The Complex Landscape of Pain: Why Our Experiences Differ

I. Introduction: The Enigma of Pain – Setting the Stage
Pain, a seemingly universal experience, presents a profound paradox: while it serves as a vital alarm system, its intensity and impact vary wildly among individuals, even in response to similar injuries. It is a phenomenon that is both deeply personal and globally ubiquitous, prompting a deeper scientific inquiry into its mechanisms and manifestations. The central premise explored in this article, mirroring the focus of the Guardian article from July 13, 2025, is “The fascinating science of pain – and why everyone feels it differently”. This immediately establishes the article’s dual focus: delving into the intricate biological underpinnings of pain and exploring the profound subjective variations in its perception.
A compelling illustration of this paradox is the extraordinary account of John Sattler from the 1970 rugby league grand final. As the leader of the South Sydney Rabbitohs, Sattler entered the match with immense pressure, seeking redemption after his team’s loss in the 1969 final. The opportunity for glory was palpable, and the team was determined to seize it. Early in the game, Sattler sustained a shattered jaw during a tackle, an injury that would typically be incapacitating. Yet, remarkably, he continued to play, completing the grand final despite the severe physical damage. This anecdote powerfully demonstrates that pain is not merely a direct, proportional response to tissue damage. If pain were solely a physical input, such an injury should have immediately rendered him unable to continue. Instead, his ability to perform suggests that pain is not just a sensation received by the brain, but rather an output or construction of the brain itself. The brain appears to determine whether and how much pain to generate based on a multitude of inputs, including the immediate context, the perceived threat, and, crucially, the individual’s motivational state. As the article states, “When it comes to suffering, perspective is everything”. This foundational understanding shifts the focus from a simplistic “where does it hurt?” to a more complex “why does it hurt this way for this person?”, laying the groundwork for exploring the multifaceted influences on pain perception.

II. Pain: More Than Just a Sensation – A Multifaceted Experience
Expanding beyond a simplistic view, pain is formally defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” This definition is critical because it immediately highlights that pain is far more than just a physical sensation, like touch or temperature. It is a complex, subjective experience that inherently involves sensory, emotional, cognitive, and motivational components. Evolutionarily, pain serves a vital protective function, driving individuals to withdraw from harmful stimuli and promoting behaviours that facilitate healing. It is an essential survival mechanism, alerting the body to danger and prompting necessary action.
To fully grasp the intricate nature of pain and its variability, the prevailing framework is the biopsychosocial model. This model posits that pain is not solely a product of biological factors, but rather an emergent phenomenon influenced by a dynamic interplay of biological elements (such as genetics, tissue damage, and neurophysiology), psychological factors (including thoughts, emotions, and coping strategies), and social factors (like cultural background, social support networks, and environmental context). This holistic perspective is indispensable for accounting for the wide spectrum of individual differences observed in pain experiences. The explicit linking of “fascinating science” with “why everyone feels it differently” in the article’s title underscores that a purely biological explanation is insufficient to account for the observed variations. The scientific understanding of pain must therefore encompass not only physiology but also psychology and sociology. The integration of these diverse domains within the biopsychosocial model represents a significant scientific advancement that explains the profound differences in individual pain experiences. This comprehensive view reveals that understanding pain necessitates moving beyond a narrow biomedical lens to appreciate its complex properties arising from the interplay of multiple systems, which is fundamental for developing effective and compassionate pain management strategies.

III. The Biological Underpinnings of Pain Perception
At the core of the biological experience of pain lies nociception, the physiological process by which noxious, or potentially damaging, stimuli are detected. This process involves specialised sensory neurons, known as nociceptors, which are activated by intense mechanical, thermal, or chemical stimuli. These signals are then transmitted to the central nervous system. It is crucial to differentiate nociception, which is the physiological process of detecting and transmitting noxious stimuli, from pain, which is the subjective, conscious experience of discomfort. The journey of a pain signal typically begins at the peripheral nociceptors, travels via the spinal cord, specifically through the dorsal horn, and ascends to various regions within the brain.
The brain’s processing of pain is not confined to a single “pain centre” but rather involves a distributed network often referred to as the “pain matrix.” Key brain regions contribute distinct aspects to the pain experience. The somatosensory cortex is involved in localising the pain and determining its intensity. The insula plays a role in the emotional and interoceptive awareness of pain, contributing to the feeling of “unpleasantness.” The anterior cingulate cortex is implicated in the emotional and cognitive aspects, including the motivational drive to escape pain, while the prefrontal cortex contributes to cognitive modulation, decision-making, and the overall interpretation of the pain experience. This intricate network highlights the profound complexity of pain processing within the central nervous system.
Furthermore, a complex array of neurotransmitters and neuromodulators plays a critical role in facilitating or inhibiting pain signals at different levels of the nervous system. Neurotransmitters like substance P and glutamate facilitate pain transmission, while others, such as GABA, can inhibit it. Neuromodulators, including the body’s endogenous opioids (endorphins), serotonin, and norepinephrine, are crucial components of the body’s intrinsic pain-modulating systems, which can either amplify or dampen pain signals.
Individual pain thresholds and tolerance are also influenced by genetic predispositions. Variations in genes coding for ion channels, opioid receptors, and inflammatory mediators can predispose individuals to different pain sensitivities or even to the development of chronic pain conditions. Conditions related to blood disorders, such as haemophilia, which often involve joint pain, can manifest unique pain experiences due to underlying biological mechanisms. This reinforces the significant role of biological factors in shaping an individual’s pain experience. However, while these biological foundations are crucial components of the “fascinating science of pain” , they are not entirely deterministic. Genetic predispositions or specific biological conditions might influence the capacity for pain, but they do not fully dictate the subjective experience. There is a biological predisposition or capacity for pain, but the actual experience is profoundly modulated by other factors. This sets the stage for understanding the critical interplay between “bottom-up” biological signals and “top-down” psychological and social modulations, explaining why two individuals with similar biological injuries might report vastly different levels of pain.

IV. Psychological and Social Modulators of Pain
Beyond the biological circuitry, psychological and social factors profoundly shape pain perception, demonstrating how the brain’s “perspective” truly comes into play. The individual’s state of mind and their broader social environment exert a powerful top-down influence on how nociceptive signals are processed and ultimately experienced.
Mood and emotion are significant modulators. Conditions such as anxiety, depression, fear, and chronic stress can amplify pain signals, lower pain thresholds, and prolong pain experiences. The brain, when in a state of heightened emotional distress, may interpret incoming signals as more threatening, thereby increasing the perceived intensity of pain. Conversely, positive emotions, a sense of safety, or states of calm can sometimes mitigate pain, demonstrating the reciprocal relationship between emotional well-being and pain perception.
Attention and expectation also play a critical role. When an individual’s attention is focused intently on their pain, its intensity can be amplified. Conversely, distraction, whether through engaging activities or mental exercises, can significantly reduce perceived pain. The placebo and nocebo effects serve as powerful demonstrations of how expectations alone can profoundly alter pain perception. If an individual expects a treatment to relieve pain (placebo), they may experience genuine relief, even if the treatment is inert. Conversely, if they anticipate negative effects (nocebo), their pain may worsen. Past experiences and learning also contribute to an individual’s pain profile. Previous painful encounters, especially traumatic ones, can “prime” the nervous system, leading to heightened sensitivity, a phenomenon known as central sensitisation, where the nervous system becomes overly responsive to pain signals. Furthermore, an individual’s coping strategies significantly influence their pain experience. Active coping mechanisms, such as problem-solving, seeking social support, or engaging in physical activity, can reduce the impact of pain and improve functionality. In contrast, passive coping strategies, like catastrophising (exaggerating the negative aspects of pain) or avoidance behaviours, can exacerbate pain and contribute to chronicity.
The social and cultural fabric surrounding an individual also profoundly influences pain. Cultural norms dictate how pain is expressed, interpreted, and managed. What is considered stoic endurance in one culture might be viewed as excessive suffering or a call for immediate intervention in another. These cultural scripts shape an individual’s willingness to report pain, their coping behaviours, and their expectations of treatment. Social support, or its absence, is another critical factor. Feeling understood, validated, and supported by family, friends, or healthcare providers can significantly reduce distress and enhance coping mechanisms. Conversely, social isolation or a lack of validation can worsen pain and contribute to feelings of helplessness. The broader environmental context, such as being in a safe, supportive hospital environment versus a chaotic or threatening battlefield, can also dramatically alter pain perception, further reinforcing the idea that “perspective is everything”. The brain does not merely receive pain signals; it actively interprets them through the lens of an individual’s psychological state, their past experiences, and their current social environment. This “top-down” modulation can either amplify or diminish the “bottom-up” nociceptive signals originating from tissue damage. This dynamic interplay between mind and body explains why two individuals with identical physical injuries might report vastly different levels of pain, underscoring the necessity of moving beyond purely pharmacological pain treatments towards multidisciplinary approaches that address the whole person, including their mental health and social circumstances.

V. Why Pain is Personal: Exploring Individual Differences
The profound variability in pain experience, captured by the article’s central question of “why everyone feels it differently” , is the culmination of the intricate interplay between biological predispositions, psychological states, and social contexts. Pain is not a simple input-output mechanism but an emergent property of a complex, dynamic system, making each individual’s experience truly unique. The brain integrates all available information – sensory input, past memories, current emotions, future expectations, and social cues – to construct a personal meaning of the pain. This personal meaning then dictates the intensity, unpleasantness, and overall impact of the pain. The John Sattler anecdote, where his brain prioritised the goal of winning over the raw nociceptive input from a shattered jaw , perfectly illustrates this capacity for the brain to construct an experience based on overarching goals and context.
Consider two hypothetical scenarios that highlight these divergent pain experiences:
* Scenario 1: Two individuals present with identical lower back disc herniations, confirmed by imaging. One, a highly anxious person with a history of trauma and limited social support, experiences debilitating, chronic pain that significantly impairs their daily life. Their pain is amplified by fear of movement, catastrophising thoughts, and a sense of helplessness. The other individual, an optimistic person with strong social support, effective coping strategies, and a positive outlook, experiences manageable, acute pain that resolves relatively quickly with targeted physical therapy. Despite identical physical injuries, their pain journeys are vastly different due to their psychological and social landscapes.
* Scenario 2: A child experiences a minor scrape on their knee, while an adult sustains a similar superficial injury. The child’s pain might be amplified by fear, a lack of understanding of the injury’s benign nature, and a desire for comfort, leading to intense crying and distress. The adult, drawing on past experiences and learned stoicism, might downplay the pain, quickly apply a plaster, and continue with their activities, perceiving it as a minor inconvenience.
To further clarify the nuances of individual pain, it is helpful to distinguish between pain threshold and pain tolerance. Pain threshold refers to the minimum intensity of a noxious stimulus that is perceived as painful. This is largely a physiological measure, indicating the point at which nociceptors are activated and signals reach conscious awareness. In contrast, pain tolerance is the maximum intensity or duration of pain that a person is willing or able to endure before withdrawing or seeking relief. Pain tolerance is highly subjective and significantly influenced by psychological and social factors, such as motivation, emotional state, cultural background, and prior experiences. This distinction helps to explain why people “feel it differently” – while their pain thresholds might be similar, their tolerance for enduring that pain can vary widely.

VI. Implications for Pain Management and Empathy
A deeper understanding of pain’s inherent individuality is fundamentally transforming pain management, moving away from a simplistic “one-size-fits-all” approach towards more personalised, multidisciplinary strategies. Effective pain assessment now extends beyond merely identifying physical symptoms to comprehensively evaluating psychological distress, social circumstances, and individual coping styles. This holistic approach recognises that treating pain effectively requires addressing the whole person, not just the physical injury. Consequently, modern pain management often integrates pharmacological treatments with a range of non-pharmacological therapies, including psychological interventions such as Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT), physical therapy, and social interventions aimed at improving support networks and environmental factors.
Given the subjective nature of pain, the crucial role of empathy and validation in clinical settings and everyday interactions cannot be overstated. Because pain is a personal construction, validating an individual’s experience, even when objective physical findings are minimal or disproportionate to the reported pain, is paramount for building trust and facilitating recovery. Dismissing someone’s pain, for instance, by suggesting “it’s all in your head,” can exacerbate distress, erode trust in healthcare providers, and ultimately hinder effective treatment. Such dismissal invalidates the individual’s lived experience, which is a real and impactful phenomenon, regardless of its underlying physical pathology.
Furthermore, a better understanding of the complex aetiology of pain can help address the significant societal challenge of invisible pain, such as chronic back pain or fibromyalgia. These conditions often lack clear objective markers, leading to skepticism and stigma. By acknowledging that pain is a complex output of the brain influenced by a multitude of biological, psychological, and social factors, society can move towards reducing this stigma and fostering greater support for those affected. The scientific insights into pain’s multidimensionality directly lead to the necessity of a holistic, patient-centred approach to pain management. This means moving beyond solely treating the “injury” to treating the “person” experiencing the pain. Moreover, the subjective nature of pain necessitates a fundamental shift towards greater empathy and validation, particularly for chronic conditions where physical pathology may not fully explain the reported pain. This understanding bridges the gap between theoretical scientific knowledge and its real-world application, advocating for more effective, humane, and patient-centred pain care.

VII. Conclusion: Towards a Holistic Understanding of Pain
The exploration of pain reveals it to be a complex, dynamic, and profoundly personal experience, shaped by an intricate interplay of biological, psychological, and social factors. The “fascinating science” of pain lies precisely in unravelling this complexity and comprehending why “everyone feels it differently”. It is not merely a signal of tissue damage but a sophisticated output of the brain, influenced by a myriad of internal and external cues.
Circling back to the compelling case of John Sattler, whose ability to play a grand final with a shattered jaw highlighted that “When it comes to suffering, perspective is everything”. This perspective is not merely a mental state; it is an emergent property of the entire biopsychosocial system, where motivation, context, and the brain’s interpretation of threat and reward can profoundly alter the experience of pain.
Ongoing research in pain science, including advancements in neuroimaging, genetic studies, and the development of integrated care models, continues to deepen our understanding of this multifaceted phenomenon. This evolving knowledge holds broader societal significance, informing healthcare policy, promoting public education, and fostering a more compassionate and nuanced approach to pain in daily life. Ultimately, the journey into the science of pain reveals not just the mechanics of discomfort, but the remarkable adaptability, resilience, and inherent complexity of the human experience itself. This scientific understanding empowers both individuals experiencing pain and those who provide care for them, paving the way for more effective and empathetic support.

Manage Longstanding Low Back Pain by Spending Time in Nature

Study Overview

The article “Being away from everything”: Exploring the importance of access to nature for individuals living with chronic low back pain, published in the Journal of Pain, investigates how nature can aid in managing chronic low back pain (cLBP). It involved ten semi-structured interviews with people averaging 50.1 years old and living with cLBP for about 19.1 years.

Key Findings

The study found that nature can provide distraction, reduce isolation, and offer a calming environment, enhancing pain self-management. However, many face challenges like physical disabilities, environmental hazards, or lack of proximity to natural spaces. It suggests integrating nature-based activities into treatment plans and exploring virtual reality for those unable to access nature.

Detailed Analysis and Background

The article presents a pioneering qualitative cross-sectional study focused on understanding the role of natural environments in managing chronic low back pain (cLBP). The study, conducted and published in June 2025, addresses the growing evidence against the effectiveness of ‘one-size-fits-all’ pharmacological approaches, advocating for alternative non-pharmacological therapies such as green social prescribing and spending time in nature.

Methodology and Participants

The research methodology involved ten semi-structured interviews, primarily with women (9 out of 10 participants), with an average age of 50.1 years and an average duration of living with cLBP of 19.1 years. This qualitative approach aimed to explore the lived experiences of individuals, providing deep insights into their coping strategies and the role of nature in ameliorating pain. The analysis was conducted using Reflexive Thematic Analysis, identifying two main themes: (1) Importance of Nature and (2) Inaccessible Nature, each with four subthemes respectively.

Key Findings and Themes

The theme “Importance of Nature” underscores the benefits of accessing natural environments, which can significantly aid in self-management of cLBP. Participants reported that being in nature offered distraction, reduced feelings of isolation, and provided a calming environment, which helped alleviate pain and improve mental well-being. For instance, those able to immerse themselves in larger green spaces, such as forests, felt more positive, as they could lose themselves in the environment and focus less on their pain levels.

However, the theme “Inaccessible Nature” revealed significant barriers, including physical disabilities, environmental obstacles or hazards, and geographical limitations. These challenges often undermined the ability to access nature, highlighting an unmet clinical need. The study emphasizes that many individuals encounter substantial obstacles, such as uneven terrain, limited seating, or difficulties leaving their homes, making it challenging to benefit from the restorative properties of nature.

Implications and Recommendations

The findings suggest that integrating nature-based activities into treatment plans could be beneficial, offering a promising avenue for improving overall well-being for those with cLBP. The researchers recommend exploring virtual reality interventions to simulate nature experiences for those unable to access outdoor spaces, addressing accessibility issues. This approach could help make the benefits of nature accessible to everyone, potentially through technological innovations. Simple changes, such as better paths and seating, were also suggested to enhance real-world access.

The study marks the first qualitative investigation focusing directly on the nuanced role of natural settings within the coping mechanisms employed by people with cLBP. This pioneering aspect underscores the need for further research into how nature can be incorporated into holistic and multidisciplinary frameworks for treating pain, aligning with leading international organizations’ recommendations.

Contextual Background

Chronic low back pain is a major public health issue, with the highest prevalence globally among musculoskeletal conditions and being the leading cause of disability worldwide. It affects individuals of all ages, with peak cases at 50–55 years, and women experiencing it more frequently. The condition often leads to work loss, participation restriction, and reduced quality of life, making innovative approaches like nature-based interventions particularly relevant.

The study’s emphasis on accessibility challenges also aligns with broader discussions on health equity, addressing significant physical barriers faced by people living with chronic pain, as highlighted in the University of Plymouth news release. This includes the need for better infrastructure, such as improved paths and seating, to facilitate access to natural spaces.

Conclusion

In conclusion, the article provides valuable insights into the therapeutic potential of nature for individuals with cLBP, while also highlighting significant accessibility barriers. It advocates for innovative solutions like virtual reality to bridge these gaps, contributing to the broader discourse on holistic pain management. The findings are particularly timely, given the current understanding of cLBP as a major global health challenge, and offer a foundation for future research into nature-based interventions.

Food Choices Affect Pain

Introduction

Chronic pain is a widespread issue that significantly impacts quality of life and healthcare systems. While obesity is a well-documented risk factor for chronic pain, recent evidence suggests that other factors, such as diet quality, may also play a role. A recent study explores the relationship between diet quality and body pain in adults, regardless of their levels of adiposity (body fat).

Objective

The primary aim was to investigate whether better diet quality is linked to lower levels of body pain in adults and whether this association remains significant independent of adiposity.

Methods

The research used data from the Whyalla Intergenerational Study of Health, which includes a diverse sample of adults from Whyalla, South Australia. Participants completed detailed assessments, including:

• Diet quality evaluation: Using the Australian Recommended Food Score (ARFS), which measures adherence to dietary guidelines.
• Body pain measurement: Using validated self-reported questionnaires that assess the severity and frequency of pain across the body.
• Adiposity indicators: These included body mass index (BMI), waist circumference, and body fat percentage.
  The study also controlled for confounding factors such as age, sex, physical activity, smoking status, and socio-economic status.

Key Findings

1. Diet Quality and Pain:
   • Higher ARFS scores, indicating better diet quality, were significantly associated with reduced levels of body pain.
   • The association was consistent across various demographic and lifestyle groups.
2. Independence from Adiposity:
   • While higher adiposity was associated with increased body pain, the relationship between diet quality and pain remained significant even after adjusting for adiposity measures.
   • This suggests that diet quality has an independent role in pain modulation.
3. Potential Mechanisms:
   • Nutritional components such as anti-inflammatory foods, antioxidants, and omega-3 fatty acids might contribute to reduced systemic inflammation and pain perception.
   • Conversely, poor diet quality may exacerbate pain through increased inflammation and metabolic dysregulation.

Implications

The findings highlight the importance of a high-quality diet in managing body pain, regardless of body fat levels. This has potential implications for public health strategies and clinical interventions aimed at reducing chronic pain prevalence.

• For individuals: Encouraging adherence to dietary guidelines may help alleviate body pain alongside other health benefits.
• For policymakers and healthcare providers: Integrating dietary advice into pain management protocols could improve patient outcomes.

Conclusion

The study concludes that better diet quality is associated with reduced body pain in adults, and this relationship is independent of adiposity. These results underscore the importance of dietary quality as a modifiable factor in chronic pain prevention and management. Further research is needed to explore specific dietary components and their mechanisms in influencing pain pathways.

This research supports the broader understanding that nutrition plays a critical role in overall health and highlights diet quality as a key factor in pain management strategies.

The Musculoskeletal Syndrome of Menopause

Wright el al. have recently published a review article on the musculoskeletal syndrome of menopause – a complex issue that affects millions of women worldwide. 

The Role of Estrogen in Musculoskeletal Health

Estrogen plays a crucial role in maintaining bone density, muscle mass and tendon structure. It helps to:

• Stimulate bone formation: Estrogen promotes the activity of osteoblasts, cells responsible for building new bone tissue.
• Inhibit bone resorption: It reduces the activity of osteoclasts, cells that break down bone tissue.
• Maintain muscle mass: Estrogen helps to regulate muscle protein synthesis and breakdown, preventing excessive muscle loss.
• Maintain tendon structure and function: It influences collagen metabolism and maintains optimal tendon stiffness.
• Maintain healthy joints: Estrogen helps decrease inflammation and maintain joint structure.

When estrogen levels decline during menopause, these processes become imbalanced, leading to bone loss, increased risk of fractures, muscle atrophy, joint pain and stiffness, and increased predisposition to tendinopathies and risk of tendon ruptures.

Risk Factors for Musculoskeletal Syndrome of Menopause

Several factors can increase a woman’s risk of developing musculoskeletal issues during or after menopause:

• Genetics: A family history of osteoporosis or other bone disorders can increase susceptibility.
• Lifestyle factors: Smoking, excessive alcohol consumption, and a sedentary lifestyle can contribute to bone loss and muscle weakness.
• Nutrition: Inadequate intake of calcium and vitamin D can impair bone health.
• Medical conditions: Certain conditions, such as autoimmune diseases or thyroid disorders, can affect bone metabolism.

Treatment and Prevention Strategies

While there is no cure for the musculoskeletal syndrome of menopause, effective management strategies can help alleviate symptoms and improve quality of life. These include:

• Hormone replacement therapy (HRT): When used appropriately, HRT can help maintain bone density and reduce the risk of fractures. However, it’s important to discuss the potential risks and benefits with a healthcare provider.
• Lifestyle modifications: Regular exercise, especially weight-bearing activities, can help strengthen bones and muscles. A balanced diet rich in calcium, vitamin D, and protein is also crucial.
• Medications: In some cases, medications like bisphosphonates or selective estrogen receptor modulators (SERMs) may be prescribed to treat osteoporosis.
• Supplements: Calcium and vitamin D supplements can be beneficial for maintaining bone health.

By understanding the causes, risks, and treatment options for the musculoskeletal syndrome of menopause, women can take proactive steps to protect their health and well-being during this important life stage.

Meditation and the Brain

Meditation can be defined as “a family of mental training practices aimed at monitoring and regulating attention, perception, emotion and physiology” (Fox and Cahn, 2019). As with other forms of learning, meditation has the potential to change the brain (neuroplasticity). Fox and Cahn (2019) reviewed decades of meditation research in a paper entitled “Meditation and the brain in health and disease”. Here are some of their findings. The table below summarises the areas of the brain that have been implicated in meditation.

Brain Region	Function
Insula	Awareness of internal environment (breathing, heartbeat, abdominal sensations, etc.)
Somatosensory Cortex	Awareness of external environment (touch, pain, etc.)
Rostrolateral Prefrontal Cortex	‘Higher’ thinking ability
Anterior Cingulate Cortex	Emotional awareness and regulation
Hippocampus	Memory
Corpus Callosum	Integration of information between the 2 hemispheres

Although “psychologically distinct meditation practices show correspondingly diverse neural correlates”, most practices modulate activity in the insula. Given that awareness of breathing or other body sensations is central to most forms of meditation, and the insula’s role in the awareness of the internal environment, it’s not surprising that meditation leads to a change in structure and function of the insula.

Some interesting discoveries have been made regarding pain. The experience of pain is the combination of the purely sensory aspect of pain with feelings of distress, thoughts relating the pain to the self and various negative emotional interpretations of the experience. “These cognitive-affective elaborations appear to be dissociable from, and temporarily subsequent to, the purely sensory aspects of pain – and what’s more, they may contribute significantly to the subjectively experienced unpleasantness of nociceptive experience (Rainville et al., 1997)”. Meditators were found to have lower pain sensitivity. This may be due to their decreased functional connectivity between primary sensory pain areas and secondary affective-elaborative areas. This supports the idea that seasoned meditators remain focussed on purely sensory aspects of pain whereas non-meditators dwell on emotional and cognitive associations of pain.

Other fascinating discoveries are the impact of meditation on aging. There is usually a decrease in function (glucose metabolism) and structure (amount and density of grey matter) of the brain with aging. However, studies show that meditation may help stave off the effects of aging. In fact, some studies have found no age-related decline in function and/or structure!

But, the limitations of current research must be acknowledged:

• It’s a new field of inquiry
• Agreement amongst researchers is the exception rather than the norm
• Few studies control for factors that may exist between meditators and controls e.g. Diet, stress, sleep, personality, etc.
• Publication bias (the preferential publication of only positive studies)

Pain and Sleep

A few days ago, Krause et al. from the University of California (Berkeley), published the results of their research on the relationship between pain and sleep. They found that poor sleep quality was linked to increases in pain experience, whereas better sleep quality decreased pain. Krause notes that “the results clearly show that even very subtle changes in nightly sleep – reductions that many of us think little of in terms of consequences – have a clear impact on your next-day pain burden”. In the laboratory, they were able to identify that sleep deprivation amplifies the reactivity in parts of the brain (somatosensory cortex) responsible for the perception of pain. Whilst deactivating the responses from some pain relieving centres (insula and nucleus accumbens).

The irony is that pain often disrupts sleep, and thus the pain experience gets magnified and a vicious cycle is created.

How Does Cannabis Relieve Pain?

The use of cannabis to relieve pain is controversial, not just for legal reasons but also because of the conflicting research findings with regards to its efficacy. A recent study by Martin De Vita et al., from Syracuse University in New York, looked into the effects of cannabis on pain. They selected, reviewed and analysed studies that had researched the effect of cannabis on experimentally induced pain. De Vita et al. conclude that “although the cannabinoids examined in this review may prevent the onset of laboratory-induced pain by increasing pain thresholds, they do not appear to reduce the intensity of experimental pain that is already being experienced. Instead, these substances make experimental pain feel less unpleasant and more tolerable, suggesting a notable influence on affective processes. The cumulative research synthesized in this review has helped characterize how cannabis and cannabinoids affect different dimensions of pain reactivity.”

There are 2 components to pain: the purely sensory component and the affective (emotional) component. It’s been known for a while that opioids and our endogenous opioid pathways play an important role in sensory pain perception. It now appears that cannabis and our endogenous cannabinoid pathways play a part in the emotional dimension of pain. Interestingly, mindfulness meditation, which has proven effects on pain relief, doesn’t use opioid pathways. In fact, the mechanisms underlying mindfulness meditation’s pain-relieving effects are as yet unknown. Could it be possible that they employ cannabinoid receptors and pathways?

Acceptance and Commitment Therapy Helpful for Chronic Pain

Yu et al recently published the results their study on the effects of acceptance and commitment therapy (ACT) in people with chronic pain. The article appeared in last month’s issue of Journal of Pain. ACT “is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility. The objective of ACT is not elimination of difficult feelings; rather, it is to be present with what life brings us and to “move toward valued behavior”. Acceptance and commitment therapy invites people to open up to unpleasant feelings, and learn not to overreact to them, and not avoiding situations where they are invoked” (Wikipedia).

The study involved over 400 hundred adults referred to a pain management clinic. Treatment significantly improved pain acceptance, pain-related interference, work and social adjustment and depression. This was true immediately post-treatment as well as at a 9-month follow-up. ACT also changed something known as “self-as-context” (SAC). SAC can be described as “the you that is always there observing and experiencing and yet distinct from one’s thoughts, feelings, sensations, and memories” (Wikipedia). Of note was the fact that positive changes in “self-as-context” were associated with positive changes in outcomes.

It’s really interesting how acceptance and commitment therapy has incorporated Buddhist principles and techniques such as mindfulness, acceptance and the self. In fact, it seems that the use of Buddhist philosophy and principles are becoming more common within therapy nowadays.

Chronic Pain Linked to Memory Decline and Dementia

A study by Whitlock et al from the University of California, published in this month’s Jama Internal Medicine, looked into the relationship between persistent pain, memory decline and dementia. Over 10,000 senior citizens (median age of 73 years) from the Health and Retirement Study were followed for 12 years.

At baseline, persistent pain affected 11% of participants and was linked with more restrictions in daily activities and more symptoms of depression. Those with persistent pain had a greater risk (9%) of having a more rapid memory decline than those without pain. They also had a smaller increase in risk (2%) of developing dementia. These changes significantly increased the chances of being unable to manage medications (16%) or finances (12%).

What’s the causal connection between chronic pain, memory decline and dementia? The authors believe the severity of pain can decrease attention capacity and impair memory consolidation. Additionally, pain leads to stress, and stress has been shown to promote cognitive decline, mainly through hypotrophy of the hippocampus. In my opinion, the disruption of sleep can also contribute to poor memory and a decline in cognitive ability because, as we know, sleep is involved in memory processing and consolidation.

Fortunately, physiotherapy, rehabilitation, relaxation and mindfulness meditation are effective at addressing chronic pain.

Shared Reading Improves Mood and Decreases Pain

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Earlier this year Billington et al. from the University of Liverpool published the results of their study looking at the effects of shared reading (SR) on people with chronic pain. The shared reading model they used was the one employed by the charity “The Reader“. “The Reader is an award-winning charitable social enterprise working to connect people with great literature through shared reading. We’re here to bring books to life, creating welcoming environments in which personal feeling is recognised and valued, forming vital connections between people and literature through which everyone can feel more alive.”

The researchers concluded “Qualitative evidence indicates SR’s potential as an alternative or long-term follow-up or adjunct to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by patients with chronic pain. In addition, quantitative analysis, albeit of limited pilot data, indicated possible improvements in mood/pain for up to 2?days following SR. Both findings lay the basis for future research involving a larger sample size.”

The preliminary findings are encouraging. There may be other factors such as distraction, social bonding and the benefits of having regular scheduled activities that may also play a part in improving the well-being of the participants.