See Inside September / October 2009

MIND on Pain: The Psychology of Pain

Our expectations, mood and perspective on pain powerfully influence how much something actually hurts—and the decisions we make every day

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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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