so preceding pain attacks 🤕.
Feelings of depression 😞 appear to result from pain 🤕 people with chronic discomfort ⏳ experience on previous days ⏮️, and lead to pain 🤕 on subsequent days ⏭️. Pain 🤕 is itself very stressful 😰, and many people with chronic pain ⏳ consider their discomfort 😣—the actual pain 🤕 and the physical limitations 🛑 it produces—to be the most prominent stressor 📈😰 in their lives. Health psychologists 👨🔬 who work with pain patients 🤕 often try to assess how well they cope 💪 with their pain.
Coping with Pain 💪🤕
Part of the stress 😰 that chronic pain patients ⏳ experience stems from their common belief 💭 that they have little personal control 🎮❌ over their pain, aside from avoiding activities 🙅♂️ they believe can trigger an attack 💥 or make it worse 📈. As a result, they tend to deal with their stress 😰 by using emotion-focused coping strategies 😢. That is, rather than trying to alter the problem itself 🎯, they try to regulate their emotional responses 😢 to it. Some of the more common coping methods 🛠️ adults 🧑 and children 👶 with chronic pain ⏳ use include hoping 🙏 or praying 🕊️ the pain will get better someday 🔮 and diverting their attention 👀, such as by counting numbers 🔢 or running a song 🎵 through their heads 🧠. These approaches are not very effective ❌ in reducing chronic pain ⏳.
How effectively do people cope 💪 with pain 🤕? Studies that tested pain patients with the MMPI 📋 have found some fairly consistent outcomes 📊. These outcomes lead to three conclusions 3️⃣: First 1️⃣, individuals who suffer from various types of chronic pain ⏳, such as severe headache 🤕 and low back pain 🦴, show a characteristic MMPI profile 📊 with extremely high scores 📈 on hypochondriasis, depression 😞, and hysteria—the neurotic triad scales. But their scores on the seven other MMPI scales tend to be well within the normal range ✅. Second 2️⃣, this pattern appears to hold regardless of whether their pain has a known organic source 🧬. In other words, people whose pain might be classified as psychogenic 🧠 by a physician 🧑⚕️ tend to show similar problems of adjustment on the MMPI as those whose pain has a clear organic basis 🧬. Third 3️⃣, individuals with acute pain ⏱️, such as patients recovering from injuries 🤕, sometimes have moderately elevated scores 📈 on the neurotic triad scales, but these scores and those for the remaining MMPI scales are generally well within the normal range ✅. These findings make sense and reflect the differential psychological impact 🧠 of pain that patients expect will end soon ⏱️ versus pain they fear will never end ⏳. Keep in mind also that people with chronic-recurrent pain conditions 🔄 show worse psychological symptoms 😢 during pain episodes 💥 than during pain-free periods 🚫🤕.
It is clear that being in frequent, severe discomfort 😖 is related to having high scores 📈 on the MMPI neurotic triad scales 📊, but does chronic pain ⏳ cause maladjustment 😞? One school of thought 💭 is that the causal sequence may be the other way around 🔄—that is, chronic pain ⏳ may be a symptom of a psychological disorder 🧠, such as depression 😞, that preceded the pain syndrome. But most current evidence 📊 points in the other direction ➡️—indicating, for instance, that people in chronic pain ⏳ become depressed 😞 because of the stress 😰 they experience without being able to change their situations 🔄❌. They develop a sense of helplessness 😔, which leads to depression 😞. One type of evidence indicating that pain 🤕 leads to depression 😞 is that people whose pain has ended 🚫🤕 show substantial reductions 📉 in various measures of psychological disturbance 😢.
Of course, this does not mean psychological factors 🧠 cannot lead to physical pain 🤕—for instance, we've seen that stress 😰 can cause headaches 🤕. One study examined this issue prospectively 🔮 for 8 years ⏳ and found support for both causal directions 🔄. People who are depressed 😞 are somewhat more likely than others to develop a chronic pain condition ⏳ in the future 🔮, and people with chronic pain ⏳ are much more likely than others to become depressed 😞. Pain 🤕 and maladjustment 😞 involve interactive processes 🔄, with each feeding on the other over time ⏳, but chronic pain ⏳ is more likely to lead to maladjustment 😞 than the other way around ➡️. Also keep in mind that not all patients with severe chronic pain ⏳ become maladjusted 😞—many adapt to their conditions much better 💪 than others do. Coping well 💪 with chronic pain ⏳ is a struggle that unfolds over time ⏳, as this arthritis patient 🦴 noted: "Over time ⏳ I've figured out 🧠 that I can do things to bring on the pain 🤕 and things that could limit it 📉. I also figured out that my flares 🔥 won't last forever ⏳, although while they're happening it seems like forever. It took quite a while to figure that out 💭."
Summary 📌
To summarize, the process by which people perceive pain 🤕 involves a complex chain 🔗 of physiological 🧬 and neuro-chemical events ⚡. These events can be affected by psychosocial processes 🧠, such as people's beliefs 💭 about whether a drug 💊 will reduce their discomfort 📉. Pain 🤕 also affects and can be influenced by people's learning 📚, cognition 🧠, social experiences 👥 and emotion 😢. Although people can indicate through their behavior 🧍♂️ that they are feeling pain 🤕, the pain they perceive is actually a private 🔒 and subjective experience 💭.
How can researchers 👨🔬 and clinicians 🧑⚕️ who work with patients who have painful symptoms 🤕 assess the level and type of pain these individuals perceive? We will be answering this question ❓ in our next lecture 📘.