BY KAI KAROS. Pain is a very personal and subjective experience. At the same time, pain is also constantly communicated to and interpreted by others, making it an interpersonal experience as well. This begs the question: Does pain affect our social relationships and can social relationships affect our pain?

Kai Karos

Overlap between feeling and seeing pain?

“I can feel your pain” is not only a popular saying to describe empathy for others, but it might literally describe how empathy works. We know that seeing others in pain relies on the same networks in the brain that are activated when we experience pain ourselves. Consequently, there might be an overlap between experiencing pain yourself and seeing it in others.

Putting it to the test

A new study that has been making headlines this year tried to put this idea to the test. Researchers from Ohio State University studied the effect of a common painkiller (Paracetamol) on empathy for others. They reasoned that if empathy relies on the experience of pain, diminishing the experience of pain might reduce empathy as well. In other words: If I cannot feel my own pain, I can also not feel someone else’s pain.
What did they do? They tested a total of 194 college students and randomly gave half of them Paracetamol and the other half a placebo. Then they had to complete three tasks:

• Participants had to read short stories about others being in physical pain (e.g. being cut by a knife) or psychological distress (e.g. losing someone you love).
• Participants watched others being excluded and their empathic concern was assessed.
• Participants also rated their distress in response to physical pain (i.e. loud noise) and had to estimate how distressing the same noise would be for others.

All in all, the effects were worrisome: Paracetamol did not only reduce the perception of pain, but it also reduced empathy for others. Participants who received Paracetamol not only rated painful noise blasts as less distressing, they also thought others would find them less distressing. Moreover, they were less distressed by the description of physical pain and psychological distress in others and showed reduced empathic concern for others being excluded.

Paracetamol did not only reduce the perception of pain, but it also reduced empathy for others.

Of course this study is only the beginning and further replications are needed but it does support the idea that the perception of physical pain is tightly linked to the perception of pain in others.

How does social context affect pain?

So far we know that our perception of pain can affect our social relationships. What about the other way around? It seems to be that the relationship goes both ways. Earlier studies have shown that being socially excluded can actually affect how we perceive physical pain: After being excluded by others we experience physical pain as more severe and distressing.

These findings are in line with research conducted in our own group in Leuven: We are investigating how a threatening social context can affect the perception of pain, how we think and feel about pain (e.g. how afraid we are of pain and as how threatening we perceive pain) and how we learn about pain (e.g. being able to predict pain). In a first study, we found that simply presenting participants with angry faces compared to happy faces while participants received painful stimuli, affected how well they were able to predict the occurrence of pain. In fact, a threatening social environment facilitated their ability to distinguish between threat (pain) and safety (no pain) (for more information, see here). While this ability might be beneficial in the short-term, it could become maladaptive when someone is exposed to a threatening social context for a longer period of time.

The experience of pain can affect how we feel about pain in others but at the same time our social environment can affect how we perceive pain ourselves

We are currently running a second study in which we place participants in a threatening or safe social context and look at their perception of pain. Can social context affect how we perceive pain itself? It seems so. Participants in a threatening social context perceive the pain as more threatening (e.g. to be associated with actual tissue damage) as well, even though the actual pain in the two contexts is identical. This finding shows that our social environment can directly affect how we perceive pain itself.

For better or worse

In summary, there seems to be a fascinating interplay between the perception of physical pain and our social environment. The experience of pain can affect how we feel about pain in others but at the same time our social environment can affect how we perceive pain ourselves, for better or worse. Eventually, this realization will hopefully be an integral part of treatment with the goal to harness the power of our social environment to facilitate treatment and recovery from pain.