11/7/84, Updated 11/5/01

Controlling Pain

David A. Gershaw, Ph.D.

There is a wide variation in responses to pain. Some people react minimally to a painful stimulus that would have others screaming in agony. What causes these differences? How can people reduce their sensations of pain?

Although pain is unpleasant, it serves a positive function in nature. It warns you of some process that is destroying your body, so you can stop it. In very rare instances, people are born without the ability to feel pain. Being burned or cut does not cause the same strong, negative reactions. For example, if you put your hand on a hot stove, pain would cause you to jerk your hand away immediately. However, a person, who feels no pain, would probably not react until he smelled his own flesh burning! Essentially, the complete lack of pain impairs a person's ability to survive.

You may think, "Okay, so I need some pain, but how can I reduce the amount I feel?" There are several factors that influence your perception of pain. Among these are selective attention, anxiety control and interpretation.

The perception of pain is relatively subjective.

Selective attention involves distracting yourself from the pain. Have you ever been in a fight? While in the fight, you are concentrating on dealing with your opponent. However, after the fight is over, and you are no longer paying attention to your opponent, you become very aware of the pain of many bruises, cuts and aches. These injuries occurred during the fight, but you were not aware of them until afterward.

This selective attention does not need to involve a fight. It is also very typical of participating in sports. Even becoming engrossed in a book or TV program can drastically reduce your perception of pain.

In addition, many psychological studies consistently find that high overall levels of anxiety or fear increase our feeling of physical pain. If you have an injury, you do not only have physical pain. You may also experience anxieties about paying medical bills, not being able to go to work or take care of the children, and so on. These anxieties will increase your perception of the pain.

In contrast to civilians, soldiers wounded in battle display a surprising insensitivity to pain. Why? Their anxiety is reduced. At least for a while, they will not have to go beck into combat.

Pain over which the person has no control is very upsetting. The loss of control seems to increase pain by increasing anxiety and emotional distress. People who are allowed to regulate, avoid or control a painful stimulus suffer less. In general, the more control that a people believe they have over a painful stimulus, the less pain is experienced. This may be the way a placebo works. (A placebo is a substance with no true remedial value like a "sugar pill.") Merely believing that you have something to control your pain reduces your anxiety. In turn, this reduces your pain.

The interpretation of the meaning given to a painful stimulus also affects your feeling of pain. We all have small pains now and then. If we interpret them as the minor discomforts of everyday life, the pain is minimized. However, if a twinge of pain is interpreted as a sign of a heart attack, anxiety will rise, and your attention to the pain will increase. This will intensify your feeling of pain.

All of these factors interact to determine how much you feel the pain. This can be illustrated with training for "natural" childbirth. ("Natural" childbirth minimizes the use of drugs or other painkillers during the birth process.) In her training, the prospective mother learns what to expect during her labor. This reduces her anxiety tremendously. She is given methods of breathing and pushing to concentrate on during labor. This causes selective attention toward what she has to do and gives her a feeling of greater control over the birth process. With this reduction of anxiety and feeling of control, birthing is interpreted as a more positive process.

If these factors can be used to reduce the pain of childbirth, you can adapt the same methods to reduce any pain you might feel without using drugs.

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