Pain: Symptom or cause?

The bad news is that the more we study pain, the stronger we find is the link between body and mind - that in more cases than previously believed, physical pain has mental pain at its root. The good news is that allows for more personal control of it with less costly medical intervention. If we can begin with compassion.

Dozens of studies during the last decade covered this subject, some outlined in prior columns. A handful in the last three years illustrate a social twist.

How we treat each other doesn't simply affect how we feel emotionally; it also affects what we feel physically.

Building on earlier studies showing how human connectedness, happiness, and social interaction affect physical health, disease risk, and life span, more recent research illustrates the connection between negative interactions and subsequent pain. With some surprising results.

"Our study is among the first to show in humans that the perception of physical pain can be immediately impacted by the types of social experiences that people have in their everyday lives," said Dr. Terry Borsook, author of a 2010 study at University of Toronto showing the influence of social interactions on patients' perception of pain.

In that study, healthy participants rated the intensity of painful stimuli before and after interacting with a trained actor who was instructed to be either friendly or indifferent. The surprise was that indifference didn't make things worse; if anything, perhaps better. After the indifferent social exchange, patients reported less sensitivity to pain, at least short-term. After the positive interaction, however, participants exhibited no change in pain sensitivity. Borsook attributed results to a fight-or-flight response, in which the body inhibits pain to increase response in a threatening situation.

Borsook told Science Daily that the results should be important to doctors and patients alike.

"Health practitioners who are aloof, lack understanding, or are generally unresponsive to patients may provoke an analgesic response resulting in underestimated reports of pain, with insufficient pain control measures being a possible consequence."

Indifference aside, pain from social rejection hurts the same as any other, according to a 2011 study at the University of Michigan. The same area of the brain becomes active in response to painful sensory experiences, such as spilling hot coffee on yourself, as it does during experiences of social rejection, such as thinking about a break-up. Previous studies suggested a shared emotional distress response in the brain, but this one was the first to show a neural overlap, using more than 500 MRI scans.

"These results give new meaning to the idea that social rejection 'hurts'," said social psychologist Ethan Kross, lead author of the article published in the Proceedings of the National Academy of Sciences. "These findings are consistent with the idea that the experience of social rejection, or social loss more generally, may represent a distinct emotional experience that is uniquely associated with physical pain."

This work was reinforced by a study published last month by Sissa Medialab, an international science school in Italy, which found that social pain activates brain circuits related to physical pain, whether we experienced it personally or vicariously as an empathic response. The Italian study also used MRI scans, but rather than using simulations with cartoon/static images, they used real people and videos with more complex - and thus, realistic - situations.

We don't need a study to remind us that pain (both types, or are they the same?) affects behavior. I wonder if anyone has done a study on bullies, schoolyard violence, and physical pain felt by young perpetrators (there are plenty which focus on victims of violence). Is there a scientific connection between feeling intense pain and causing it? I found no such study, but there is some evidence of the link between how children are treated socially and their physical symptoms.

A British study also published last month in the journal "Nursing Children and Young People" concluded that many children are admitted to clinical wards with mental health problems which are mistaken for physical disease. Somatic symptoms, such as abdominal pain, headaches, limb pain and tiredness, often mask underlying emotional problems, according to Britain's National Health Service. The study identified links to children's upbringing and home environments, including unstable home lives, "a chaotic upbringing" (e.g., shouting, violence, neglect, or lack of family structure), and parental over-protectiveness. The authors suggest that nurses are in an ideal position to identify these cases, ask questions, and provide holistic care, so medical provider training should be adapted to diagnose them, also likely saving money in unneeded medical care.

What's more important than how we treat one another? Nothing we do is without consequence, connection, or fails to touch another person - who eventually in turn, touches us.

"Never lose sight of the fact that the most important yardstick of success will be how you treat other people - your family, friends, and coworkers and even strangers you meet along the way." - Barbara Bush

Sholeh Patrick is a columnist for the Hagadone News Network. Contact her at sholeh@cdapress.com.