Contact: Mustafa al’Absi, PhD
For Release: Immediately
With chronic pain such a huge public health problem—affecting about one in five adults— research to understand it and reveal ways to lessen its awful impact is desperately needed.
Some novel, cutting-edge findings in the field of pain are highlighted in a special November/December issue of Psychosomatic Medicine, journal of the American Psychosomatic Society. The studies focus on three themes: risk factors for chronic pain; how our expectations shape pain perception; and potential non-drug ways that our bodies can lessen pain. An introductory overview is given by issue co-editors Lauren Atlas, PhD, of the National Institutes of Health, and Prof. Mustafa al’Absi, PhD, the Max and Mary LaDue Pickworth Chair at University of Minnesota Medical School.
When something painful happens, the brain receives pain signals and in turn tells us, “You hurt,” but our past experiences can amplify or lessen these pain messages sent from the brain, new studies suggest. “What happened to us yesterday can render our brains less effective in coping with problems today,” says al’Absi. Sexual assault survivors and adults with serious childhood hardships (such as abuse, alcoholic or imprisoned parents) are known to suffer more chronic pain than peers without these experiences.
In a study comparing reactions of adults who were sexually assaulted with adults never assaulted, scientific measurement of nerve activity showed that equal levels of pain stimulation in the participants’ bodies resulted in the assault survivors describing the pain as significantly worse. The brain can naturally activate its own pain-reducing “machinery,” which evidently may not work as effectively in adults with a sexual assault history, says al’Absi.
In another study comparing adults with traumatic childhoods to others without such trauma, painful stimulation on the skin sent a “hurt” signal to the brain more quickly in those with the troubled childhoods; these adults also showed heightened sensitivity to the pain for a longer period of time, and reactions over a larger area of the skin. Not surprisingly, people with troubled childhoods are at greater than average risk for high use of opioids.
Turning to ways of reducing pain, early imaging studies and some clinical experience suggest that expressing painful emotions unrelated to pain, for example in therapy, actually can lessen physical pain. The theory is, when the brain doesn’t voice emotional pain, the awareness of pain comes out another way. “If you don’t know how to express the effects of early life stress, it can manifest in experiencing greater physical pain—that’s what some researchers think,” says al’Absi. This line of research is at a very early stage.
The brain’s striking power to temper pain is clear from studies on experienced meditators and on how expectations can alter how much discomfort we feel. New findings with meditators show their ability to minimize the experience of pain isn’t due to release of opioids, so the natural pain relief afforded by meditation doesn’t work through the same mode as currently overused opioid drugs. Intense inner focus and distraction probably explain the pain lessening, al’Absi speculates. “The brain has something like a gate with only so much space, and when it’s focused strongly elsewhere, less of the pain may come through.”
Other studies informing participants beforehand that a procedure will or won’t hurt confirm that expectations create a strong effect on how much pain we feel. Medical professionals “absolutely” should act on the mounting evidence of positive placebo power for therapies, including conditions causing pain, he adds.
Pain studies so far typically include small samples. Given the crisis in pain treatment we face, it’s time to take the research to the next level, says al’Absi. We need larger studies, clinical trials and work across disciplines—physiology, psychology and psychiatry, neuroscience, as well as pharmacology.
The American Psychosomatic Society (APS) (http://www.psychosomatic.org),
founded in 1942, is an international multidisciplinary academic society that conducts an annual scientific meeting and educational programs. Psychosomatic Medicine is its scientific journal. The membership of over 700 is composed of academic scientists and clinicians in medicine, psychiatry, epidemiology, health psychology and allied health services. The mission of the APS is “to advance and integrate the scientific study of biological, psychological, behavioral and social factors in health and disease.”