Wouldn't it be wonderful 🌟 never to experience pain 🤕, many people have thought when they or others they have known were suffering 😢. Pain hurts 😖, and people typically dislike it 😣 and try to avoid it 🙅♂️. But being able to sense pain 👁️ is critical to our survival 🛡️—without it, how would we know when we are injured 🤕? We could have a sprained ankle 🦶 or an ulcer, for instance, without realizing it 🤔, and not seek treatment 🏥. And how would we know we are about to be injured ⚠️, such as when we approach a hot flame 🔥 without seeing it 👁️? Pain serves as a signal 🚨 to take protective action 🛡️.
Are there people who do not feel pain ❓ Yes—several disorders can reduce or eliminate ❌ the ability to sense pain 🤕. People with a condition called congenital insensitivity to pain 🚫🤕, which is present from birth 👶, may report only a "tingling" or "itching" sensation when seriously injured 🤕. A young woman 👩 with this disorder seemed normal in every way ✅, except that she had never felt pain 🚫🤕. As a child 👶 she had bitten off the tip of her tongue 👅 while chewing food 🍽️, and had suffered third-degree burns 🔥 after kneeling on a hot radiator to look out of a window 🪟. When examined by a psychologist 👨🔬, in the laboratory 🔬, she reported no pain 🚫 when parts of her body were subjected to strong electric shock ⚡, to hot water 🌡️ at temperatures that usually produce reports of burning pain 🔥, or to a prolonged ice-bath ❄️. Equally astonishing was the fact that she showed no changes in blood pressure 🩸, heart rate ❤️, or respiration 😮💨 when these stimuli were presented. Furthermore, she could not remember ever sneezing 🤧 or coughing, the gag reflex could be elicited only with great difficulty ⚠️, and the cornea reflexes 👁️ (to protect the eyes) were absent ❌. This disorder contributed to her death ☠️ at the age of 29.
People with congenital insensitivity to pain 🚫🤕 often die young 👶☠️ because injuries 🤕 or illnesses 🤒, such as acute appendicitis, go unnoticed 🙈.
Health psychologists 👨🔬 study pain 🤕 because it influences whether individuals seek 🔍 and comply with medical treatment 🏥 and because being in pain can be very stressful 😰, particularly when it is intense 💥 or enduring ⏳. In this and coming lectures we will examine the nature 🔬 and symptoms of pain 🤕, and the effects it has on its victims when it is severe 😖. As we consider these topics, you will find answers to questions you may have about pain. What is pain 🤕, and what is the physical basis for it 🧬? Can people feel pain when there is no underlying physical disorder ❓ Do psychosocial factors 🧠 affect our experience of pain? Since pain is a subjective experience 💭, how do psychologists 👨🔬 assess how much pain a person feels 📊?
What is Pain? 🤕❓
Pain 🤕 is the sensory 👁️ and emotional 😢 experience of discomfort 😣, which is usually associated with actual or threatened tissue damage 🧬 or irritation. Virtually all people experience pain 🤕 and at all ages 👶👧🧑👴—from the pains of birth 👶 for mother and baby 👩👶, to those of tummy ache 🤰 and teething 🦷 in infancy 👶, to those of injury 🤕 and illness 🤒 in childhood and adulthood. Some pain becomes chronic ⏳, as with arthritis, problems of the lower back 🦴, migraine headache 🤕, or cancer 🎗️.
People's experience with pain 🤕 is important for several reasons. For one thing, no medical complaint is more common than pain 📈. According to researcher Paul Karoly 👨🔬, "pain is the most pervasive symptom in medical practice 🏥, the most frequently stated 'cause' of disability ♿, and the single most compelling force underlying an individual's choice to seek or avoid medical care 🏥" (1985, p.461). As we know that people are more likely to seek medical treatment 🏥 without delay ⏱️ if they feel pain 🤕. Also, severe and prolonged pain 😖⏳ can come to dominate the lives of its victims 😞, impairing their general functioning 📉, ability to work 💼, social relationships 👥, and emotional adjustment 😢.
Last, pain has enormous social and economic effects 💰 on all societies 🌍 of the world. In the United States 🇺🇸 at any given time, a third or more people suffer from one or more continuous or recurrent painful conditions 🤕 that require medical care 🏥, and tens of millions of these people are partially or completely disabled ♿ by their conditions. Americans spend tens of billions of dollars 💵 each year on pain-related expenses 📈, such as for treatment 🏥, loss of income 💰, disability payments 💳, and litigation ⚖️.
The Qualities and Dimensions of Pain 🎨🤕
Our sensations of pain 🤕 can be quite varied and have many different qualities 🎨. We might describe some pains as "sharp" 🗡️ and others as "dull" 📉, for example—and sharp pains can have either a stabbing 🗡️ or pricking feel. Some pains involve a burning sensation 🔥 and others have a cramping, itching 🐛, or aching 😣 feel. And some pains are throbbing 💓, or constant ⏱️, or shooting ⚡, or pervasive 🌐, or localized 📍. Often the feelings we experience depend on the kinds of irritation or damage ⚠️ that has occurred and the location 📍. For instance, when damage occurs deep within the body 🧍♂️, individuals usually report feeling a "dull" or "aching" pain 📉; but damage produced by a brief noxious event to the skin 👤 is often described as "sharp" 🗡️.
The painful conditions people experience also differ in how the pain originates 🔬 and how long it lasts ⏳. We will consider two dimensions that describe these differences, beginning with the degree to which the origin of the pain can be traced to tissue damage 🧬.
Organic Versus Psychogenic Pain 🧬 vs 🧠
People who suffer physical injuries 🤕, such as a serious burn 🔥, experience pain that is clearly linked to tissue damage 🧬. When discomfort is caused mainly by tissue damage, it is described as organic pain 🧬. For other pains, no tissue damage appears to exist ❌—at least, medical examinations 🏥 fail to find an organic basis 🔬. The discomfort involved in these pains seems to result primarily from psychological processes 🧠. For this reason, this type of discomfort is described as psychogenic pain 🧠. I once witnessed an extreme example of psychogenic pain in a schizophrenic man 🧑: he claimed—and really looked like—he was "feeling" stings from being "shot by enemy agents 🔫 with laser guns 🔴."
Not long ago, researchers 👨🔬 considered organic 🧬 and psychogenic 🧠 pain to be separate entities, with psychogenic pain not involving "real" sensations. As pain researcher Donald Bakal 👨🔬 has noted, a practitioner's 🧑⚕️ reference to pain as "psychogenic" 🧠 was taken to mean "due to psychological causes 💭," which implied that the patient was "imagining" 💭 his pain or that it was not really pain simply because an organic basis 🧬 could not be found. Psychogenic pain 🧠 is not experienced differently, however, from that arising from physical disease 🤒 or injury 🤕. Psychogenic and organic pain both hurt 🤕.
Researchers 👨🔬 now recognize that virtually all pain experiences involve an interplay 🔄 of both physiological 🧬 and psychological 🧠 factors. As a result, the dimension of pain involving organic 🧬 and psychogenic 🧠 causes is viewed as a continuum 📊 rather than a dichotomy ⚖️. Different pain experiences simply involve different mixtures 🎨 of organic and psychogenic factors. A mixture of these factors seems clear in the findings that many people with tissue damage 🧬 experience little or no pain 🚫🤕, others without damage report severe pain 😖, and the role of psychological factors 🧠 in people's pain increases when the condition is long lasting ⏳. When people experience chronic pain ⏳🤕 with no detectable physical basis ❌, psychiatrists 🧑⚕️ diagnose the condition as a pain disorder (classified within somatoform disorders) and often assume the origin is mainly psychogenic 🧠. Keep in mind, however, that failing to find a physical basis 🔬 for someone's pain does not necessarily mean there is none ⚠️. Unfortunately, many health care workers 🧑⚕️ still think pain that has no demonstrated physical basis is purely psychogenic 🧠, and their patients struggle to prove that "the pain isn't just in my head 🧠, Doc" (Karoly, 1985).
Acute versus Chronic Pain ⏱️ vs ⏳
Experiencing pain either continuously ⏱️ or frequently over a period of many months or years ⏳ is different from having occasional and isolated short-term bouts with pain 🤕. The length of experience ⏳ an individual has had with a painful condition is an important dimension in describing his or her pain.
Most of the painful conditions people experience are temporary ⏱️—the pain arrives and then subsides 📉 in a matter of minutes ⏱️, days 📅, or even weeks, often with the aid of painkillers 💊 or other treatments prescribed by a physician 🧑⚕️. If a similar painful condition occurs in the future 🔮, it is not connected in a direct way to the earlier experience. This is the case for most everyday headaches 🤕, for instance, and for the pain typically produced by such conditions as toothaches 🦷, muscle strains 💪, accidental wounds 🤕, and surgeries 🏥.
Acute pain ⏱️🤕 refers to the discomfort people experience with temporary painful conditions that last less than 6 months ⏰ or so. Patients with acute pain often have higher than normal levels of anxiety 😰 while the pain exists, but their distress subsides 📉 as their conditions improve 📈 and their pain decreases 📉.
When a painful condition lasts for more than 6 months ⏳, it is called chronic ⏳🤕. People with chronic pain continue to have high levels of anxiety 😰 and tend to develop feelings of hopelessness 😞 and helplessness 😔 because various medical treatments 🏥 have not helped ❌. Pain interferes ⚠️ with their daily activities 📅, goals 🎯, and sleep 😴; and it can come to dominate their lives 😖. Pain patients 🤕 frequently say that they could stand their pain much better if they could only get a good night's sleep 😴... They feel worn down 😫, worn out 😩, exhausted 😴. They find themselves getting more and more irritable 😠 with their families 👨👩👧, they have fewer and fewer friends 👥📉, and fewer and fewer interests 🎯. Gradually, as time goes by ⏳, the boundaries of their world seem to shrink 📉. They become more and more preoccupied 🧠 with their pain 🤕, less and less interested in the world 🌍 around them. Their world begins to center around home 🏠, doctor's office 🏥, and pharmacy 💊.
Although pain itself 🤕 can interfere with sleep 😴, intrusive thoughts 💭 and worry 😟 before getting to sleep may be a more important factor ⚡. Another problem of people with chronic pain ⏳ is that many leave their jobs 💼🚪 for emotional 😢 and physical reasons 🧍♂️ and must live on reduced incomes 💰📉 at the same time that their medical bills 💵 are piling up 📈. The experience of pain 🤕 is very different when the condition is chronic ⏳ than when it is acute ⏱️.
The effects of chronic pain ⏳🤕 also depend on whether the underlying condition is benign ✅ (harmless) or is malignant ⚠️ (injurious) and worsening 📈 and whether the discomfort exists continuously ⏱️ or occurs in frequent and intense episodes 💥. Using these factors 📊, researchers have described three types of chronic pain 3️⃣:
- Chronic-recurrent pain 🔄🤕 stems from benign causes ✅ and is characterized by repeated and intense episodes 💥 of pain separated by periods without pain 🚫🤕. Two examples of chronic-recurrent pain are migraine headaches 🤕 and tension-type (muscle-contraction) headaches 😣.
- Chronic-intractable-benign pain ⏳🤕✅ refers to discomfort that is typically present all of the time ⏱️, with varying levels of intensity 📊, and is not related to an underlying malignant condition ✅. Chronic low back pain 🦴 often has this pattern.
- Chronic-progressive pain ⏳📈🤕 is characterized by continuous discomfort ⏱️, is associated with a malignant condition ⚠️, and becomes increasingly intense 📈 as the underlying condition worsens 📈. Two of the most prominent malignant conditions that frequently produce chronic-progressive pain are rheumatoid arthritis 🦴 and cancer 🎗️.
As we shall see later in this lecture and in the next one, the type of pain people experience 🤕 influences their psychosocial adjustment 😢 and the treatment 🏥 they receive to control their discomfort 💊.
Perceiving Pain 👁️🤕
Of the several perceptual senses 👁️👂👃 the human body 🧍♂️ uses, the sense of pain 🤕 has three important and unique properties 3️⃣. First 1️⃣, although nerve fibers 🧠 in the body sense and send signals ⚡ of tissue damage 🧬, the receptor cells for pain are different from those of other perceptual systems 👁️, such as vision 👁️. For instance, the visual system 👁️ contains specific receptor cells that transmit only messages about a particular type of stimulation—light 💡—there are no specific receptor cells in the body that transmit only information about pain 🤕. Second 2️⃣, the body senses pain 🤕 in response to many types of noxious stimuli ⚠️, such as physical pressure 💪, lacerations 🩹 and intense heat 🔥 or cold ❄️. Third 3️⃣, the perception of pain almost always includes a strong emotional component 😢. As we are about to see, perceiving pain 🤕 involves a complex interplay 🔄 of physiological 🧬 and psychological 🧠 processes.