Pain is a familiar experience for everyone, but its nature remains a troubling enigma for sufferers and scientists alike. Why do different patients who undergo the same surgical procedure experience markedly different post-operative pain? How is it that people with little or no medical explanation for a persistent pain become partially or totally disabled by it, even with extensive and resourceful treatment?
Many doctors would like to think of pain as a simple sensation that usefully calls disease or injury to our attention. But pain resists explanation as a simple sensation, just as music resists explanation as simple tones. A contemporary non-medical writer described the qualities of intense pain as including extreme unpleasantness, an ability to annihilate complex thoughts and other feelings, an ability to destroy language, and a strong resistance to objectification. She reminds physicians that, for the person suffering intense pain, what dominates awareness above all else is a powerful negative emotion.
Most of the time, pain occurs after simple nerve endings detect tissue injury in various ways and generate signals that travel to the spinal cord and from there to the brain. For many years, scientists thought that these signals traveled along a few well-defined routes to reach a relay station in the brain called the thalamus. From there, scientists believed, the signals went on to the part of the brain's cortex that managed body awareness, and somehow the cortex turned them into conscious experience. Unfortunately, the neural roadmap for sensory messages of tissue injury explains only a part of how we experience pain. It cannot explain why pain involves emotion and cognition.
Psychologists are quick to point out that whenever humans experience strong emotions, cognitions--thoughts, memories, expectations, beliefs, and interpretation of the situation--help form the experience. In other words, pain may
begin
with a neural message of tissue injury or disease, but it is the end product of complex events within the brain. The conscious experience of pain involves emotion and cognition as well as sensation. We always experience pain as a distressing thing happening in some part of the body, in some particular circumstance, and usually it has a particular meaning.
New evidence points to more complex mechanisms for pain that involve higher levels of the brain. Injury messages, it seems, travel to many brain structures, not just to sensation-generating areas. Some injury messages directly excite brain structures that produce emotion, and these in turn stimulate areas of the brain that create the meaning of the immediate situation. Pain emerges into awareness only after sensory, emotional, and cognitive processes have combined to form a coherent, integrated pattern of experience.
Studies of functional brain imaging in people experiencing pain tend to confirm this view. As we might expect, sensation-generating areas are active, but so are structures in emotion-generating areas of the brain and structures related to attention and thinking. Even motor structures that enable so-called "fight or flight" responses to a dangerous situation become active. Such studies show that simple signals of tissue injury generate many simultaneous brain processes. These processes combine to produce the private and unpleasant bodily awareness that we call pain.
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Because emotions and cognitions are an intrinsic part of the experience of pain, people differ greatly in their responses to a common injury, such as a standard surgical operation. Individual memory, beliefs, cultural background, and personal meaning all shape pain, so that an injury that is horrible to one person can be a minor discomfort to another. Psychological researchers are beginning to investigate why individual patients form the experience of pain differently when they experience similar tissue injury.
Why seemingly healthy body areas can hurt persistently, and thereby disable a person, still eludes explanation. Some researchers are finding that long-lasting injury signals in neural pathways can change the way those pathways function, and over long periods of time, relentless signals of injury can even alter neural structures themselves. The altered parts of the nervous system might keep generating injury messages, even after the original injury has healed.
Other researchers apply the same principle to higher levels of the brain. Memory of tissue injury rather than new messages of injury might contribute to the formation of pain, and in this way the brain might continuously create pain in the absence of its original cause. Alternatively, the brain might turn minor signaling of tissue injury into a major pain by mixing cognitive and emotional memories into the formation of the pain experience.
Research on pain is progressing on many fronts. Perhaps the most challenging is that of understanding how the brain integrates sensory, emotional, and cognitive processes when an injury occurs to form the complex bodily awareness that we know as pain. Unlocking this secret may help doctors prevent, treat, or eliminate some chronic pain disorders.
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Pain is a familiar experience for everyone, but its nature remains a troubling enigma for sufferers and scientists alike. Why do different patients who undergo the same surgical procedure experience markedly different post-operative pain? How is it that people with little or no medical explanation for a persistent pain become partially or totally disabled by it, even with extensive and resourceful treatment?
Many doctors would like to think of pain as a simple sensation that usefully calls disease or injury to our attention. But pain resists explanation as a simple sensation, just as music resists explanation as simple tones. A contemporary non-medical writer described the qualities of intense pain as including extreme unpleasantness, an ability to annihilate complex thoughts and other feelings, an ability to destroy language, and a strong resistance to objectification. She reminds physicians that, for the person suffering intense pain, what dominates awareness above all else is a powerful negative emotion.
Most of the time, pain occurs after simple nerve endings detect tissue injury in various ways and generate signals that travel to the spinal cord and from there to the brain. For many years, scientists thought that these signals traveled along a few well-defined routes to reach a relay station in the brain called the thalamus. From there, scientists believed, the signals went on to the part of the brain's cortex that managed body awareness, and somehow the cortex turned them into conscious experience. Unfortunately, the neural roadmap for sensory messages of tissue injury explains only a part of how we experience pain. It cannot explain why pain involves emotion and cognition.
Psychologists are quick to point out that whenever humans experience strong emotions, cognitions--thoughts, memories, expectations, beliefs, and interpretation of the situation--help form the experience. In other words, pain may begin with a neural message of tissue injury or disease, but it is the end product of complex events within the brain. The conscious experience of pain involves emotion and cognition as well as sensation. We always experience pain as a distressing thing happening in some part of the body, in some particular circumstance, and usually it has a particular meaning.
New evidence points to more complex mechanisms for pain that involve higher levels of the brain. Injury messages, it seems, travel to many brain structures, not just to sensation-generating areas. Some injury messages directly excite brain structures that produce emotion, and these in turn stimulate areas of the brain that create the meaning of the immediate situation. Pain emerges into awareness only after sensory, emotional, and cognitive processes have combined to form a coherent, integrated pattern of experience.
Studies of functional brain imaging in people experiencing pain tend to confirm this view. As we might expect, sensation-generating areas are active, but so are structures in emotion-generating areas of the brain and structures related to attention and thinking. Even motor structures that enable so-called "fight or flight" responses to a dangerous situation become active. Such studies show that simple signals of tissue injury generate many simultaneous brain processes. These processes combine to produce the private and unpleasant bodily awareness that we call pain.
Secure your copy of PS Quarterly: The Year Ahead 2025
Our annual flagship magazine, PS Quarterly: The Year Ahead 2025, has arrived. To gain digital access to all of the magazine’s content, and receive your print copy, subscribe to PS Digital Plus now.
Subscribe Now
Because emotions and cognitions are an intrinsic part of the experience of pain, people differ greatly in their responses to a common injury, such as a standard surgical operation. Individual memory, beliefs, cultural background, and personal meaning all shape pain, so that an injury that is horrible to one person can be a minor discomfort to another. Psychological researchers are beginning to investigate why individual patients form the experience of pain differently when they experience similar tissue injury.
Why seemingly healthy body areas can hurt persistently, and thereby disable a person, still eludes explanation. Some researchers are finding that long-lasting injury signals in neural pathways can change the way those pathways function, and over long periods of time, relentless signals of injury can even alter neural structures themselves. The altered parts of the nervous system might keep generating injury messages, even after the original injury has healed.
Other researchers apply the same principle to higher levels of the brain. Memory of tissue injury rather than new messages of injury might contribute to the formation of pain, and in this way the brain might continuously create pain in the absence of its original cause. Alternatively, the brain might turn minor signaling of tissue injury into a major pain by mixing cognitive and emotional memories into the formation of the pain experience.
Research on pain is progressing on many fronts. Perhaps the most challenging is that of understanding how the brain integrates sensory, emotional, and cognitive processes when an injury occurs to form the complex bodily awareness that we know as pain. Unlocking this secret may help doctors prevent, treat, or eliminate some chronic pain disorders.