Pain and Suffering: Is It All in Your Head?

Pain is pain, regardless of the type or source. Even on a neurological level, emotional heartache can be every bit as painful as touching a hot stove.

Almost nothing is as familiar to us as the experience of pain. But just what pain is, what gives rise to it, and exactly what causes each one of us to experience it in such very different ways and degrees has been a matter of scientific inquiry and debate for a long time. And recently, some surprising research findings have begun to shed some new light on the nature of pain.

Regardless of its source or origin, pain is ultimately an experience of the brain, and all organisms with a central nervous system are now thought to be capable of experiencing some type and degree of pain. In its fundamental essence, the experience of pain is an unpleasant sensory event that generally serves the adaptive functions of either motivating us to avoid a potentially harmful situation or to keep a damaged part of our body safe and protected during any necessary healing process. For the most part, the ability to experience pain is essential to our survival. And recent findings suggest that regardless of its type or cause, a certain area of our brain plays a key role in the experience of pain.

For much of the recent past, pain that could be attributed to a diagnosed physiological cause was differentiated from “psychogenic” pain (i.e., pain thought to be either solely produced by or at least exacerbated by emotional or other psychological factors). And it was once fairly commonplace, even for medical practitioners, to trivialize the complaints of individuals whose reports of pain could not be immediately or firmly attributed to a “real” or detectable organic cause, and to dismiss the pain as “all in their heads.” Today, of course, we know that many of the complaints once regarded as purely “psychosomatic” actually have genuine physical underpinnings, although they might indeed at times be prompted or intensified by mental, emotional, or behavioral factors.

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A recent study conducted at the University of Michigan draws into question whether there’s sufficient foundation or practical reason to differentiate psychogenic from physical pain. (See “Social rejection shares somatosensory representations with physical pain“.) Researchers measured activity in a region of the brain thought to play a key role in the perception of pain. What they found was that subjects showed increased activity in that brain region regardless of whether the “source” of their discomfort was a “painful” physical stimulus to a tactile nerve receptor (e.g., being touched with a probe that felt “hot”) or the viewing and mental imaging of an emotionally-distressing scenario (specifically, looking at pictures of and thinking about a person with whom they had recently broken-up). To the brain, it seems, pain is pain, regardless of the type or source, and one cannot help but conclude that even on a neurological level, emotional heartache can really be every bit as painful as touching a hot stove burner with your hand.

We still have a lot to learn about pain and its role in helping us survive. We’ve come to appreciate that some pain can indeed be quite constructive, like the initial discomfort of vigorous exercise. But over time, enduring the pain builds stamina and strength, and promotes long-term health (hence the mantra: “no pain, no gain!”). But for individuals seemingly cursed with chronic unabated pain, such as in the case of severe arthritis, suffering appears to have no useful purpose and life can literally be a living hell. So, it’s often difficult to strike a balance between the need to tend to nature’s signals about something being amiss and attempt to correct the underlying cause of pain vs. simply improving the quality of life by ameliorating the pain itself, especially when a “cure” for the underlying cause is elusive. That’s why it’s always such tricky business for a physician to prescribe any of the powerful pain-relieving agents (including psychogenic pain-relieving agents) available today.

No matter how far we advance in our understanding of human suffering or in our medical sophistication in ameliorating it, life will probably never be totally pain-free. But every day we’re learning more about one of life’s most constant companions. So perhaps we are drawing ever nearer the day when the torment in our heads is truly out of mind.

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