How to cope with pain

The latest episode of our Research Digest podcast PsychCrunch asks what psychology can teach us about dealing with pain. It is presented by Ginny Smith, and sponsored by Routledge Psychology.

Ginny talks to Dr Richard Stephens from Keele University, who has written for us before on how swearing can increase your pain tolerance (see below). Then she speaks to Dr Sam Hughes, a research fellow in pain neuroimaging at King's College London who works with patients with chronic pain. Here's a chunk of that part of the conversation.

Why did you become interested in using virtual reality to help pain patients?

Virtual reality has shown to be quite effective in treating pain associated with medical procedures. Things like dental work and burn patients, where they have their wounds dressed and everything, so it can help to reduce the severe burning pain associated with that. It's a way of distracting people away from the pain, that's probably the simplest way to put it. And we are trying to understand how that distraction might work in the brain and how that might link to pain relief. 

How exactly does this relate to chronic pain?

We use a model of chronic pain in healthy volunteers. So with that, you place some cream that contains capsaicin, which is the active ingredient in chili peppers, but we've concentrated it down into a paste, and you rub that on the leg. Over about 35 to 40 minutes, it begins as a very light tingling sensation on the skin, and then it starts to become into a sort of relatively moderate to severe burning pain that's ongoing for about an hour. And what that basically does is mimics some of the distinct symptoms that a chronic pain patient might have. One of these symptoms is called secondary hyperalgesia. It sounds complicated, but really all it is is pain around the area that is injured, that is more painful than it should be.

So that's what happens if you cut yourself or something – the area around it gets all red and becomes really sore if you touch it.

Yeah, it's a similar kind of idea, and it's similar to sunburn in a way as well. You get levels of sensitivity that spread away from the sunburn. And that all happens in your central nervous system. We're really interested to know, how can this immersion in this world of virtual reality, reduce that?

We use the Arctic as an environment that they were sort of exploring. That was kind of based on the idea that they have a burning pain, therefore, can we counteract that with a cold environment? And it was as simple as that, really. We used a freely available YouTube video, put it through the headset and explore a nice Arctic landscape whilst your leg's burning. 

What we've shown is actually that it increases levels of what we call 'endogenous pain control'. It's not too dissimilar to how a lot of drugs actually work to reduce pain, but we're not obviously administering any drugs… we're trying to sort of mimic similar types of pain relief that we already have in the body to try and activate it. So it's feasible to say that actually, if we gave that over and over again, it might slowly increase our levels of endogenous pain control that we have.

You've got this kind of proof-of-concept that it does work for this type of pain. What's the next step for this research? 

We want to try it out in a number of different chronic pain conditions. One that would be really interesting is people who have had surgery and often develop what we call 'chronic post surgical pain', where they might be having an incision, which has started as an acute pain, but then once the wound is healed, they then start to develop chronic pain. That's a really interesting patient population to try this out on, I think, because they're previously pain free, so you could do some pre-operative assessments of their endogenous pain control and then track them over time and then see, are there certain patients who have got diminished or reduced levels of their endogenous pain control after the surgery which might benefit from some kind of VR, plus some kind of other intervention? We would hypothesise that maybe that would reduce the likelihood that they would develop chronic pain.

And I guess you could see whether the people who go on to develop chronic pain have low levels of endogenous control before the surgery, or if it's something that develops afterwards. 

Exactly. The levels of endogenous pain control – they change dramatically within a population of people and also within a person. If I've not slept very well, and I've been up all night tossing and turning, I would probably have a lower level of endogenous pain control. And chronic pain is an interesting condition to try this out on in general, because they've got reduced endogenous pain control in general. It has lots of potential for translatable clinical research.

You can find the podcast here. Find plenty more on pain from our archive...

Pain at Christmas
Ella Rhodes reports from the British Neuroscience Association's Christmas symposium

Encouraging self-compassion may help people with chronic pain lead more active, happier lives
Alex Fradera for the Research Digest

5 minutes with… Dr Harbinder Sandhu
…who is leading a large trial of an intervention that aims to help people with chronic pain taper their opioid use 

Super altruists (who've donated a kidney to a stranger) show heightened empathic brain activity when witnessing strangers in pain
Christian Jarrett for the Research Digest

Overrated: Self-management
Karen Rodham argues that an empowering idea is yet to translate into practice 

Women who practice submissive BDSM displayed reduced empathy and an atypical neural response to other people's pain
Alex Fradera for the Research Digest

The limits of empathy
Diana Kwon on when walking in another's shoes is not enough 

The pain of youth
Line Caes and Abbie Jordan call for creativity in research design with adolescents living with chronic health conditions

How sentient is this mouse?
Helen Cassaday poses an ethical dilemma on animal testing, referring to the pain that can be caused, provides her view and seeks responses 

What's different about the brains of the minority of us who feel other people's physical pain?
Emma Young for the Research Digest

Minds run free
Christian Jarrett and Ella Rhodes on psychologists running, and overcoming the pain 

Phantom suffering?
Joanna Bourke looks into physical and emotional wounding after the First World War 

Big Picture: Portraits of pain
Words by Karen Rodham 

Pain – the backdrop of our lives
Ella Rhodes reports from a conference at UCL

Watching someone suffer extreme pain has a lasting effect on the brain
Alex Fradera for the Research Digest 

5 minutes with… Dr Zoey Malpus
…a contributor on behalf of the British Psychological Society to the Royal College of Anaesthetists Core Standards for Pain Management Services

The moral implications of placebos
Ginny Smith reports from the Cheltenham Science Festival

Does it matter whether or not pain medication is branded?
Christian Jarrett for the Research Digest

Can reassurance hurt?
Yuefang Zhou and Gerry Humphris have their own worries about the 'don't worry' message in medical procedures

The cycle-ology of the Tour
Ella Rhodes investigates how psychology touches the Tour de France, including pain tolerance

Happy people think they're good at empathising with the pain of others. They're wrong
Alex Fradera for the Research Digest

Swearing – the language of life and death
Richard Stephens leads us through a colourful research journey in an article plus audio interview 

Cope with pain by changing how you picture it
Christian Jarrett for the Research Digest

Coping and acceptance in chronic childhood conditions
Jeremy Gauntlett-Gilbert and Hannah Connell look at novel approaches to helping children live with pain and discomfort

I feel your pain!
Clare Allely with the neurological and anecdotal evidence to suggest we really can feel others' pain. 

Pain - the patient's viewpoint
Amanda C. de C. Williams talks to three people who have used their own pain to ease that of others

A normal psychology of chronic pain
Christopher Eccleston explains how psychology is working to help people disabled by pain

Ouch! The different ways people experience pain
Christian Jarrett examines the psychology of pain perception

The story of pain
Ronald Melzack, an author of the hugely influential gate control theory of pain, on an important paradigm shift over the last half-century 

Orgasm
Barry R. Komisaruk, Carlos Beyer and Beverly Whipple on orgasm, including changing pain thresholds during orgasm