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Pain is a reaction of the body to an objectively measurable stimulus. How we sense pain subjectively, whether we rate it as merely unpleasant or as unbearable depends on more factors than just physical reactions. Apart from individual characteristics, environment also plays a considerable role. How social support, relationships and empathy influence pain and which psychological mechanisms can explain such effects is being examined by an international and interdisciplinary research team. Potsdam-based social-cognitive psychologist Anne Springer is a member of this team. Sabine Sütterlin spoke with her.
“Why Love Hurts: The Social Modulation of Pain”: The unusual title of your research project immediately arouses curiosity. What is this project about?
We proceeded from the repeatedly reported connection between pain and social factors. Since the 1970s, it has been known that patients ask for fewer painkillers after an operation if they have been mentally prepared for and informed about the potential pain. Labor pain is another example. Studies in the 1980s showed that it also depends on the empathy of the partner and midwife during childbirth. In an earlier project, we basically looked at social influences on experiencing pain. We were interested in the underlying mechanisms of this effect, which is still fairly open from a psychological and neuroscientific point of view. In contrast to many previous studies, we have not only explored mere correlations but have also pursued an experimental approach. The current project “Why Love Hurts” was established on the basis of the older project. It focuses on the influence of humans or animals to whom we have a close emotional relationship. Our project title addresses this point. A lot of loving kindness and attention can even intensify pain.
The international project team includes researchers from various disciplines: neuroscientist Aikaterini Fotopoulou from University College London and philosopher Verena Gottschling from York University in Toronto, Canada. You are a social-cognitive psychologist who researches at the Department of Sport and Health Sciences of the University of Potsdam. How does such cross-border collaboration come about, and how does it work?
We met at a workshop in Döllnsee near Berlin in 2006 that had been kickstarted by the Volkswagen Foundation as part of their initiative “European Platform for Life Sciences, Mind Sciences and the Humanities”. The aim of the program is a more intensive exchange among young researchers who work at the intersections of cognitive neurosciences and the humanities and social sciences. Over the course of cluster projects, the hope is that participants develop new interdisciplinary questions for joint research and overcome the interdisciplinary borders. Each of us applied with her own project proposal. During a workshop, we discussed the imagined topics from the perspectives of various disciplines. After two days in Döllnsee, the original constellations had become quite mixed up. New teams had formed, including ours. After that, the groups elaborated proposals for new research projects. These were evaluated by an international academic committee and were, in the best case, approved.
Why are you interested in pain at all?
Pain is a central issue in medicine. Chronic backache is obviously the secondmost common reason why people see a doctor. The general German health insurance provider AOK names it as the most common reason for inability to work. In Germany, chronic backache is estimated to cost the state up to 22 billion Euros annually, an enormous sum. In other European countries, the situation is similar. The more precisely we understand pain and the involved mechanisms, the better we can treat it. The puzzling aspect of pain is the specific combination of physical sensation of an objectively measurable stimulus with the subjective emotional component. In other words, pain is much more than just a mere physical signal. We therefore cannot understand it solely from a medical perspective. Individual and interpersonal factors also play a considerable role. Exactly these factors are increasingly coming into the focus of neuroscientific and psychological pain research. Our studies should help to better understand how relationships between individuals can influence pain, i.e. what the role of interpersonal relations is. It is also important to better understand the decisive individual characteristics. Our results are therefore important for those with chronic pain and their relatives, for medical as well as other fields like pain management, physiotherapy, psychotherapy or care. Even children can suffer from chronic pain like backache.
At the beginning of the current project, which ends in 2014, you first recorded the state of knowledge.
In a recently published overview article we have described all available experimental studies that had analyzed, for example, how the presence of others, their behaviour, empathy or even their physical proximity to the sufferer can influence pain perception. We found 26 articles altogether, comprising a wide range of different social factors and collected pain reactions. As a result, we were able to ascertain that the modulation of pain seems to depend on the extent to which present social partners can actively support the sufferer or at least have the opportunity to give active support by getting help. It is also important if and to what extent the sufferer is aware of the intended actions of others. The relationship between the test person and observer was significant – unknown, related or one’s own partner. Based on our findings, we assume that social interactions in situations of pain are seen as cue stimuli signaling “safety” or rather “danger”. As a consequence, others can increase or reduce the intensity of painful stimuli.
And how do you experimentally investigate this?
We exposed our test subjects to a quite artificial kind of pain. We ask them to put their hands into a bucket of cold water (3°C). The advantage of this is that we can systematically manipulate and control in the laboratory the external factors that interest us. From the measured effects of pain perception, we can draw specific conclusions about the factors that substantially influenced the pain. A good example is an experiment that we have recently submitted for publication. For this, the participants were asked to bring along either their dog or a good friend. A third group was alone in the lab during the cold-water task. Apart from that, the test conditions were identical, and the systematic differences in assessing the pain should reflect only the presence or absence of the dog or friend. The next exciting question was which direction the effect would go and whether the pain would be stronger or alleviated.
Dog or friend – who did better?
In fact, dogs seem to help more than good friends do. Our test subjects rated the stimulus, i.e. the contact with the icy cold water, as less painful if they had their dog with them compared to being alone or with a good friend. They also stated that they felt less helpless and could hold their hands in the cold water for longer than other participants. Interestingly, their unconscious, that is, genuine physical reactions, like skin conductance or tension of the masticatory muscle, were reduced. Our results suggest that one’s own dog can have especially positive effects on handling acute pain and can support the person suffering from pain even more than a human friend could. Our three test groups were as comparable as possible. All test subjects had a pet with a similarly close relationship to him or her. They were also similar in terms of their experience with painful situations and handling of the cold-water task. Thus, all these factors cannot explain the observed “dog effect”. We assume that the unconditional and completely value-free love of a pet toward his or her caretaker positively influences the human’s emotional state in painful situations.
So, more pets in hospitals?
Since we have examined only healthy test subjects so far, we cannot generalize these findings for pain patients. We can nevertheless assume that pets can contribute to the treatment of pain. It may be possible that contact to a pet can be therapeutically reasonable if medical or other traditional forms of treatment are not or only limitedly applicable for pain. There have been many successful examples with children in cases of ADHD or anxieties, among others. We have already planned a study with test subjects suffering from chronic backache to test the influence of pets on them as well.
Can human consolation also have an effect?
Yes, of course! Our experiments so far suggest, though, that the presence of others does not necessarily have positive effects on the experience of pain in all cases. The effect others have on pain obviously depends on their empathy and the kind of social relationship they have with the sufferer as well as on the individual style of bonding and the strategies the sufferer uses to handle pain. An example: People who tend to avoid social relationships show less pain when exposed to unpleasant stimuli alone rather than in the presence of others. People who have a greater need for bonding endure pain better if there is an empathic observer in the room compared to a less empathic one. This was proven by a study of our project published in 2010.
Regarding the neuroscientific side: How does the brain ensure that love hurts or helps?
In a series of studies conducted in London, we alsolooked at how such social influences are processed in the human brain and in turn how such processing affects the subjective experience of pain. We used neuroimaging and electrophysiological methods to study how the presence and empathy of our own partner may affect our pain and we found that the brain achieves this by increasing processing in areas that are known to map the salience or importance of events for the organism. For example, when our partners seem emotionally concerned about our pain, the brain decides that the organism needs to attribute self-attention and care to that body part. Finally, we have also investigated the neurobiology of the social context of pain, by studying how pain is affected when healthy individuals are given a safe quantity of a neuropeptide called oxytocin which is known to increase affiliative feelings and social trust, and is linked to physiological processes involved in many social activities such as birth, lactation and sex. We found that intranasal oxytocin administration decreased both the subjective experience of pain and the corresponding electrical activity in the brain. These studies suggest that pain is subject to social influences and not a mere, direct outcome of damage to the body and importantly provide the first key steps in understanding the neurobiological mechanisms by which social factors influence subjective pain.
“Why Love Hurts: The Social Modulation of Pain”
The social-cognitive psychologist Dr. Anne Springer has been at the University of Potsdam since 2010. She has worked on the interdisciplinary project “Why Love Hurts: The Social Modulation of Pain” that she founded in cooperation with neuroscientist Dr. Aikaterini Fotopoulou of University College London, the principal investigator of the team, and philosopher Dr. Verena Gottschling of York University in Toronto. In the meantime, some external partners have joined the project, including psychologist Professor Ursula Hess of Humboldt Universität, Berlin, and Yannis Paloyelis, Charlotte Krahe, Matt Howard and Steve Williams from King’s College London. The VW Foundation funds the project that started in 2011 and is planned for a four-year period.
Department Sport- und Gesundheitswissenschaften
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Text: Sabine Sütterlin, Online-Editing: Agnes Bressa, Translation: Susanne Voigt