Pain Sensation and Pain Perception
Research has shown that there are multiple steps involved in the experience of pain and that pain is not a simple ‘Event-Reaction’ experience. While it may initially seem like a single physical event, psychological factors are involved, and a person’s beliefs and perceptions can heavily influence how pain is experienced.
When a painful event happens, e.g., stubbing a toe, there are several pathways and junctions that the body must use to ‘inform’ a person of the painful event. When I stub my toe, my nerves in that joint are activated. How intensely the nerves are activated depends both on (a) the severity of injury (how hard did I hit that toe?) and (b) the sensitivity of my nerves (how easily they are activated). Those activated nerves then send a signal to my spine, which then sends a signal for my brain. Again, the path between the toe and spine gives another opportunity for intensity to be affected by the body (the spinal gateway). When the brain finally receives the signal, it must be processed before we are fully aware of what has happened. While this is a very simplified version of events, it gives an idea of how and why an injury sends a signal to the brain.
All signaling feels instantaneous in experience, but it is actually just very fast. In fact, certain areas have set ups called ‘reflex arcs’ so that a possibly injured body part will move from danger before the brain gets the message and can react (e.g., bumping your shin kicks out your leg). This allows the body to avoid the step-by-step process of pain perception and protect itself. In full pain perception, the multiple points of pain signal transmission create opportunities for the body and mind to differ in the sensation of pain and the experience of pain. Each transmission point is an opportunity for the signal to be modified.
The Mind can Modify a Pain Experience
To give an example, take the pain of being pricked with a needle in your finger when you are paying attention versus when you are distracted. The pain of the same prick is vastly different for when you are focused (e.g., at the doctor’s office giving a blood sample) from when you are thinking of other things (sewing and prick your finger by accident). Even though it is technically the same injury, the attention your mind gives it creates a big difference in the processing the injury receives. A point of signal transmission (your mind) changes how that pain was ‘felt’. So while the sensation is the same (needle prick in finger) the processing is different, and thus the experience of severity of pain differs between the two.
While state of mind (current thoughts/moods) can affect pain processing, characteristics (enduring qualities) of a person can modify pain perception as well. Anxiety and depression can make individuals experience more intense pain than individuals without mood disorders. Genders differ in pain experience as well, though research varies in conclusions regarding these differences. Interpretation tendencies regarding pain (e.g., hypochondria) also affect how pain will be experienced.
Pain Experience Severity is affected by Pain Self-Efficacy
Pain self-efficacy is a characteristic that can affect how the mind experiences pain. Confidence in acting despite the pain and feeling capable of managing the pain while acting are both aspects that affect many mental mechanisms of processing pain. Attention, fear, expectations, etc. (regarding pain and activity), are all influenced by pain self-efficacy. Thus, it makes intuitive sense that a strong sense of pain self-efficacy would impact the minds processing of pain. Research supports this assumption.
Scientific investigation has shown that the experience of pain severity/intensity is affected by pain self-efficacy. In 2006, Meredith et al. executed a study with a sample of 152 chronic pain patients to examine the effects that pain-self efficacy and anxiety had on pain intensity (as well as disability). The group found that pain self-efficacy was a strong predictor of pain intensity, more so than anxiety, as well as being a good predictor of disability
(Meredith, 2006). The study supported that pain
self-efficacy should be considered when treating/managing pain and that it had
an impact on the physical experiences of a patient.
In a practical examination, another study focused on treating pain by improving patient pain self-efficacy beliefs. The researchers taught individuals cognitive methods of pain control and focused on strengthening perceived self-efficacy beliefs
(Bandura A. O., 1987). The groups in this
study were divided in both their exposure to cognitive methods to improve pain
self-efficacy, as well as whether they were given an opioid placebo or no
treatment at all. Those who were taught cognitive coping to strengthen their
pain self-efficacy far outperformed the others in both their
perceived self-efficacy and in the amount of pain they were able to tolerate.
Participants given placebos had a high initial perception of pain self-efficacy,
but this seemed to waver in the face of actual pain, meaning that the absence
of tools directly affected their ability to cope. Thus, building up pain
self-efficacy in a realistic and helpful manner has a direct impact on how pain
Numerous studies have investigated the impact of pain self-efficacy in regards to patient outcomes. In comparing outcomes for chronic lower-back pain patients undergoing rehabilitation, those with a higher sense of pain self-efficacy reported lower pain than their counterparts at a 6-month follow up assessment
(Altmaier, 1993). Another study showed that in long-term
outcomes, pain self-efficacy was a strong mediator of pain intensity changes
for chronic lower back pain over 12-months (and stronger than avoidance of
painful activities) (Costal, 2011). Other studies have also shown better
patient outcomes for those with whiplash injuries.
Perhaps most significant for this argument is the large meta-analytic review of multiple studies done by Jackson et al. this year. A meta-analysis takes the results of many different but related studies to statistically analyze the results to measure their consensus or differing meaning. In the review, researchers examined 86 studies for the relationship between self-efficacy and patient functioning (particularly pain severity). The results showed that self-efficacy was significantly associated with lower pain severity in chronic pain patients
(Jackson, 2014). This means that, in general, 86
studies found that a higher sense of self-efficacy predicted a reduced pain
What do these papers indicate? What does this relationship between pain self-efficacy and pain severity mean for you? It means that a person’s belief in their ability to do things despite the pain they are in helps to determine how much pain that person is in. This is even if you separate out the painfulness of their condition/reported pain—pain self-efficacy and pain intensity correlate with and interact with one another. Most importantly, it means finding a way to improve your sense of self-efficacy could reduce the severity of pain you experience.