Cognitive Factors in Pain Perception

Pain is defined as the "unpleasant sensory and emotional experience with actual or potential tissue damage or described in terms of such damage" (Lincoln, 2003). Nearly everyone on the planet can relate a story of feeling pain, from cutting hands while cooking, to breaking a leg playing sports, etc. Most of us also associate a certain type of pain to a certain type of injury, for example associating a stinging pain to paper cuts, and a gnawing pain to a burn. Because we're able classify pain, we're also able to imagine what a certain painful sensation would feel like, which often prevents people from acting irrationally or in a dangerous manner. In general, we know what a burn feels like, and as such, avoid other situations in which a burn might occur (i.e. we use oven mitts when pulling something out of the oven or off the stove, we use skewers and the like when pulling food from an open fire, etc). Part of this has to do with the psychological role in pain perception. While the body may make it seem as though the feeling of pain is pure limited to the area or areas of the body affected, in fact the brain has a great deal to do with pain perception and how we cope with pain (Scheman, & Covington, 2005).

The psychological factors influencing pain include: early experience, anxiety about the pain, depression, helplessness, locus of control, and perceived self-efficacy.

The first of these, early experience, deals with the pain that individuals experience early in life, and how they cope with these experiences early in life. When you got your first vaccination shot, did you scream? Cry? Did you actually think it painful? Do you recall the event as being a terrible experience? The psychology of pain suggests that this experience will continue to affect your experience of needle pricks. Interestingly enough, this also plays a part in another factor that influences pain, anxiety and depression. According to Scheman (2005), how we feel is less determined by events than by our interpretation of them. As such, having anxiety about a particular event (such as anxiety about getting a vaccination or having blood taken) will cause it to feel as though it hurts more than it actually would if the anxiety did not exist.

In contrast, depression causes people to feel less sensitive to pain. A study by Dickens, McGowan, and Dale (2003) found that "depressed subjects are less likely to perceive sensory stimulus as being painful as compared with nondepressed controls." This phenomena is thought to be attributed to how much attention one pays to the painful sensory stimulus. According to Goldstein (2010) relayed a story in which burn victims were given virtual reality games before dressings were changed (a notably painful procedure). Those burn victims responded to the virtual reality distraction in noting that they experienced less pain during the dressing changing. Thus, if we pay less attention to the pain we're experiencing, it actually works to make it hurt less. This is the same manner in which depression causes desensitization to pain allowing for more pain to be experienced before it is noted by the individual experiencing it.

Helplessness and locus of control are the next two factor affecting pain perception. One's locus of control describes whether an individual attributes the events of their life to their own behavior or to the world around them. Individuals who believe that their own behaviors control their lives have an internal locus of control, while those who believe that other people and events control their "fate" have an external locus of control (Scheman, 2005). An external locus of control fosters feelings of anxiety and depression (as well as feelings of helplessness), and thus affects pain accordingly (as mentioned in previous sections of this piece). Similarly, self-efficacy affects pain because it puts more power into the individual's hands, thus reducing the sensation of pain. This phenomena has a great deal to do with what the individual is putting their attention on, and how they are choosing to address their situation.

References

Dickens, C., McGowan, L., & Dale, S. (2003). Impact of depression on experimental pain perception: A systematic review of the literature with meta-analysis. Psychosomatic Medicine, 65, 369-375.

Goldstein, E. (2010). Sensation & perception, 9th ed. Belmont: Wadsworth.

Lincoln, N. (2003). Pain. Retrieved December 1, 2009, from http://www.psychology.nottingham.ac.uk/staff/nbl/c82app/Pain.pdf

Scheman, J., & Covington, E. (2005). Psychological factors in pain. Spinal Column. N/A.
http://cms.clevelandclinic.org/spine/documents/SpinalColumnF05.pdf

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