Why does the brain connect pain with emotions? : Coups

When Sterling Witt was a teenager in Missouri, he was diagnosed with scoliosis. The curvature of his spine quickly caused chronic pain.

It's "that kind of low-intensity, menacing pain that went through my spine and mostly my lower back and right shoulder blade, and even a little in my neck," says Witt.

The pain was bad. But the feeling of helplessness she was producing was even worse.

"I had the impression of being attacked by this invisible enemy," says Witt. "It's nothing that I asked, and I did not even know how to beat myself."

So he channeled his frustration to the music and the art illustrating his pain. It was "a way for me to express myself," he says. "It was liberating."

The Witt experience is typical of how an uncomfortable sensation can become something much more complicated, say the scientists.

"Deep down, the pain is just something that hurts or makes you say something," says Karen Davis, senior scientist at the Krembil Brain Institute in Toronto. "Everything else is the result of pain, how it affects your emotions, your feelings, your behaviors."

The pain begins when something – heat, certain chemicals or mechanical force – activates special nerve endings called nociceptors.

"Once activated, they trigger a whole cascade of events with some sort of representation of that signal going through your nerves and into the spinal cord, then up to your brain," says Davis.

And that's where things get really complicated.

Pain signals interact with many areas of the brain, including those involved in physical sensation, thought, and emotions.

"There is a whole series of activities that enter the brain and lead to all the complexities of what we feel associated with this initial injury," Davis said.

All this treatment can have benefits, she says, as we sometimes allow to ignore the pain signals.

Suppose you played hockey and you just got hit on the board, Davis said. "If you focus on that, you will not be able to continue skating, so you need to be able to calm the pain and manage it later."

Witt learned that he was able to calm the pain by immersing himself in the composition of songs or painting.

"When I'm doing art and music, I feel less pain," says Witt, now 40 and earning a living as an artist and musician in the Kansas City area. "While I'm doing these things, I'm so distracted from my pain that it's almost like I do not have it."

But as a young man, Witt still struggled against the emotional fallout of his back pain. He was depressed and felt like an outcast in society.

Why does the brain connect pain with emotions?

Robyn Crook, a biologist and neuroscientist at San Francisco State University, is one of the scientists trying to answer this question.

Crook studies the evolution of pain and his laboratory compares the pain system found in mammals to his counterpart in squid and octopus.

The most obvious reason for the evolution of pain, she says, is to prevent or minimize the damage to the body. Touch a warm stove and the pain tells you to move your hand. Quick.

But evolution has not stopped there, Crook says.

"In some animals with more complex brains, the experience also has an emotional or pain component," she says.

In dogs, for example, pain seems to cause emotional distress in the same way as in men. And there must be a reason for that, Crook says.

One possibility, she says, involves memory.

"Having this emotional component related to the sensory experience is really a great stimulus to memory," she says. "And so, humans, for example, can remember a unique painful experience sometimes throughout their lives."

So, they never touch that hot stove again.

And there may be another reason why people and other very social animals have a brain that connects pain and emotion, says Crook.

"Living the pain yourself creates empathy for other members of the group or other family members who are suffering," she says. As a result, if one of them is hurt "you will offer them help because of the empathic response or the emotional reaction to the pain."

This answer has obvious advantages for animals living in groups, explains Crooks. But an octopus is a solitary animal with no obvious need for empathy. Crook's lab is trying to determine if the pain has the same connection to emotions in these marine animals.

For people, the connection between pain and emotion is a good thing. But sometimes it can also be destructive, says Beth Darnall, a psychologist at Stanford University.

"Mental health disorders amplify pain," she says. "They engage brain regions associated with pain management, and can also facilitate rumination and frightening focus on pain."

And when the pain does not go away, says Darnall, it can cause disabling changes in the brain.

"The pain is really a signal of danger," she says. "But once the pain becomes chronic, once it's continuous, these pain signals are no longer useful for anything."

Over time, these signals can lead to problems such as depression, anxiety and stress.

This is what happened to Witt at the age of 20. Her pain caused negative thoughts and depression, which further aggravated the pain.

But it's often possible to break this cycle, says Darnall, by learning techniques that allow patients with pain to gain some control over how their brains treat pain signals.

For example, she has a system to teach pain patients to slow down their breathing and relax their muscles.

"This state of relaxation is an antidote to hard-wired responses that are automatically triggered by the experience of pain," she says.

For some patients, such techniques may be an alternative to pain medication, including opioids. And for pain patients who rely on medication, psychological therapies can often help drugs work better.

But patients rarely receive psychological treatments for pain, says Darnall.

"We have emphasized too much that pain is a biomedical phenomenon requiring biomedical intervention," she says.

Witt, the artist and musician, agrees. He has been suffering from back pain for over two decades.

But he no longer creates songs or paintings about pain. And he chooses not to take medicine for pain.

Instead, Witt says he stretches and exercises, monitors his diet, and strives to remain optimistic.

"In reality, I'm not convinced that I have to live with it until the end of my life," he says. "I can very well do it, but at the same time, I live in that state of mind all the time there is hope."