Can You Take It?! - Sense Week

ADDITIONAL CONTRIBUTORS

Photo courtesy of Wikimedia Commons.

Two children are playing outside together, racing up and down their block. At the end of one race they both simultaneously trip and fall over a baseball bat someone left lying around. Both kids fall to the ground, jolting their systems and scraping their knees and elbows. One stands up, a little startled, brushes the dirt off his knees and skips off to find a new game. The other remains on the gravel, where he has begun crying and will continue to cry for some time. Both children experienced the same injury but with very differing results. Why? The answer to this question affects humans of all ages and continues to be a source of hot debate and active research for pain specialists. This is the human pain matrix.

Pain is a necessary evolutionary adaptation of mankind that alerts us to potential bodily danger, warning us to either stop an activity, or move our bodies away from a hazardous stimulus. At its most essential level, pain is just a reaction. But as we shall see, how our bodies experience that stimulus is not a direct “cause and effect” journey. Pain may begin with an exterior stimulus, but it is strongly and complexly influenced by physiological and psychological factors before it becomes part of our consciousness.

Questions and ruminations surrounding the nature of pain have occupied the minds of learned men for ages. It is said that the ancient Greeks comprehended pain as an emotion, but much later on the notion of pain as sensation took hold. Beginning in the mid-twentieth century, medical scientists started to understand that pain is really a combination of these two earlier interpretations. An experience of both sensation and emotion-  one that is highly subjective and discriminative.

Pain messages travel from receptors (Nociceptors) at the site of an injury and through the spinal cord to the brain stem. They are then relayed to the sensory, emotional, and cognitive regions of the brain where many factors are computed, and finally, your highly individualized experience of pain is perceived.

Though this process is still a lively area of research that continues to grow, a rough outline of the central nervous systems pathways, which mediate psychological aspects of pain perception, is beginning to be formed. It is becoming apparent that memories, emotions, thoughts, and particularly expectations, have an enormous effect on how each person experiences pain. Areas of the brain that channel emotion (the frontal and temporal lobes and the amygdala) directly interact with the brain’s pain controlling neural pathway.  Moreover, the regulation exerted by this pathway is bidirectional, meaning that it has the power to either reduce or enhance pain.

As far as the spectrum of pain tolerance goes, it seems not all individuals are created equal. Gender and ethnicity play a role- women and minority groups such as African Americans and Hispanics have shown a lower tolerance to pain in laboratory tests than Caucasian males. Genetic differences can account for up to 60 percent of pain tolerance levels in individuals as well, but the rest can be chalked up to cultural factors.

Interestingly, cultural influences related to ethnic identity such as religion, education or social expressiveness might bestow specific meanings on pain or suggest coping strategies. Such shared beliefs and practices may not only influence people’s outward expressions of pain; they may also sculpt the biological infrastructure that underlies the experience of pain.

Also, how an individual thinks of pain directly affects their pain tolerance and how much it “hurts” them. Masochists, for example, experience pain differently than most people because they associate painful behaviors with pleasure.

Ultra-competitive people or those who see athletics as empowering may find it easier to deal with pain because their minds perceive the pain sensation as akin to the idea of “weakness leaving the body.” Whereas those who do not enjoy exercise or who have suffered a previous injury are more likely to feel more pain because they associate it with a bother or a fear.

Wild animals, professional athletes, and soldiers are often able to overcome, or simply not feel, extreme pain while in the midst of heated action. In the case of the non-human animal kingdom, the animal’s system anticipates tissue damage, which would normally be painful, but being incapacitated by pain would lead to even greater injury; therefore, the animal has evolved the ability to dampen its perception of pain temporarily. This basis for animal’s reactions is being used as a template to figure out how humans achieve similar feats of strength in high-pressure situations.

As intriguing and newfangled as all this research is, it does actually have a very practical use. Being able to unravel an individual patient’s level of pain tolerance could lead to more accurate diagnosis, better pain prevention, and safer, more efficient painkillers. While findings on the precise makeup of the psychological aspects of pain experience are still being hotly debated, some of the current research does suggest the possibility that if we can understand the exact nature of pain then we might one day be able to teach ourselves how to have better control over it. It seems that in some cases, pain really can be a working illustration of mind over matter.

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