"Expectations of Pain: I Think, Therefore I Am" by Michelle D. Jones-London, PhD

Expectations of Pain: I Think, Therefore I Am: National Institute of Neurological Disorders and Stroke (NINDS)

Portrait of René Descartes by Jan Baptist Weenix
circa 1647

Expectations of Pain: I Think, Therefore I Am 
For release: Wednesday, February 15, 2006 

While the theory that “mind over matter” exists is an ancient belief, the scientific studies to support this idea have 
remained elusive. A new study provides brain imaging evidence that positive thinking interacts with and shapes the 
sensory experience of pain. This study suggests that decreasing the expectation of pain can reduce both the pain 
related brain activity and perception of pain intensity. This knowledge may lead to new and effective ways to manage 
chronic pain. 

“Our data shows that what you think really changes what you experience,” says Robert Coghill, Ph.D. of Wake Forest 
University School of Medicine in Winston, Salem . “Positive thinking could be an important adjunct to managing 
chronic pain. The most effective treatment for patients suffering from chronic pain may be a combination of medicinal 
and psychological therapies.” The study was funded by the National Institute of Neurological Disorders and Stroke 
(NINDS), a component of the National Institutes of Health (NIH), and appears in the September 6, 2005, issue of 
Proceedings of the National Academy of Sciences*. 

When expecting pain, we first form an active mental picture of the event that is about to happen. This picture is 
composed by incorporating past experiences with the current situation and what we believe will happen. Secondly, 
brain regions that are involved with the mental picture interact with the brain areas responsible for processing pain. As 
a result, the brain regions supporting the experience of pain are modulated by these predetermined expectations. 
The new study focuses on this modulation of pain that is controlled by our expectations. The study uses functional 
MRI, a technology that shows which areas of the brain are activated during a task, to reveal the brain regions involved 
in the expectation of pain and the resulting experience. This is one of the first studies to look at pain perception 
through brain imaging techniques. 

In the experiment, subjects participated in several sessions using a computer-controlled miniature heat pump to 
stimulate the sensation of pain. Researchers taught participants to expect three different levels of painful heat after 
different timed intervals. A seven-second interval signaled a heat level that caused mild pain, a 15-second interval 
signaled a heat level that produced moderate pain, and a 30-second interval signaled a heat level that produced 
severe pain. The heat stimuli were on for only 20 seconds and didn’t produce enough heat to cause burns or damage 
to the skin. 

One or two days after training, participants underwent the fMRI testing during 30 different heat trials. During testing the 
researchers unexpectedly mixed the signals for the pain levels, so that participants were expecting one temperature, 
but actually received either a higher or lower temperature about 30 percent of the time. The researchers were able to 
see that levels of pain reported were reflected in the fMRI scans of the brain. People with decreased expectations for 
pain reported less pain. At the same time, activity decreased in areas of the brain important to both sensory and 
emotional processing of pain. These areas included the primary somatosensory cortex, the insular cortex and the 
anterior cingulate cortex. These lower expectations reduced reports of pain by more than 28 percent. “Expectations 
about pain can affect its intensity at a level of pain reduction that is comparable to that of a normal dose of the 
painkiller morphine,” says Dr. Coghill. 

Many factors change the way that pain is perceived, and pain can be viewed as more intense or less intense 
depending on the situation. Different factors that can alter perception specifically when it comes to pain include how 
much attention is focused on the symptom. People also have different pain thresholds at which sensory nerves that 
carry pain information will send those signals. Some people need only a little stimulation in order for their nerves to 
send pain signals, while others need a much greater amount of stimulation. Future research in the lab will examine the 
brains of people with these different thresholds for pain. 

This study shows that the nature of pain perception is different in each individual. Not only are there individual 
differences in the nervous system but also individual experiences contribute to how pain is perceived. The 
researchers are planning to use the fMRI technique to examine the effect of different personality types on pain 
perception. The study will examine how optimistic versus pessimistic personality types influences how people deal 
with pain and modulate pain processes in the brain. 

“Pain needs to be treated with more than just pills,” says Dr. Robert Coghill. “The brain can powerfully shape pain, 
and we need to exploit its power." 


*Koyama T, McHaffie JG, Laurienti PJ, Coghill RC. “The subjective experience of pain: Where expectations become 
reality.” Proceedings of the National Academy of Sciences, September 6, 2005, Vol.102, pp.12950-12955. 

-by Michelle D. Jones-London, Ph.D.

Date Last Modified: Wednesday, February 15, 2006 

"Can You Help?"

If you have CRPS, you're probably used to having medical types whipping out cameras and photographing your dystrophic beauty.  Believe me, I know what a boost it can be to the ego, and I remember the early days, when the ensuing struggle with vanity was almost a lost cause.

Since then, I've watched a lot of America's Next Top Model, learned all I could from Tyra and
The Jays, and now when a doctor pulls out a camcorder or a smartphone, depending on his specialty, I give him either a Fierce Eye or a full body Smize, then put my worst foot forward.

Yes, I jest, in a way.  It has become rare for me to be interested in "raising awareness for CRPS," even when it's done by art ('cause you know what an art patron I am, particularly of the bad and the grotesque!) because of the huge gaping emptiness that ensues.  I think I once wrote a post asking what came after "awareness."

Ah, but this is precisely where I am at risk of selling my soul to the Hornèd One (I tell you, hanging out at All Poetry has its perks -- Did you catch that?  "Hornèd"?  I added another syllable and set back poetry a hundred years with hardly any effort at all!).  This is when people manage to signal one another behind my back, shaking their heads in pitying sadness.  I hate pitying sadness.

If we're gonna do this, my fellow CRPSers?  We're gonna do it with Fierce Eyes one day, and a slinky Smize the next, and with engaging snark peppered with factoids from the NINDS cheat sheet.  "Yes, my brother, yes, my sister, that factoid is straight from the mouth of the National Institute of Neurological Disorders and Stroke, a major subdivision of the National Institutes of Health... snap..."

Or we can try this other thing that I just heard about on Twitter.  Read about on Twitter.  Since my Twitter experiences are mostly hallucinogenic, I hear, see, read, touch, and taste the flitting, flying 140 characters of stuff before me.  Sometimes, I feel them, too.

So there is this girl.  Her name is Nadia, and she is a Brit.  She is 17 years old and in her second year of studying Art and Design.  Her Dad has CRPS / RSD and she decided to organize her final project for school around the idea of a visual campaign to raise awareness of this disorder, disease, this madness, this... well, this CRPS / RSD thingy.

What she is asking is pretty simple, though it takes a bit of courage to put yourself out there.  Leave it to a smart and talented 17 year old to believe in us -- that we can show the world, or at least whoever sees her art show, what CRPS / RSD can look like.

You are to hold a placard of some sort -- paper, cardboard, whatever doesn't hurt you -- and record on it your name (optional), where you live, the areas of your body afflicted, how long since you've been diagnosed, and then sum up yourself or your experience with the pain of CRPS... in one word.

Nadia requests that you email your photos to NadzaCRPSProject@virginmedia.com and kindly remember that she has a deadline to receive them by 20 May 2013.  Obviously, if you have questions about the project, or formatting, or anything, email her directly.

What won me over was the photo of her Dad.  I expected something artsy-fartsy, maybe in scary black and white (though shooting CRPS in black and white feels like one is almost insulting the disease, you know?) -- maybe he'd sport a top hat and bunny slippers.  Or -- and this is tiresome -- he'd be half-collapsed, hand across his defeated brow, staring death rays at the camera.

Instead, she, or her Mom, or someone, took a snapshot of her Dad, just her Dad, and there's a lot of love in the mere act, and there's a real awareness of what CRPS is doing to that dear Dad.

Oh, boogers.  I am using it without her permission.  Well... hmmm.   She is distributing it on Twitter as an example of what she is looking for, so I'm hoping that I am just extending her own gesture.  I'll shoot a copy of this post over the pond to see if it's okay.  I promise.  I swear.  (Huge sigh of relief.  It's okay.  And Nadia took the picture, and apparently he, as will most of us, struggled with that one-word choice.  Thanks for the permission, and again, it's a great photo.)

I like his face.  I understand his face.

For me, the hard part of participating in Nadia's Project was dealing with the whole "awareness" issue, until that hair was finally so split as to be nonexistent.  The photograph was easy, except that it hurt to do it, but that's nothing.  Making the sign appear legible took three tries and that, too, was a bit hard.  Also hard -- time since diagnosis?  How many people with CRPS had it for years prior to diagnosis {waving::hands::like::a::maniac}?  Also... that ONE word bit.  I went with something that I feel captures the real moi as well as the impact of CRPS pain -- what a word coup!  But it was a difficult moment, deciding whether to tell the truth or to lie.  So I did what I thought Nadia would want, and used her Father for a reference.

This is what I just sent her:

By the way, those are two of the SIX (that's SIX) cotton/linen blend throw pillows that I got for $40 (that's FORTY buckaroos, mis amigos!).  They are a bit matchy-matchy for my taste but make a great clean and nature-oriented background for a shot of my necrotic and nasty feet.

I did not picture my face because I did not want to.  Then I wouldn't be able to see through the tears to type.  Sob.  Sob.  Besides, I love keeping track of my feet on the color wheel of the seasons.  We are in full winter here, and so, my feet are, of course, smaller than you've probably ever seen them, and much more in the blue range than the red.  I remember when Fred and I lived in a half-room cabin up in the hills, no electricity, leaky roof, dirt floor -- but we always had a guitar to play and blessèd free time to watch my feet change color for entertainment.  (We had one of them as-seen-on-TV Olde Brooklyn Lanterns.)

So let's help Nadia, and through Nadia, ourselves, via her final art project.  And here's a big hope and a prayer that her Dad feels better soon.

NOTE: Up top, in the first line "CRPS" is linked to the photographic gallery section of the Clinical Practice Guidelines, first put together by Dr. Anthony Kirkpatrick, now in its Third Edition and overseen by a distinguished Scientific Advisory Committee.  I happen to think it's a great document, and with a little time and work, accessible even to us laypeople.  So should a doctor give you The Shrug, and say something like "well, we're all working in the dark, here!" -- first, buy her an Olde Brooklyn Lantern and then gift him with a printout of the Third Edition of the Clinical Practice Guidelines.