Nature Of Pain
Pain is a subjective experience influenced by physical (nociceptive and neuropathic), psychological and environmental factors. Pain can be acute, sub-acute, recurrent, or chronic. Left untreated or under-treated, acute pain can become chronic. Chronic pain can become a disease in its own right.
- 1 What is the nature and characteristic of pain?
- 2 What are the different types of pain and nature of pain?
- 3 What are the 2 classifications of pain?
- 4 What are the characters of pain?
- 5 What is the psychological meaning of pain?
- 6 What is the physiological explanation of pain?
- 7 What is the psychological term for pain?
What is the nature of pain in health psychology?
Abstract – Introduction: Pain is defined “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Pain is a sensation of the body, and is always an unpleasant emotional experience.
The role of psychology is auxiliary and supplemental to medicine. This is an aid addressed to the patient, physician and patient’s caregivers: professional caregivers, family members and significant others. At each stage of the diagnostic and therapeutic process, psychology offers help, both from the cognitive and practical aspects.
Objective: The objective of the article is to present important psychological aspects of studies concerning pain, and the psychological methods and techniques of pain treatment. State of knowledge: Pain is the leading reason for patients seeking medical care and is one of the most disabling, burdensome, and costly conditions.
- Pain accompanies many diseases, each one of which generates unique/separate diagnostic, therapeutic and research problems.
- DEPRESSION AND RELATED PSYCHICAL DISORDERS: There is a significant relationship between depression and pain symptoms, as well as between pain and suicidal thoughts.
- Patients with a long history of pain disorders also have increased depression and anxiety symptoms, as well as suicidal thoughts.
Patients with more severe depression and anxiety symptoms also have an increase in pain problems. The intensity of pain correlates with the intensity of psychopathological symptoms – both with mood lowering and with anxiety symptoms and worry. Active pain coping strategies strive to function in spite of pain, or to distract oneself from pain, are associated with adaptive functioning.
Passive strategies involve withdrawal or relinquishing control to an external force or agent and are related to greater pain and depression. Pain catastrophizing is a negatively distorted perception of pain as awful, horrible and unbearable. Catastrophizing is strongly associated with depression and pain.
Studies in which functional magnetic resonance imaging (fMRI) was used showed that pain catastrophizing, independent of the influence of depression, was significantly associated with increased activity in brain areas related to anticipation of pain, attention to pain, emotional aspects of pain and motor control.
Pain behaviour is a conditioned pain. Care and concern on the part of others, secondarily enhance a patient’s pain behaviours, which lead to an increase in the intensity of the pain experienced. A history of early life adversity (ELA) – rejection, neglect, physical or sexual abuse is related to the development of irritable bowel syndrome (IBS) in adulthood.
Ovarian hormones have been shown to modulate pain sensitivity. IMAGING OF THE HUMAN BRAIN IN CHRONIC PAIN: Acute pain and chronic pain are encoded in different regions of the brain. Chronic pain can be considered a driving force that carves cortical anatomy and physiology, creating the chronic pain brain/ mind state.
What is the nature and characteristic of pain?
Introduction – A definition of pain is provided by the International association for the Study of Pain (IASP) as follows: An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage Pain is always subjective and everyone learns the use of this word through experiences related to injury in early life.
Pain is a sensation in a part or parts of the body. It can vary in intensity, quality, duration and pain can refer to other parts of the body, Pain is usually an unpleasant sensation and therefore it also has an emotional aspect, It is strongly linked to suffering. Even in the absence of tissue damage or any likely pathophysiological cause, people still report pain.
This could happen for psychological reasons. In these cases, it is challenging to distinguish whether someone’s experience of pain arises from damaged tissue or not, as it can only be based upon the subjective report of such experience. In the following video, Karen D.
What are the different types of pain and nature of pain?
Pain Classifications and Causes: Nerve Pain, Muscle Pain, and More Medically Reviewed by on January 12, 2023 It’s safe to say most of us are not big fans of pain. But it is one of the body’s most important communication tools. Think about what would happen if you felt nothing when you put your hand on a hot stove. Pain is one way the body tells you something’s wrong and needs attention. But pain – whether it comes from a bee sting, a broken bone, or a long-term illness – is also something that feels bad both physically and emotionally. It has many causes, and people respond to it in many different ways. The pain you push your way through might be unbearable to someone else.
Even though the experience of pain is different from one person to the next, it is possible to group the types of pain. Here’s an overview of the types of pain and what makes them different from one another. There are several ways to classify pain. One is to separate it into acute pain and chronic (long-term) pain.
Acute pain usually comes on suddenly and lasts for a limited time. Some type of damage to tissue – such as bone, muscle, or organs – often causes it. When it happens, it can cause anxiety or other emotional issues. lasts longer than acute pain. It generally can somewhat resist medical treatment.
It’s usually linked to a long-term illness, such as osteoarthritis. In some cases, such as with fibromyalgia, pain is one of the main traits of the condition. Chronic pain can be the result of damaged tissue. But very often, nerve damage is behind it. Both acute and chronic pain can be overwhelming. And both can affect and be affected by a person’s state of mind.
But the nature of chronic pain – the fact that it’s ongoing and in some cases seems almost constant – can make you more likely to get mental health issues such as depression and anxiety. At the same time, these issues can make the pain worse. About 70% of people who take medication for chronic pain have what’s called breakthrough pain.
Those are flare-ups of pain that happen even when you’re taking your pain meds regularly. Sometimes breakthrough pain can come out of the blue. Or it can be set off by something that seems unimportant, such as rolling over in bed. And sometimes it may happen when pain medication wears off before it’s time for the next dose.
Pain is most often grouped by the kind of damage that causes it. The two main types are pain caused by tissue damage (also called nociceptive pain) and pain caused by nerve damage (also called neuropathic pain). A third category is psychogenic pain, which is pain that is affected by psychological factors.
- Psychogenic pain most often has a physical origin either in tissue damage or nerve damage.
- But the pain gets worse or lasts longer because of things like fear, depression, stress, or anxiety.
- In some cases, pain comes from a psychological condition.
- Pain is also classified by the type of tissue that’s involved or by the part of the body that’s affected.
For example, pain may be referred to as muscle pain or joint pain. Or a doctor may ask you about chest pain or back pain. Certain types of pain are referred to as syndromes. For instance, myofascial pain syndrome refers to pain that starts in trigger points in the body’s muscles.
Is an example. Most pain comes from tissue damage – when your body’s tissues are injured. The injury can be to bone, soft tissue, or organs. It can come from a disease such as cancer. Or it can come from a physical injury, like a cut or a broken bone. The pain you feel may be an ache, a sharp stabbing, or a throbbing.
It could come and go, or it could be constant. You may feel the pain get worse when you move or laugh. Sometimes, breathing deeply might make it feel especially strong. Pain from tissue damage can be acute. For example, sports injuries like a sprained ankle or turf toe often happen when soft tissue is damaged.
- Or it can be chronic, such as arthritis or chronic headaches.
- And certain medical treatments, such as radiation for cancer, can also cause tissue damage that causes pain.
- Nerves work like electric cables sending signals – including pain signals – to and from the brain.
- Damage to nerves can interfere with the way those signals are sent.
That can cause pain signals that don’t work the way they are supposed to. For instance, you may feel like your hand or whatever is burning, even though there’s no heat. Diseases such as diabetes can damage nerves. Or an injury can damage them. Certain drugs may cause nerve damage.
- Nerves can also be damaged by a stroke or an HIV infection, among other things.
- Pain could be from damage to the central nervous system (CNS), which is made up of the brain and spinal cord.
- Or it could come from damage to peripheral nerves, those nerves in the rest of the body that send signals to the CNS.
Pain caused by nerve damage, neuropathic pain, is often described as burning or prickling. Some people describe it as an electrical shock. Others say it’s like pins and needles or a stabbing feeling. Some people with nerve damage are often very sensitive to temperature and to touch.
- Just a light touch, like brushing against a bed sheet, can set off the pain.
- A lot of neuropathic pain is chronic.
- Examples of pain caused by damaged nerves include: Central pain syndrome.
- This chronic pain starts with damage to the central nervous system.
- The damage can be from a, multiple sclerosis, tumors, or several other conditions.
The pain – which is usually constant and may be very bad – can affect a large part of the body or smaller areas, such as the hands or feet. Movement, touch, emotions, and temperature changes can often make the pain worse. Complex regional pain syndrome.
This is a chronic pain syndrome that can follow a serious injury. It’s described as constant burning. And you might have unusual sweating, changes in skin color, or swelling where the pain is. Diabetic peripheral neuropathic pain, Diabetes causes nerve damage that affects the feet, legs, hands, or arms.
It might feel like burning, stabbing, or tingling. Shingles and postherpetic neuralgia. The same virus that causes chickenpox causes, It’s a localized infection with a rash and pain that can be very bad. It happens on one side of the body along the pathway of a nerve.
- Postherpetic neuralgia is a common problem that comes up, in which the pain from shingles lasts more than a month.
- Trigeminal neuralgia.
- Inflammation of a nerve in the face causes pain described as very serious and lightning-like.
- It can happen in the lips, scalp, forehead, eye, nose, gums, cheek, and chin on one side of the face.
Touching certain areas or even slight motion can set off the pain. © 2022 WebMD, LLC. All rights reserved. : Pain Classifications and Causes: Nerve Pain, Muscle Pain, and More
How do you assess nature of pain?
Pain scales – Pain measurement tools may be categorized as either single-dimensional or multidimensional scales. The measures require patient self-report on an aspect or aspects of the pain. The results must be viewed as guides and not absolutes. They should be viewed as only adjuncts to the history and physical examination of the patient.
Single-dimensional scales Single-dimensional scales are a simple way for patients to rate one aspect, typically intensity, of their pain. These scales may be useful in acute pain when the etiology is clear, such as trauma, pancreatitis, and otitis media. However, they can oversimplify the pain experience and results vary between certain patient populations and different diagnoses.
The three most commonly utilized tools to quantify pain intensity include verbal rating scales, numeric rating scales, and visual analogue scales. Verbal Rating Scales (Verbal Descriptor Scales) utilize common words (eg, mild, severe) to grade pain intensity.
- The Melzack and Torgerson scale uses five verbal descriptors: mild, discomforting, distressing, horrible, and excruciating.
- Numeric Rating Scales are common and simple.
- Patients may be asked to circle numbers equally spaced on a page or verbally rate pain intensity using a scale of 0–10, in which 0 represents “no pain” and 10 represents “the worst pain imaginable.” Advantages of numeric scales are their simplicity, reproducibility, and sensitivity to small changes in pain.
Children that are able to count and have a concept of numbers may use this scale. The Visual Analog Scale is similar to the numeric rating scale, except that the patient marks on a measured line, in which one end represents “no pain” and the other end represents “the worst pain imaginable.” Other visual tools may use pictures of the human body for the patient to mark the location of pain. Faces Pain Rating Scale. Multidimensional scales Multidimensional scales are more complex and time consuming, but may measure the intensity, nature, and location of the pain, and impact the pain is having on activity or mood. These are useful in complex or persistent acute or chronic pain cases when intensity needs to be assessed as well as social support, interference with activities of daily living, and depression.
The McGill Pain Questionnaire provides quantitative measurement of pain and can discriminate between sensory and emotional aspects of pain. It can also be beneficial to detect response to treatment. It involves four parts and requires 5–15 minutes to complete. It primarily consists of different adjectives used to describe pain in three dimensions: sensory, affective, and evaluative.
The words are subdivided into 20 subclasses that are tiered to represent relative intensity. Distribution, temporal pattern, and intensity of pain are also evaluated. Two adaptations have been developed: the short-form McGill Pain Questionnaire (SF-MPQ) and the SF-MPQ2; which are shorter, easier to complete and more sensitive to change.
- The Brief Pain Inventory quantifies both pain intensity and interference or impact on function.
- It is used for patients with cancer, human immunodeficiency virus, and arthritis.
- It takes 5–15 minutes to complete and uses 11 numeric scales to address pain intensity, mood, ability to work, relationships, sleep, enjoyment of life, and the effect of pain on general activity.
The Brief Pain Inventory can measure the progress of a patient with a progressive disease and can show improvement or decline in the patient’s mood and activity level. Evaluating function is important in overall pain management. The Memorial Pain Assessment Card is a simple and quick multidimensional pain assessment tool for patients with cancer.
Is pain a human nature?
The experience of pain is one of the fundamental human senses and most ancient protective survival skills.
Is pain a physical or an emotion?
What Is the Relationship between Pain and Emotion? Bridging Constructs and Communities 1 Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA 94304, USA Find articles by 2 Department of Psychology, Stanford University, Stanford, CA 94305, USA Find articles by 3 Department of Psychological and Brain Sciences, Dartmouth College, HB 6207, Moore Hall, Hanover, NH 03755, USA Find articles by 4 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA Find articles by 1 Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA 94304, USA Find articles by
1 Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA 94304, USA 2 Department of Psychology, Stanford University, Stanford, CA 94305, USA 3 Department of Psychological and Brain Sciences, Dartmouth College, HB 6207, Moore Hall, Hanover, NH 03755, USA 4 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
* Correspondence: Although pain is defined as a sensory and emotional experience, it is traditionally researched and clinically treated separately from emotion. Conceptual and mechanistic relationships between these constructs highlight the need for better understanding of their bi-directional influences and the value of bridging the pain and emotion research and clinical communities.
- Pain is a natural, adaptive response that protects our body from actual or potential tissue injury.
- However, when pain persists, it can lead to suffering and to substantial clinical and economical burdens, at both personal and societal levels ().
- Many people consider pain to be purely physical, but since pain can be reported in the absence of noxious sensory activations, pain is actually defined as an unpleasant subjective experience with a sensory and an emotional component ().
Indeed, mental or better yet psychological health comorbidities, especially anxiety, depression, and anger, are highly prevalent in people with chronic pain (). However, how can we fully understand what pain is, if the age-old question “what is an emotion?” is still vigorously debated ()? Critically, how does this impact our understanding of the relationship between pain and emotion? We begin by reiterating the difference between pain and nociception (), which is helpful when considering the complex conceptual, functional, and neurophysiological relationship between pain and emotion.
- We suggest several perspectives on the nature of this relationship and call for further scrutiny of their bi-directional influence.
- The inherent connection between pain and emotion emphasizes the need for closer interactions between the traditionally siloed fields of pain and emotion, which we believe will lead to substantial progress in the theoretical, empirical, and clinical understanding of their normative and pathological manifestations.
Underlining the difference between pain and nociception is crucial, since colloquially (and in many textbooks), the terms still tend to be used interchangeably. Nociception is defined as the neurophysiological process of encoding noxious stimuli that produce actual or potential tissue injury.
- The word noxious derives from the Latin word noxa, associated with meanings of harm, hurt, injury, and damage.
- Counter to the false dualistic inclination to separate subjective experiences into physical and mental categories, these words clearly associate with both somatic and emotional harms.
- We are hurt and in pain when we are interpersonally insulted, as when we are physically injured.
Although language is key for articulating subjective experiences, we should avoid essentialism: our nervous system is the primary determinant of our experiences. We therefore highlight that nociception refers to peripheral neurophysiological pathways embedded in the sensory nervous system that encode objective information about the physical properties of various stimuli (thermal, mechanical, chemical, and/or electrical) and relay this information from the body (transduction) to the spinal cord (transmission).
We refer to a normatively functioning system, though variability in the encoding process can result from pathophysiology (from birth or acquired through development or injury) or other factors impacting individual differences (genetic, neuroanatomical, and other biological or potentially psycho-socio-cultural factors).
Importantly, as in other sensory modalities (vision, audition), nociception generates biological signals that mediate between events in the external world and an organism’s internal milieu. Downstream reflexive behavior is then generated to protect the organism and thus increases evolutionary fitness.
- In most animals, including humans, response to and modulation of nociception can occur before and probably without perception, making it highly conserved across species.
- Pain is a more “reflective” process that in many cases (but not always) is a result of perceiving nociceptive information, whether the source of this input is external (e.g., an electric shock) or from within our body (e.g., a torn muscle).
When the brain processes this information, we can consciously experience the stimulus as painful and ponder its location, intensity, sensory and emotional qualities, and any other characteristic feature. It is then that complex behavioral expressions (e.g., facial, bodily, verbal) might manifest.
- Individual differences should also be considered.
- One person submerging their hand in a 3°C cold-water bath cries out in anguish, rating the pain as 9 on a 0 to 10 scale from “no pain” to “worst pain imaginable,” whereas another person barely moves a muscle, rating it as a 1 on the same scale.
- People might experience pain differently depending on various socio-cultural factors, such as whether a supportive loved one is present in the room or whether one has been continuously exposed to discriminatory health care.
Cognitions, such as thoughts (e.g., how much it hurts, whether it will end), beliefs (e.g., pain reflects tissue damage, physical exercise makes it worse), and expectations (e.g., placebo and nocebo effects) are additional important modulators of pain.
Notably, we can calibrate the average kinetic energy of H 2 O molecules to 3°C. But can we truly know what the qualitative experience is for another person submerging their hand in water at that temperature? Can we truly know how painful it is for them? There are various philosophical perspectives on such questions.
Nevertheless, we can imagine pain, bring it back to memory, or even resonate with another person’s experience and expressions of pain, considered the basis for empathic processing. All the above emphasizes that there is no direct one-to-one relationship between nociception and pain, that pain is a learned process shaped over the lifespan, and that biological, psychological, and socio-cultural factors (and their interactions) impact both acute and chronic pain ().
- Therefore, pain is a contextualized, multidimensional construct resulting from interactions of peripheral and central nervous systems with potential external factors, but that in itself cannot be reduced to peripheral activity in sensory pathways.
- Debates about the nature of emotion began early in religion and philosophy in both Eastern and Western ancient worlds and is still very much alive today.
For example, basic emotion perspectives view emotions such as fear, sadness, and anger as unique mental states with specific underlying mechanisms that cannot be decomposed into more basic ingredients. On the other hand, constructionist perspectives do not view emotions as unique in form, function, or cause but rather as built by more basic ingredients that are not specific to emotions, such as valence and arousal.
A summary of contemporary theoretical perspectives and of key open questions is beyond our current scope and is provided elsewhere (; ). Nevertheless, most perspectives hold that emotional experiences are outcomes of interactions between somatovisceral patterns mediated by functionality of the peripheral nervous system, as well as cognitive processes (e.g., memory and attention) and meta-cognitive attributions (e.g., appraisals or evaluations) mediated by functionality of the central nervous system (CNS).
Within the CNS, emotional states preferentially engage subcortical circuits that seem to be dedicated to adaptive behaviors, such as the fight-freeze-flight survival responses. Emotions can thus be evoked by physiological states (e.g., hunger or thirst), by events in the environment (e.g., a roaring lion or an interpersonal insult), as well as by cognitive processes (e.g., imagining, remembering, or expecting an emotion-inducing situation), making them functionally adaptive to various stressors.
- Theories vary in the influence given to socio-cultural and contextual factors and in the emphasis given to variability within and between emotion categories.
- Emotional experiences also frequently co-occur with various behavioral expressions (facial, bodily, verbal).
- Clearly, the constructs pain and emotion are substantially overlapping, conceptually and functionally.
Importantly, as pain cannot be reduced to the characteristics of a noxious stimulus, so an emotion such as fear cannot be reduced to a particular eliciting stimulus—a roaring lion can be a joyous experience when on a safari. Similarly, nociception can be pleasurable, such as for practitioners of masochism, and can even generate relief, as is the case in deliberate self-harming behaviors (often characterizing borderline personality disorder).
- This raises the question: in what way, if any, is pain different from any other emotion? One potential response is that pain is sensed by and referred to localizations within the body.
- However, pain can be experienced even in a limb that was amputated, as demonstrated by phantom pain.
- At the same time, emotions seem to have differential somatic referents within the body.
Thus, perhaps it is the pattern of somatosensory referents and their associated neural manifestations that differentiates between various painful and emotional experiences, rather than the presence or absence of a somatic referent, per se. The complexity of the pain-emotion relationship is indeed further illustrated by examining their potential underlying neural circuits using functional magnetic resonance imaging (fMRI) of the brain.
Meta-analytic maps of brain activations ( and ), as well as within-subject studies that incorporate experimental manipulations of both pain and emotion paired with multivariate analytic approaches (; ), identify both functionally dissociable, as well as shared neural, coding within brain regions, such as the insula and cingulate cortices.
This highlights the need to study pain and emotions together, especially their bi-directional influence, and how and which peripheral and central circuits mediate their experience. Pain and Emotion: What Is their Relationship and How Can We Deepen our Understanding Thereof? (A and B) These panels present four meta-analytic maps generated with Neurosynth (), two for the term pain (yellow; 516 studies) and two for the term emotional (red; 1,708 studies).
(A) displays voxels that are consistently active in studies that load highly on each of these two terms separately. (B) displays voxels that are more consistently active in studies that load highly on each of the terms separately than for studies that don’t. All maps are corrected at a false discovery rate of 0.01, with voxel intensities binarized.
(A) suggests potential overlap between the two terms, as observed in brain regions classically associated with pain, such as anterior and posterior insula, anterior cingulate cortex (ACC), thalamus, and periaqueductal gray (PAG), as well as in brain regions classically associated with emotions, such as the amygdala, ventral striatum, and ventral regions of the medial prefrontal cortex (PFC).
B) suggests potential distinctions between the terms, and, as observed, some of the same regions that previously overlapped, such as the insula, cingulate, and amygdala, now seem to be specific for each of the two terms, and much less overlap is observed. In comprehending these findings, we should note potential limitations for understanding brain processing of pain and emotion—the maps do not distinguish between activations and deactivations, do not provide information about connectivity between brain regions, and are not sensitive to differences between healthy and chronic pain populations.
Moreover, experimental paradigms differ between the terms, with emotion inductions mostly using visual stimuli (e.g., faces or scenes), whereas pain inductions commonly requiring physical contact (e.g., thermal or mechanical). This might suggest (B) is more reflective of sensory-specific discrimination.
- A conceptual consideration of the pain-emotion relationship must therefore complement and guide empirical findings.
- Coordinates of brain slices are in the Montreal Neurological Institute space.
- FFG, fusiform gyrus; PAG, periaqueductal gray; PCC, posterior cingulate cortex; SI/SII, primary/secondary somatosensory cortex; SMA, supplementary motor area; A, anterior; P, posterior; L, left; R, right.
(C) Using Venn diagrams, this panel presents potential theoretical perspectives regarding the relationship between pain and emotion. Venn1 illustrates the common view of pain as having an emotional component, in addition to sensory and other important components (e.g., cognitive, motivational, socio-cultural).
It is thus challenging to conceive of pain and emotion as completely separate phenomena. On the other hand, pain could be conceptualized as a type of emotion category (Venn2), such as fear or anger. Pain could also be conceptualized as a feeling, a more rudimentary neurophysiological element (such as thirst or hunger), though controversy also exists regarding how to differentiate between feelings and emotions, which is beyond our current scope.
These two perspectives suggest a vertical relationship between pain and emotion. However, a horizontal relationship between pain and emotion would define them as separate constructs with certain shared and other distinct underlying conceptual and neurophysiological processes (Venn3).
Further empirical findings will determine the amount of overlap (as marked by the double-sided arrow), which might even reach complete overlap (Venn4), thereby conceptualizing experiences of pain and emotions as based on the exact same underlying mechanism. (D) Above and beyond theoretical perspectives, we need to deepen and improve our understanding of the bi-directional relationship between pain and emotion at multiple levels of analysis (from the genetic to the socio-cultural) and considering the multiple components (e.g., sensory, motivational, etc.) of the two constructs.
This panel highlights several actionable items that will support this process. In this regard, both the insula and cingulate cortices are part of the cortical end points for interoceptive processing, the brain’s representation of the state of the body (; ).
Interoception is conceptualized as a continuous stream of sensations (some might refer to this as affect, others as feelings, though they need not be consciously perceived) that might serve as ingredients from which emotional experiences are then generated and regulated. Multiple such pathways mediate different sensations crucial for survival, such as hunger or thirst.
The nociceptive pathways are considered part of these interoceptive pathways that together converge in the CNS, suggesting pain experience might similarly be generated and regulated. Nevertheless, in light of the above descriptions of pain and emotion, neither interoception in general nor nociception in particular seem either necessary or sufficient for such experiences.
Despite all these connections between pain and emotion, what makes pain so clear and confounding, maybe even unique compared to emotion, is that we do have dedicated nociceptive systems facilitating perception of noxious stimuli. Such systems were already present 500 million years ago in some of the most primitive organisms (e.g., nematodes, arthropods, and mollusks), as a set of peripheral mechanisms dedicated to promoting survival-relevant behaviors, even without the spinal cord.
Subsequently, shaped by the increasing complexity and interactions of the physical and social environment, the phylogenetic evolvement of and interactions with spinal cord, brainstem, sub-cortical and cortical circuits, CNS mechanisms developed for more advanced protective behaviors that required cortical representations and interpretations.
- These presumably serve as a foundation for experiences such as pain, thus further adapting complex organisms to multiple environmental and contextual situations.
- Yet, we do not seem to have, at least as current evidence suggests, dedicated peripheral pathways for “fear-ception,” “anger-ception,” “sad-ception,” or any other emotion category.
Taken together, the inherent and complex relationship between pain and emotion clearly requires further theoretical, empirical, and clinical scrutiny. Both constructs are based on primitive pathways that promote protective survival behaviors against imminent dangers.
Through evolution, these pathways seemed to have crisscrossed each other, generating mechanisms that allow us to predict and respond to both real and imagined physical and psycho-social threats. Yet, if the activation thresholds of these mechanisms are too low due to sensitization, overgeneralization, or other reasons, they might negatively impact our physical, psychological, and social well-being, and potentially deteriorate to chronic maladaptive conditions.
Since both pain and emotion capture overlapping yet differential conceptual and neuroanatomical spaces, there might well be several alternative perspectives on their relationship (). Additional aspects of pain and emotion not touched upon here should also be integrated.
- For example, the involvement of pleasure and reward in experiences of pain and emotion or the endogenous opioids’ role in their generation and regulation.
- Considering the contribution of other biological factors, such as at the genetic, endocrine, or immune system levels and how they interact with all the other factors, is also of great importance.
Ultimately, we need to better characterize the bi-directional impact that pain and emotion have on each other. For example, there is a general lack of studies directly examining how the separate induction of each impacts the current and downstream experience of the other and what neuro-physiological processes, interoceptive or other, mediate or contribute to their activation or inhibition.
- These efforts are imperative for people suffering from chronic pain or emotional disorders, since both populations are highly comorbid with each other.
- The conceptual, mechanistic, and clinical connections between the constructs of pain and emotion should spur greater collaboration between the two historically and institutionally siloed scientific communities of pain (mostly from bio-medicine) and emotion (mostly from humanities and social sciences).
Both fields ask similar questions, such as (1) do animals experience pain/emotions? (2) What changes in pain/emotions occur throughout development? (3) How are pain/emotions regulated? Or (4) what makes some people more vulnerable/resilient to pain/emotion abnormalities? Each field will benefit by incorporating within its research and clinical practice the theories, methods, and findings accumulated in the other.
- Clinical psychologists treating pain with various interventions, such as cognitive-behavioral therapy or mindfulness-based stress reduction, represent a focal point connecting the two fields.
- Further elucidating how pain and emotion interact might help us improve diagnosis and treatment.
- Indeed, recent advances in interventions emphasizing emotional awareness, acceptance, and expression seem to have increased benefit in providing relief for people with chronic pain ().
Some scholars from both fields have separately begun laying out their theoretical views regarding the inter-relations of pain and emotions (; ; ; ). We believe that there are several ways to foster greater integration and synergy across these two fields ().
This approach will ultimately (1) deepen and improve our conceptual understanding of pain and emotion and their inter-relationships, (2) support the development of novel, safe, and effective therapies, and (3) shape policy decisions that impact the lives of hundreds of millions of people suffering from pain and emotional disorders worldwide.
Fundamentally, whether one is a clinician (e.g., physician, nurse), a scientist (e.g., biologist, psychologist), a humanist (e.g., philosopher, historian), or any other person, pain and emotion are more closely intertwined than we think.S.C.M. and G.G.
- Thank the Redlich Pain Research Endowment and the Feldman Family Foundation Pain Research Fund for their financial support.
- The following National Institutes of Health grants provided further financial support: R01 NS109450, K24 DA029262, R01 DA035484, and P01 AT006651 (to S.C.M.); R01 MH076136, R01 DA046064, and R01 MH116026 (to T.D.W.); and P30 AG064201, R01 AG058702, UG1 CA189824, and U2C NR014637 (to F.J.K.).
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Baliki MN, and Apkarian AV (2015). Nociception, Pain, Negative Moods, and Behavior Selection, Neuron 87, 474–491. Barrett LF (2017). The theory of constructed emotion: an active inference account of interoception and categorization, Soc. Cogn. Affect. Neurosci 12, 1–23. Corradi-Dell’Acqua C, Tusche A, Vuilleumier P, and Singer T (2016). Cross-modal representations of first-hand and vicarious pain, disgust and fairness in insular and cingulate cortex, Nat. Commun 7, 10904. Damasio A, and Carvalho GB (2013). The nature of feelings: evolutionary and neurobiological origins, Nat. Rev. Neurosci 14, 143–152. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, and Turk DC (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions, Psychol. Bull 133, 581–624. Gross JJ, and Barrett LF (2011). Emotion Generation and Emotion Regulation: One or Two Depends on Your Point of View, Emot. Rev 3, 8–16. Krishnan A, Woo CW, Chang LJ, Ruzic L, Gu X, López-Solà M, Jackson PL, Pujol J, Fan J, and Wager TD (2016). Somatic and vicarious pain are represented by dissociable multivariate brain patterns, eLife 5, e15166. Lumley MA, and Schubiner H (2019). Psychological Therapy for Centralized Pain: An Integrative Assessment and Treatment Model, Psychosom. Med 81, 114–124. Mackey S, and Kao M-C (2019). Managing twin crises in chronic pain and prescription opioids, BMJ 364, l917. Shackman AJ, and Wager TD (2019). The emotional brain: Fundamental questions and strategies for future research, Neurosci. Lett 693, 68–74.
: What Is the Relationship between Pain and Emotion? Bridging Constructs and Communities
What is subjective nature of pain?
Discussion: – MAP is expected to help clinicians validate pain reports as important and legitimate, regardless of other findings, and help our field develop more comprehensive, valid, and compassionate approaches to assessing pain. Key Words: pain assessment, qualitative methods, mixed-methods, patient communication, narrative medicine, medical ethics, brain imaging, definition of pain, compassionate care, mechanism-based management Pain is an enigmatic phenomenon that is challenging to treat and study.
One challenging attribute is its subjective nature. Pain is defined as a subjective experience, 1 which means that it cannot be directly observed by those who are not experiencing it. Yet, clinicians and researchers rely upon observations and measures to assess and infer the pain experienced by other people.
This raises the fundamental question of how the inherent subjectivity of pain can and should be addressed and integrated within its assessment. Current frameworks for guiding pain assessment do not adequately tackle this problem. For instance, biopsychosocial frameworks encourage a multidimensional approach to pain assessment.
- However, they do not specify the different ways through which this assessment can be conducted.
- They also do not delineate how different forms of assessment relate to the subjective experience of pain.
- Different approaches to assessment include observing direct expressions of pain, such as the words and behaviors used by the person in pain.
They also include administering quantitative measures of pain, such as self-report questionnaires as well as physiological and psychophysical measures. The overwhelming emphasis in the pain literature is on quantitative methodologies. As a result, pain assessment strategies are typically focused on aspects of pain most readily communicated through numbers, such as pain intensity ratings or pain threshold levels.
Although quantitative pain measures are vital to understanding and targeting mechanisms and benchmarking management, they often overlook important attributes of the subjective experience, such as personal context and meaning, which can profoundly shape the experience of pain. Current models do not adequately emphasize what aspects of the pain experience can be uniquely accessed through more qualitative forms of assessment, such as talking, observing, and listening.
Previous reports show that patients with pain often do not feel listened to or understood by their health care providers.2 – 6 These findings highlight the need for assessment models that specifically emphasize how to address subjectivity related to pain.
- Current models of pain assessment also fail to provide adequate guidance on what forms of assessment should be prioritized to best align with our conceptualization of pain as a subjective experience.
- This creates ambiguity in what should be regarded as a root proxy for the pain experience.
- Specifying an observable, root proxy for pain is an essential step in establishing a conceptual bridge between the nonobservable experience of pain and our assessment methodology.
Recent debate on how to best integrate physiological measures of brain activity within pain assessment illustrates the ambiguity in this area. On the one side, there have been calls for using measures of brain activity as objective biomarkers of the pain experience, 7 – 9 whereas on the other, self-report is prioritized as the best root proxy for pain.10, 11 Ambiguity in this area raises important challenges for people assessing pain.
For instance, when faced with discrepancies across different forms of assessment, clinicians report uncertainty in trying to decide which of their assessment findings should be relied upon as indicators for the nonobservable pain experience.12 – 16 Although there is preliminary consensus among leaders in brain imaging research that self-reports of pain should be prioritized over physiological measures, 17 there is still a lack of clarity in what this means for clinical practice and research.
For instance, what do we mean by self-reports of pain? If the intention is to support patient autonomy, should self-report measures be regarded on equal footing with direct narrative reports of pain? Also, from a research perspective, how should objective measures of pain be best anchored to more subjective forms of assessments? Assessment frameworks are needed to help inform decision-making around these questions.
- Polarities of opinion in what should be regarded as a root proxy for pain emphasize the potentially competing pillars of what we value in pain assessment.
- Objective measures of pain are valued, in part, for their usefulness in guiding mechanism-based management.7 – 9 Self-report is valued, in part, for its ability to support patient autonomy and to provide compassion-based care.10, 11, 18 Failure to support both of these pillars is associated with important risks.
For instance, failure to identify underlying pain mechanisms can result in, at best, a waste of time for the patient and clinician and, at worst, iatrogenesis by providing a rationale for potentially harmful treatments. Similarly, failure to validate pain reports and show compassion can increase patient distress, degrade therapeutic alliance, and undermine hope for improvement.5, 16, 19, 20 Current models of assessment do not provide adequate guidance on how to navigate these competing values.
- Without guidance in this area, there is increased potential for conflating the validation of a pain experience with the identification of its underlying mechanisms.
- For instance, pain reports that can be linked to specific mechanisms may be validated as legitimate, while reports without clear links may be dismissed as spurious.
Not delineating these aspects of assessment raises the risk that people living with pain continue to feel stigmatized and alienated when certain findings from their assessment are used to invalidate their reports of pain.2 – 6, 20, 21 Assessment frameworks are needed to help establish criteria for both legitimizing pain and supporting the principles of mechanism-based management.
- This paper introduces the multimodal assessment model of pain (MAP; Table 1 and Fig.
- 1 ), a novel framework that aims to address these gaps by: (1) specifying a root proxy for the subjective pain experience; (2) characterizing how different assessment methodologies relate to pain subjectivity; and (3) offering frameworks to further integrate the subjective pain experience within pain research and practice.
The first sections of this paper aim to delineate MAP’s nomenclature, postulates, and applications to clinical practice and research. This is followed by a general discussion of how MAP relates to the broader literature and implications for future work.
What are the 2 classifications of pain?
There are two main types of pain, of which include nociceptive pain and neuropathic pain. Psychogenic pain is another term that is sometimes used to describe cases of pain, although this is not an official diagnostic term. Alternatively, pain can be classified according to the duration of the pain, as acute, chronic, or breakthrough pain. Image Credit: staras / Shutterstock.com
What are the characters of pain?
Pain Character Release Notes: Data Element Version 2018A
A comprehensive pain assessment includes documentation of pain character. Examples for this component include but are not limited to:
Character – type of pain, quality or description, such as throbbing, aching, sharp, dull etc.
What does the pain feel like?
Components of the comprehensive assessment must be documented in the medical record within one day of the pain screening to select “yes”. The time frame for documentation is the day of and the day after the pain screening. The comprehensive assessment documentation may be completed by any member of the palliative care core interdisciplinary team.
- The core interdisciplinary team is comprised of the following: Physician(s); Registered nurse(s) or advanced practice nurse(s); Chaplain(s) or, spiritual care professional(s); Social worker(s).
- It is possible to include elements of the pain assessment for nonverbal patients.
- A family report may be used to complete one or more of the components of the comprehensive assessment.
Clinical notes about assessment of nonverbal indicators of pain are also acceptable to select “1”. Examples included but are not limited to:
Nonverbal indicators of pain include nonverbal sounds such as crying, whining, and groaning; facial expressions, such as grimaces and clenched jaw; and protective body movements or postures such as bracing, guarding, rubbing, or clutching a body part.
Documentation based on whether the clinician made an attempt to gather the information from the patient/family may be used. For example, if, for a nonverbal patient, the clinician asked the family about pain character and the family responded “I’m not sure” or “I don’t know.”
Palliative care consultation notes Palliative care team progress notes Palliative care initial encounter notes Palliative care admission assessment
Pain Character Specifications Manual for Joint Commission National Quality Measures (v2018A) Discharges 07-01-18 (3Q18) through 12-31-18 (4Q18) : Pain Character
What is the psychological basis of pain?
Anxiety – A physiological model of anxiety may explain its role in pain perception;
- It is known that a state of acute anxiety stimulates the sympathetic nervous system (SNS), causing increased muscle tension, increased nociceptive input and increased sensitivity to pain stimuli, thus explaining why anxiety may correspond to increased pain perception.
- Corticosteroid hormones, for example, released after stress may play a part in pain modulation, as cortisol (a steroid hormone known to stimulate the SNS) has been found in higher levels in those with chronic pain,
- Furthermore neurotransmitters, neuropeptides and pro-inflammatory cytokines have been found to either mediate or modulate pain. Therefore, these physiological processes overlap in both anxiety and pain.
- There is evidence accumulating to show atypical sensory processing in the brain and dysfunction of skeletal muscle nociception, however the latter may not explain pain persistence in non-MSK pathologies where chronic pain has clearly been observed.
- The “pain matrix”, responsible for modulation of pain signals in the central nervous system (CNS), shares elements with brain networks responsible for stress, identifying another connection to the SNS. Pain contributes to feelings of anxiety due to fear of the cause, and if this persists a state of hypervigilance and avoidance behaviours may develop as a “maladaptive” coping response.
- A more permanent state of anxiety results in chronic muscle tension and anticipatory anxiety which leads to further disability.
- Decreases in activities, especially those which provide meaning and reinforcement, may result in greater social isolation, decreased self-efficacy, increased feelings of uselessness and subsequent increases in anxiety and depression symptoms.
This theory is closely interlinked with the ‘fear-avoidance’ model, a cycle prospected to play a vital part in sustenance of pain behaviours and which has been shown to be an independent predictor of pain severity and disability among those with MSK pain,
- Functional magnetic resonance imaging (fMRI) studies along with blood-oxygenated level dependent contrast (BOLD) techniques have been utilised in various studies to map common areas of brain activation by detecting changes in blood flow.
- These studies have been able to map similar areas of brain activation for anxiety and pain.
It has been shown that there is exaggerated brain response in patients with social anxiety disorder,
- In one study these methods were used to identify highlighted areas in the brain when anxious patients reacted to negative self-beliefs.
- The areas identified were the midline cortical regions such as: the ventromedial pre-frontal cortex (PFC), dorsomedial PFC, posterior cingulate cortex (implicated in self-referential process), emotional centre (amygdala) and memory area (hippocampal gyrus),
- This indicates that there are integrated neural pathways associated with anxiety, pain processing, memory and concept of the self – the latter potentially implicating personality traits into anxiety and pain.
What is the psychological meaning of pain?
Definition of Mental Pain – In the literature, terms such as mental pain, psychic pain, psychological pain, emptiness, psychache, internal perturbation, and psychological quality of life have been used to refer to the same construct. Bakan observed that the individual feels psychological pain at the moment when he/she becomes separated from a significant other.
- From his perspective, pain is the awareness of a disruption in the person’s tendency towards maintaining individual wholeness and social unity.
- Sandler defined psychological pain as the affective state associated with discrepancy between ideal and actual perception of self.
- Baumeister referred to mental pain indirectly in his theory on suicide.
He viewed mental pain as an aversive state of high self-awareness of inadequacy. When negative outcomes fall far below one’s standards of the ideal self and aspirations, and outcomes are attributed to the self, that person experiences mental pain. The basic emotion in mental pain is, thus, self-disappointment.
- Shneidman defined psychache as an acute state of intense psychological pain associated with feelings of guilt, anguish, fear, panic, angst, loneliness and helplessness.
- The primary source of severe psychache ‘is frustrated psychological needs’,
- Psychache is the mental pain of being perturbed,
- Perturbation refers to one’s inner turmoil, or being upset or mentally disturbed,
Bolger defined emotional pain as a state of ‘feeling broken’ that involved the experience of being wounded, loss of self, disconnection, and critical awareness of one’s more negative attributes. Essential characteristics of emotional pain were described as a sense of loss or incompleteness of self and an awareness of one’s own role in the experience of emotional pain,
Orbach et al. have defined mental pain as ‘a wide range of subjective experiences characterized as a perception of negative changes in the self and its function that is accompanied by strong negative feelings’. Intense ‘unbearable’ mental (psychological) pain is defined as an emotionally based extremely aversive feeling which can be experienced as torment.
It can be associated with a psychiatric disorder or with a severe emotional trauma such as the death of a child. Psychological pain has many metaphors borrowed from physical pain (e.g. heartache, broken heart).
What is the physiological explanation of pain?
Pain plays an important in the survival of all animals. It acts as a signal, alerting us to potential tissue damage, and leads to a wide range of actions to prevent or limit further damage. Physiologically, pain occurs when sensory nerve endings called nociceptors (also referred to as pain receptors) come into contact with a painful or noxious stimulus.
The resulting nerve impulse travels from the sensory nerve ending to the spinal cord, where the impulse is rapidly shunted to the brain via nerve tracts in the spinal cord and brainstem. The brain processes the pain sensation and quickly responds with a motor response in an attempt to cease the action causing the pain.
Nociceptive Pathways The classic nociceptive pathway involves three types of neurons:
- Primary sensory neurons in the peripheral nervous system, which conduct painful sensations from the periphery to the dorsal root of the spinal cord
- Secondary sensory neurons in the spinal cord or brainstem, which transmit the painful sensation to the thalamus
- Tertiary sensory neurons, which transmit the painful sensation from the thalamus to the somatosensory areas of the cerebral cortex.
Sensory Nerves Entering the Spinal Cord A section of a lumbar vertebra showing the sensory nerves (in yellow, with bulge) entering the dorsal part of the spinal cord. Illustration provided by 3DScience.com. Used by permission. There are two major classes of nerve fibers associated with the transmission of pain:
- Unmyelinated C fibers
- Myelinated A-delta fibers
Destinations of the Spinothalamic and Spinoreticular Tracts in the Brain The thalamus is the destination of spinothalamic tract—the sensory pathway responsible for processing pain, temperature, and crude touch. The brainstem reticular formation, which forms a diffuse, central core within the brainstem is the destination of the spinoreticular tract.
Source: 3DScience.com. Used by permission. The C fibers are small and conduct impulses slowly. They respond to thermal, mechanical, and chemical stimuli and produce the sensation of dull, diffuse, aching, burning, and delayed pain. A-delta fibers, which are myelinated and thus conduct impulses rapidly, respond to mechanical (pressure) stimulus and produce the sensation of sharp, localized, fast pain.
One of the most important central pain pathways is the spinothalamic tract, which originates in the spinal cord and extends to the thalamus. This spinal tract transmits sensory information related to pain, temperature, and crude touch. Another prominent pathway is the spinoreticular tract, which is involved in nociceptive processing.
What is the psychological term for pain?
Search for pain management physicians near you and schedule your next appointment today – If you’ve ever been sick or injured, chances are that it put you in a pretty bad mood. Experiencing pain has been known to exacerbate other symptoms, such as stress and anxiety.
- But unfortunately, just like pain can make you feel worse mentally, your mind can cause pain without a physical source, or make preexisting pain increase or linger.
- This phenomenon is called psychogenic pain, and it occurs when your pain is related to underlying psychological, emotional, or behavioral factors.
What Causes Psychogenic Pain? It’s not entirely clear why your brain sometimes causes pain when there seems to be no physical source. Some theories suggest that it’s due to pain memory, a condition that causes the nervous system to hold onto pain long after an injury has healed.
- Others suggest that this pain may be caused by signals getting confused within the brain.
- The normal sensation of pain and where it’s located in the body is generally sent through nerve receptors that transmit information to the spine, which then sends it up to the brain.
- However, there’s room for messages to get lost along the way from point A to point B, making it possible for the brain to interpret mental distress as physical pain.
Some psychological factors that might cause physical pain include anxiety disorders, bipolar disorder, depression, and stress. What Types of Pain Does It Cause? Just like pain caused by a physical stimulus, psychogenic pain can be acute or chronic, Acute pain is sharp but brief, and usually doesn’t require treatment.
Chronic pain is persistent, lasting anywhere from a few weeks to several years. Because of the continued suffering of chronic pain, treatment is highly encouraged. Chronic psychogenic pain can be felt all over the body with varying intensity, though it most commonly presents as a headache, a muscle ache, abdominal pain, or back pain.
How Is It Treated? Treatment often depends on the type of pain being experienced and if you have any history of psychological distress. A good health care provider will test for any possible physical causes before giving a diagnosis of psychogenic pain.
Treat the pain. Depending on the type of pain, physical therapy, medication, and dietary adjustments may be used to reduce or relieve the symptoms. Treat the psychological problem. Together, a therapist and the patient can try to determine the underlying mental cause and take steps to treat it. They may recommend neurological medications that have been proven to reduce pain caused by mental distress. Try alternative treatments. Health care providers may offer some alternative treatments, such as acupuncture and occupational therapy, to assist with the healing process.
Depending on the underlying psychological problem, some patients can find relief quite quickly, while others might take longer. Unfortunately, psychogenic pain and other seemingly invisible disorders have been met with skepticism and stigmatization from friends, family members, places of work, and even health care providers.