Pavlovian Humans

Have you ever seen someone on crutches with a foot in a cast dragging behind them and realized your foot has spontaneously started to hurt?  When someone trips and falls, do you wince and react to their pain for them (unless it’s a classic pratfall that requires a discreet chuckle instead)?  While you recognize that your reactions to other people’s pain is really a phantom pain and it will fade as the immediacy recedes, this phantom pain does not mean you are a hypochondriac.  It means you are an empathetic human being.  We are, from a very young age, conditioned to respond to painful situations.  Very often, we know in advance what is going to hurt, and we can feel that pain response before the actual physical interaction takes place.  It started when you were a baby learning to walk and fell down, and mom hurried to pick you up and expected you to cry when you landed on your face, although babies are notoriously bouncy and resilient.  We learn when and how to react to pain.

The studies Madden et al (see library) studied in their meta-analysis really brush lightly on the tip of the human race’s pain conditioning.  There are psychological and psycho-social reactions to pain that were not addressed and probably cannot be addressed except on a case-by-case basis.  Still, their findings are interesting.  The study groups in all the studies discussed are healthy, non-chronic pain people.  Still the majority of the studies were able to indicate that people could be conditioned to feel pain more strongly when pain was expected.  People learned what would hurt and that knowledge made the pain increase.  The studies were less clear about whether pain could be induced by expectations, but there were some indications that it was possible.  In other words, after conditioning, people could generate pain from painless conditions.

To say that pain can be induced or amplified through fear of pain may be a fair statement.  We fear pain; we feel more pain.  Mildly paradoxically, fear under normal circumstances has been shown to reduce pain.  This seems like a description of situational fear, for example for a loved one, when we rush into physical danger to rescue them and then only an hour later realize we endured fire or took gunshots because the fear has diminished the perception of pain.  However, the two situations cannot really be compared.  Fear of something (as opposed to fear for something) always increases perception.  If you fear snakes, you see snakes.  If you fear drowning, you can feel like you’re drowning in a bathtub.  If you fear pain, you feel pain.

While fear of pain simply can’t explain fibromyalgia – I would argue that people with fibromyalgia grow to fear pain as the disease process progresses – it seems that fear of pain could greatly increase fibromyalgia symptoms, either because activities become too restricted or because the perception of pain is heightened.  One of the ways of controlling or managing fibro symptoms could simply be learning to rationalize the perception of pain.  It is not negating pain, it is not belittling the actual pain that people are enduring with fibromyalgia.  But if we can be conditioned to feel heightened pain, could we be conditioned to feel less pain?