Pain is something we all share. Virtually everyone can recall minute details around a painful event, even if it happened decades ago. Our brains are wired for this, with a strong emotional component, which makes some pain literally “hard to forget.” Powerful memories associated with pain often lead to strong avoidance behaviors - like never wanting to bend over and pick up anything (or anyone) out of fear of eliciting a back spasm. In the short term this is ok, but after a while, this can lead to maladaptive pain-related fears that heighten and perpetuate the pain cycle and distances us from activities and people we enjoy and give our lives meaning.
Yet each of us responds slightly differently to pain and we can each respond differently to the same painful event at different times in our lives. One person's overlooked skinned knee can become another's chronic joint pain, but precisely what causes this wide variation is a topic of significant controversy.
Some provocative research suggests that two key emotions, fear and anticipation, could explain much of the person-to-person variability in how much pain we feel, how it affects us, and even how long pain hangs on. Ultimately, these insights can provide us with strategies on how to effectively reduce pain.
Fear of pain is a normal human response with powerful evolutionary benefits. We are designed for self-preservation, so making pain "hard to forget" makes complete sense in that it helped us avoid potentially dangerous and harmful threats. But in modern times, fearing pain has also become a cultural norm in our society, as we have come to largely consider pain as bad, or something terribly wrong with our bodies. For sure, sometimes pain can indicate a physical problem that needs attention, but far too often people reflexively reach for all sorts of painkillers and invasive treatments, assuming that whatever removes pain must be the right thing to do. In today’s society, rather than a natural phenomenon, pain is often viewed as our ultimate nemesis and this can have consequences on us.
When we react to pain with disproportionate fear and interpret it as "wrong or dangerous" we set off an emotional chain reaction that can sometimes snowball. Fear itself is made up of unpleasant sensations, and can act to further compound pain. Quickly, we can find ourselves not only focusing on getting out of the pain which initially triggered the avalanche, but also on an additional pain - that is, the fear. It turns out that the fear of pain can frequently become the most unpleasant part of a painful experience. When we evaluate a physical sensation as just that, it is nothing more than pain and more often than not can be tolerated. However, when we bring the fear element into the mix, it becomes something far more threatening in the primordial part of our mind, something that is a danger to our existence. The brain alarm goes off, “Hey, we need to get out of here now!”
To investigate the association between fear and pain and potential mechanisms for this, researchers at Stanford University used functional magnetic resonance imaging (fMRI) technology that detailed the brains in human subjects while they were receiving fluctuating levels of pain stimuli via a heat probe applied to their forearm. (The heat was never enough to cause tissue damage, but just strong enough to be sensed as painful.)
In the study, the scientists also administered various detailed psychological tests, such as the Anxiety Sensitivity Index questionnaire, to quantify each individual’s anxiety levels and predetermined beliefs about pain. For example, they measured whether each person may interpret a sore belly as an indication they had stomach cancer or more likely had just eaten some bad pizza. Another questionnaire, the Fear of Pain Questionnaire, quantified each subject’s fear level for various sorts of physical pain ranging from a paper cut to a broken neck.
Then the questionnaire scores were compared with the neural activity in particular regions of the brain seen on the MRI scans. Remarkably, the researchers saw that there was a significant association between the fear levels of subjects and a specific area in their brain called the right lateral orbital frontal cortex. This is the region of the brain that when stimulated attempts to gauge how strong a painful stimulus may be and how to respond.
Additionally, there was also a strong relationship between pain-related anxiety levels and a brain region called the medial prefrontal gyrus—the area of the brain dealing with self-focused attention about the body. This is the brain region that continuously scans the body for things that may be wrong.
The study also found that there is significant variability in how the subjects perceive pain and that these differences correlated with each individual’s degree of fear and anxiety around pain. Their future areas of research are now focusing on determining the best techniques for how people can temper pain-related fear and anxiety in order to better control pain.
When we are able to recognize that being alive comes along with feeling some pain, occasionally intense pain, we can begin to move away from fear and towards acceptance and that can significantly reduce pain. Oftentimes, the degree to which we suffer (or don't suffer) is related to the amount of tension and pressure which we place on ourselves.
The Buddha taught that we suffer when we cling to or resist experience, when we want life to be different than it is. And as some have aptly put it: "Pain is inevitable, but suffering is optional."
Techniques for Decreasing Fear of Pain
There are many different ways to do this, and you will find the ones that work best for you. Often, simply understanding this fear-pain phenomenon and how it impacts us helps dial back the fear. Dealing with pain isn’t easy for sure, but you can improve when you reduce your fear and your excessive focus on pain by practicing some self-management techniques:
- Always remember that you have the pain and not the other way around. You are in control of the pain; it does not have you.
- Get comfortable using visual imagery that you create, your personalized detailed situation. See yourself in your mind as pain-free, feeling well, whole and at ease, along with the positive emotions that accompany that image.
- Become familiar with mindfulness techniques and trust in your mind’s clout over your body. Mindfulness has been described many ways but one is “paying attention to something on purpose and with fresh eyes.” For people suffering from chronic pain, mindfulness can provide relief by “turning down the volume” of the secondary pain related to fear and anxiety. You can imagine that mindfulness sooths the part of the brain that generates the fear. While all of the biological properties of mindfulness are still being studied, its positive benefits on pain and mood are already well known.2
- Make positive affirmation or what some call “mantras.” When you sense yourself becoming fearful of a circumstance (your body usually gives you clues like chest palpitations or “butterflies in your stomach”). When this happens, begin repeating positive slogans to yourself (or out loud) such as “I can do this” or “I am tougher than this pain.” Continue repeating these affirmations over and over while also focusing on slow, deep, steady breathing. The positive mantras along with the relaxing breathing will give you confidence and help you push past your fears.
- Start believing that moving your body, even if there is some pain, will ultimately help make it stronger and less painful. Get back to doing the physical activities that you enjoy most with the people close to you. This will rebuild confidence in yourself and combat fear.
- Find a practitioner who understands this important aspect of pain to work with you.
- Pain. 2006 Jan; 120(1-2): 69–77.