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Key Concepts

• Most people think of pain as resulting from physical injury or disease, but psychological factors play a huge role in pain perception. Pain is intimately tied to brain functions that govern behavior and decision making, including expectation, attention and learning.
• Recent investigations are unraveling how factors such as expectation of reward or punishment, fear, stress and mood alter perceived pain intensity and affect our choices.
• Scientists are not only revealing just how far pain reaches into our psyches but are also using their findings to devise ways of better controlling pain and hastening recovery from painful injuries.

Several years ago an elderly man came into the emergency room at Cook County Hospital in Chicago with a large, painful abscess (boil) on the back of his neck. When I told him he needed a minor procedure to lance the boil and drain it, he became ashen, asking, “Doc, is this going to hurt?” I told him that if at any time the treatment hurt too much, he could tell me to stop—and I would. I opened the boil with a very sharp scalpel. He did not make a sound for some time. “When are you going to start?” he finally asked. “It’s done,” I said. “How did you do that?” he replied. “I didn’t feel anything.”

Most people think of pain as resulting from physical injury or disease, but psychological factors play a huge role in pain perception. In the case of my elderly patient, my reassurance that the treatment would not significantly worsen his pain—because he could stop me if it did—produced an analgesic effect. In addition, reducing the man’s fear enabled him to look forward to pain relief instead, and that positive expectation also eased his pain.

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