Is emotional pain important

Pain and sensation of pain

Pain is our only connection to reality.
Joseph Conrad


According to studies by American psychologists, the same center is activated in the brain for emotional or social pain as for physical pain: the "Anterior Cingulate Cortex"(ACC). This area is an alarm system that excites the brain when the body reports pain anywhere - and also when the emotion reports pain. The pain itself is of course different with a broken leg than with a broken heart, but brain activation goes the same way.

In an experiment, students - who were sitting in magnetic resonance machines - were allowed to play the computer game "Cyberball", in which three players throw balls at each other on the screen. The test subjects believed they were playing with other people, but a computer actually simulated the opponents. In a first phase, the test subjects were not allowed to play (ostensibly because of technical problems), then they were allowed to (phase II), but the computer was programmed in such a way that it soon stopped throwing them and only kept the two other "players" busy (Phase III), so that the subjects felt injured and excluded.

In phases I and III, the ACC's brains lit up brightly, but only in phase III - the socially and emotionally disgusting exclusion - did another brain center in the right prefrontal cortex shine, which directs the ACC excitement and searches for reactions, such as they are common with physical pain. Apparently, the social-emotional suffering was linked to the mechanism of the physical very early on, because a social connection was necessary for survival. If the ACC is destroyed in hamster mothers, they no longer take care of their young, young monkeys with a destroyed ACC do not cry out for their missing mothers.

It has therefore been known for a long time from animal experiments that the same neuronal and biochemical systems cause soul pain that also mediates physical pain, with the neurons involved in this process transmitting control signals Opioid receptors so that the body's own morphine is released to relieve physical pain. According to recent studies, the same is true of the social pain experience gene (OPRM1 gene), which also regulates physical pain, whereby a certain percentage of the population has a variant of this gene in which the base guanine is located at one point on the DNA strand section instead of the base adenine. The carriers of this gene variant react more sensitively to certain physical pain stimuli and also to social pain stimuli.

The perception of pain as a physical response to social crisis situations can presumably ensure that people feel their social ties maintained, whereby the social system has probably "borrowed" some mechanisms of physical pain perception in the course of evolution.

That people have painful experiences in their Pain memory save, makes biological sense, as it enables them to avoid painful experiences that can potentially be a threat to life and limb in the future. Some people very often talk about their pain experiences, for example with their doctor or therapist. Psychologists at the University of Jena (Richter et al., 2010) used functional magnetic resonance imaging to investigate how people's brains process words that are associated with the sensation of pain (such as "excruciating", "grueling", "plaguing"). In order to rule out that the reactions are based solely on the negative affect, the test subjects were played not only painful words but also other negative words such as "scary", "disgusting" or "disgusting". It was shown that not only painful experiences and associations that alarm the pain memory lead to activation, but verbal stimuli alone trigger activation. Negative words and neutral or positive words, on the other hand, did not activate these brain regions. Obviously, talking about pain increases the activity of the pain matrix in the brain, thus increasing the pain felt, so it is better not to talk about pain too often.

According to research, about ten percent of all people who become one develop surgery undergo, then a chronic pain syndrome, although there are risk factors that make this syndrome more likely. Previous studies have already shown a positive association between the fear of expected pain and the actual acute pain after an operation, often in connection with severe preoperative pain. Sultansei et al. (2018) have now only examined surgical patients without preoperative pain. More patients who showed an increased level of anxiety and stress processing prior to the operation tended to show postoperative pain than those who were less anxious about the procedure. A connection could also be seen with the severity of the postoperative acute pain, because those who suffered from severe pain immediately after an operation were more likely to have chronic pain for six months afterwards. Most of those affected saw the operation itself as the main cause of their chronic pain, especially those who were not fully convinced of the necessity of the procedure and felt urged to do so by doctors, subsequently developed a less favorable pain process. This confirms that a perceived injustice can have a negative impact on the recovery process. The investigation makes it clear, however, that psychological factors are related to the development of pain after an operation.

Sensation of pain

The pain is a biological protection mechanismwhose signal always takes precedence over other stimuli on its way to the brain. Receptors send a pain signal to the spinal cord, the central nervous system then forwards the pain stimulus to the brain, where the signal is processed in very different ways. The path of the pain stimulus also provides information about why everyone perceives pain differently. For example, the path of the pain stimulus can be passed through Medication influence, for example at the dentist, who uses local anesthesia to prevent the pain from reaching the brain in the first place. Some people develop little or no pain sensation from birth due to a special genetic makeup.

British scientists observed the brain waves in 46 premature babies between 28 and 45 weeks of age when blood was drawn from the heel for a routine test. Up to the age of 35 weeks, the same unspecific activity patterns emerged in the brain when the premature infants had to endure the stab in the heel or when someone just tapped with a reflex hammer. It was only after the 35th week that the toddlers' brains began to process the two stimuli in different ways. Obviously, the brain has to reach a certain maturity in order to be able to separate between pain and touch.

Studies (Krause et al., 2019) showed that Lack of sleep increases the human perception of painso one should take sleep much more seriously in therapies. According to an investigation, the activity of the somatosensory cortex, which processes pain sensations, among other things, increases by 126 percent after a sleepless night, while the reward center in the brain (nucleus accumbens) and the region responsible for evaluating pain signals (insular cortex) are less active. A lack of sleep not only increases the pain-sensitive areas of the brain, but also blocks the centers that make pain more bearable.

Every pain sensation is ultimately one emotional response based on an assessment in the brain and can therefore be controlled individually for each person. Because the human brain can learn that a certain pain is not that important, at least in part it reacts to pain by getting used to it. It is therefore also possible to train how to evaluate pain. Recent research shows that physical pain already exists after a few minutes psychological effects can show. In one study, the backs of the hands of test subjects were exposed to heat stimuli for ten minutes, the intensity of which varied greatly, and the pain stimuli had to be continuously assessed on a scale. The subjective perception of the participants changed significantly after just a few minutes, while the objective stimulus remained unchanged; In other words, the subjective perception was detached from the objective stimulus after just a few minutes. Presumably, the longer the pain lasts, over which develops Emotions a stronger pain sensation, because in this experiment emotional areas in the brain became active, so that if the pain lasts for a longer period of time, it obviously changes from a pure perception process to a more emotional process.

In children it has been shown that the fear of pain is often greater than the pain itself. If children injure themselves easily, the expression of pain also depends on the pain Reaction of parents from. Parents should therefore never panic if the child is injured, as this can under certain circumstances increase the sensation of pain. Confidence, on the other hand, makes the child feel that an injury is not bad, which often reduces the pain significantly.

As studies have shown, verbal stimuli also lead to an activation in the corresponding brain areas, because as soon as people hear words such as "tormenting", "grueling" or "troubling", precisely those regions in the brain are activated in which the pain is processed ( see Richter et al., 2010).

Also Placebo drugs Without a pharmaceutical effect, it is known that they can change the perception of pain.

For real extreme situations, the body itself provides the most powerful pain relievers by causing the brain to release Endorphins and adrenaline In the event of a traffic accident, endorphins ensure that you can still move your legs in order to get out of the car despite a break. Such endogenous pain relievers can also be triggered by your own imagination with sufficient exercise. However, if you want to influence the perception of pain in the long term, it is best to learn not to fear the pain and not to evaluate it as worse than it actually is.

At least in mice, a hormone docking point (melanocortin-4 receptor) was found at which negative sensations such as fever, pain and nausea can be transformed into positive ones, since there apparently pleasant and unpleasant perceptions are processed equally in the brain (Klawonn et al., 2018). If this receptor is blocked, these animals no longer perceive unpleasant experiences as negative, but are even experienced as positive. The brain apparently has a neuron connection (Arcuate nucleus), in which both positive and negative perceptions are processed under the control of a single type of receptor. This may have been important in evolution in order to quickly change the perception of certain environmental stimuli if necessary. It is not yet clear whether this mechanism also exists in humans. For people, however, this could be of particular clinical relevance, because with chronic inflammatory diseases, the level of suffering caused by malaise is often very great, leads to a loss of motivation and increases the risk of depression.

annotation: For Immanuel Kant the pain was the "sting of all activities" for Friedrich Nietzsche a "liberator of the mind", so that many creative people also appreciate pain as a source of ideas. Sigmund Freud Suffered from severe migraines, which he initially saw as a symptom of repression, i.e. a neurotic complaint. In order to be able to analyze himself as precisely and intensively as possible, Freud refused to take tablets and developed a philosophy of resignation in order to be able to accept pain without complaint, whereby he was able to work best with "Mittelelend": "I draw it is preferable to think clearly in agony and prefer to suffer ".

Mental pain

But probably not just getting physical pain as a biological protection mechanisms on their way to the brain always takes precedence over other stimuli, but also emotional pain and stress. However, these are often expressed in the form of concentration disorders and also accidents, as these increasingly disrupt the automated execution of life from the unconscious and demand their right to "attention". Some people are literally eaten up by such burdens and keep brooding over their fate. The term “emotional pain” often conceals a form of psychosomatics, i.e. the connection between psyche and body, which is also expressed in formulations such as “this gives me a headache”, “it is my kidneys” or “it gives me a stomachache " shows. It is therefore important to take mental pain just as seriously as physical. The person whose body reacts to problems of daily life with pain is not a hypochondriac, not a simulant, but rather a normal (physiological) reaction swa organism. B. toothache have a function, namely to signal the affected person to do something or to change.

Chronic and recurring pain changes the brain

Studies have now shown that not only chronic, but also cyclically recurring pain can change the neuronal structures in the brain, e.g. also Menstrual pain. In women with regular menstrual cramps, recurring pain reduces the areas of the brain that are responsible for the transmission of pain, the higher-level processing of sensory stimuli and affect control, and increases the volume of the relevant gray matter in areas for pain modulation and regulation of endocrine functions.


Klawonn, Anna Mathia, Fritz, Michael, Nilsson, Anna, Bonaventura, Jordi, Shionoya, Kiseko, Mirrasekhian, Elahe, Karlsson, Urban, Jaarola, Maarit, Granseth, Björn, Blomqvist, Anders, Michaelides, Michael & Engblom, David (2018 ). Motivational valence is determined by striatal melanocortin 4 receptors. The Journal of Clinical Investigation, 128, 3160-3170.

Krause, Adam J., Prather, Aric A., Wager, Tor D., Lindquist, Martin A. & Walker, Matthew P. (2019). The pain of sleep loss: A brain characterization in humans. The Journal of Neuroscience, doi: 10.1523 / JNEUROSCI.2408-18.2018.

Richter, M., Eck J., Straube, T., Miltner, W.H.R. & Weiss, T. (2010). Do words hurt? Brain activation during explicit and implicit processing of pain words. Pain, 148 (2), 198-205.

Science 2003, 302, p. 290.

Sultansei, L., Clasen, K. & Hüppe, M. (2018). Preoperative anxiety and postoperative pain are risk factors for persistent pain. Behavioral Therapy & Behavioral Medicine, 39, 269-282.

Further literature

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