The Psychology of Pain:  It’s Not All in Your Head

The Psychology of Pain: It’s Not All in Your Head

Being distracted isn’t typically a good thing. After all, being distracted at work, school, or behind the wheel, can lead to poor productivity, bad grades, or even a serious car accident. But mental distractions may make your pain easier to handle, according to two new studies in Germany.

Using high-resolution spinal imaging, researchers at the University Medical Center Hamburg-Eppendorf found that mental distractions inhibit responses to the earliest stage of pain signals — in pain-sensitive cortical and subcortical sections of the brain. Distractions also affect endogenous opioids, which are naturally produced by the brain and play a key role in the relief of pain.

“The results demonstrate that this phenomenon is not just a psychological phenomenon, but an active neuronal mechanism reducing the amount of pain signals ascending from the spinal cord to higher-order brain regions,” said lead researcher Christian Sprenger.

In the study, Sprenger and his research team asked participants to work on easy and hard memory tasks, while also being subject to painful heat to their arms. The memory tasks consisted of remembering letters.

The participants were found to perceive less pain when distracted by the harder memory tasks. Spinal imaging also revealed lower spinal cord activity, which corresponded to their less painful experience.

The researchers repeated the study by giving some participants naloxone, an opioid inhibiting drug, while others received a simple saline injection. The participants that received the opiod blocking drug saw a 40 percent decrease in the pain-relieving effects of distraction when compared to the saline infusion only group.

The researchers concluded that the perception of pain is less intense when a person is distracted from pain by a challenging cognitive mental task.

“Our findings strengthen the role of cognitive-behavioral therapeutic approaches in the treatment of pain diseases, as it could be extrapolated that these approaches might also have the potential to alter the underlying neurobiological mechanisms as early as in the spinal cord,” said Sprenger.

The study findings are being reported in the Cell Press publication, Current Biology.

Don’t Look and It Won’t Hurt

A second study found that there may be some basis behind the old adage about looking away during a needle injection. Researchers found that past experience with needle pricks, along with information received before an injection, shape your pain experience.

“Throughout our lives, we repeatedly experience that needles cause pain when pricking our skin, but situational expectations, like information given by the clinician prior to an injection, may also influence how viewing needle pricks affects pain,” says lead author Marion Höfle, a doctoral student at the Charité – Universitätsmediz in Berlin.

Study participants received a painful or non-painful electrical stimuli applied to their hand while watching video clips showing a needle pricking a hand, a Q-tip touching a hand, or a hand left untouched.  The clips were presented on a screen near the participants’ hand, giving the impression that the hand on the screen belonged to them.

Participants reported that their pain was more intense when they viewed a needle pricking a hand than when they saw a hand alone or being touched with the Q-tip.

Researchers conducted a second test, but this time participants were told that either the needle or the Q-tip videos were more likely to be associated with pain. The researchers found that those video clips were more likely to be associated with pain. This suggests that a patient’s expectation prior to a medical treatment influences the intensity of their pain.

Taken together, the study reveals several important findings. “Clinicians may be advised to provide information that reduces a patient’s expectation about the strength of forthcoming pain prior to an injection,” Höfle wrote. She further states that, “because viewing a needle prick leads to enhanced pain perception as well as to enhanced autonomic nervous system activity, we’ve provided empirical evidence in favor of the common advice not to look at the needle prick when receiving an injection.”

Their research is published in the May issue of Pain.

Authored by: Elizabeth Magill

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Linda Hull

This always makes me so mad. Oh yes my pain is in my head I need this article to tell me it may not all be in my head. I have suffered from chronic pain for years, am on disability from it, have had 3 spine surgeries and a lot of time I get this attitude from the medical profession. Let me stick a knife in your back and then tell you your pain is not all in your head.