The stra truth abou pain Nge h ut

Pain seems a fairly straightforward experience. You get hurt and, well, it hurts. But how would you describe it? By the number of broken bones or stitches? Or by the cause – the crowning baby, the paper cut, the cheating husband?

What does a seven on a pain scale of one to 10 even mean?

Pain is complicated, difficult to define and tough to explain to others.

But most of the time, the way we treat it is superficial. We avoid it at all costs or suppress it, usually with drugs.

In their new book, Ouch: Why Pain Hurts and Why It Doesn’t Have To, Margee Kerr and Linda Rodriguez Mcrobbie examine some fascinating facts about physical pain and how we can treat it.

Placebo has an evil twin

Most people are familiar with the placebo effect – experiencing a therapeutic benefit without actually receiving the “real” treatment.

For example, you take a sugar pill instead of paracetamol and still lose the headache.

But placebo has a lesser-known – and less celebrated – counterpart: the nocebo effect.

Just as we can generate our own pain relief, we can also generate our own pain, no cell damage required.

One of our favourite illustrations of the nocebo effect is the rubber hand illusion. This requires a willing participant and a fairly realistic prosthetic hand. With one of his or her real hands hidden from sight, the participant is told to watch the prosthetic hand in front of them.

Meanwhile, the researcher touches and prods the fake hand, while doing the same thing to the participant’s hidden real hand.

After a short time, the participant takes ownership of the fake hand, mentally replacing his or her real hand. The researcher then takes out a lighter, flicks it on and holds the flame to the fake hand – and only the fake hand.

More often than not, the participant panics because that fire hurts.

The reason participants feel pain when the fake hand is burned is because our perception of sensation is constructed both from external sensory inputs and what we expect to feel.

Our efficient sensory systems have evolved to be not only responsive but also predictive.

They essentially run an internal simulation, based on previous experience, of what’s happening in and around our bodies at all times.

In the case of the rubber hand, most of the cues of a painful episode were in place – hand, fire – so this model infers that pain is the logical outcome.

We aren’t consciously aware of this, although we become acutely aware when we get it wrong, for example, like almost falling on your face when the curb you’re stepping off turns out to be higher than expected. This processing has implications for how we experience pain: if we expect to feel it, we usually do.

That’s not to say the power of positive thinking or pretending the pain isn’t happening is enough to get us through but we may have more opportunities than we think to shape how we experience pain.

Back to the rubber hand illusion. Researchers also found that when a pain-relieving cream was applied to the “burn” on the fake hand, participants reported their pain abating. It seems

Two pints of beer are more effective than paracetamol for some kinds of pain

xperience of the world is, in a lot of , what we make it.

inkillers aren’t as eful as you think

most of human history, people have ed to drugs of various kinds for pain – and advances in such drugs have d lives and eased suffering across lobe. d yet, many pain relievers aren’t as tive as you might think. Take paracetamol, the most commonly used analgesic and fever reducer worldwide.

It’s suggested for everything from labour pains to childhood fevers to backache, migraine and broken bones. The snag is, it only works some of the time and only for some types of pain.

For example, recent studies have found paracetamol only offered a very small improvement in pain ratings and mobility of people suffering from hip or knee osteoarthritis.

There was a small benefit to people suffering tension headaches but it worked no better than placebo for people with lower back pain.

In fact, even more recent evidence suggests drinking two pints of beer is more effective than taking paracetamol in relieving certain kinds of pain.

That doesn’t mean we should all crack open a bottle the next time we have backache but what it does mean is we should be a bit more sceptical about the broad claims of over-the-counter painkillers. Especially as this medication comes with side effects.

The British Liver Trust says a paracetamol overdose – which can occur when taking just one or two pills over the recommended amount – is one of the leading causes of liver failure.

So if drugs don’t always work all that well, what does, aside from beer?

Yoga, mindfulness practices, or even just holding someone’s hand all have a significant impact on our perception of pain.

One very recent study showed people who grimaced or practised what’s called a Duchenne smile (better known to

Tyra Banks’ fans as “smiling with your eyes” or “smizing”) during an injection rated their pain much lower than those who held a neutral expression.

Another found that swearing helped test subjects endure a pain trial, in this case, plunging their hands in icy cold water 50 per cent longer.

And even more fun, sexual activity offered moderate to complete relief for around 60 per cent of migraine sufferers and 37 per cent of cluster headache sufferers.

Painkillers don’t just affect physical sensations

We take an over-the-counter pain reliever with the hope it will eliminate our headache or make walking with sore hips easier.

But that’s not all it might be doing: certain analgesics can turn down the dial on our good feelings too.

Several studies have shown that paracetamol, for example, makes us react less strongly to emotional content and exhibit less empathy for the suffering of others.

It’s not that we don’t know, or can’t cognitively assess, that someone is in pain or something is funny – we just don’t feel it.

This has, as you can probably imagine, serious implications for how we live. Experiencing a wide range of emotions, especially empathy, is critical to our own wellbeing and for creating close, trusting relationships.

Two cross sectional studies that together included more than 37,000 participants found that experiencing a wide variety of emotions was a powerful predictor of mental and physical health.

So before you blame a new comedy for being less than hilarious, or your friends or loved ones for being less engaging, ask yourself if it might be the drugs.

Study shows swearing helped some people endure pain 50 per cent longer

Pain can ‘treat’ pain

It sounds counter-intuitive, but actually, we’ve been using pain to treat pain for millennia. The Ancient Egyptians used the zap from electric torpedo rays and Nile catfish to relieve pain, much in the same way we use TENS machines now.

The TENS machine has become a staple for physical therapists and women in labour.

Two electrodes are positioned above the point of pain and the electricity supply is dialled up to a point about two steps back from intolerable.

TENS units’ stimulation engages our pain receptors, which in turn works to signal the need for an increase of our own body’s painkillers.

This is also one, among many, of the reasons acupuncture is effective. The aching, soreness, numbness, tingling or heaviness, referred to as ‘de qi’, is an expected part of acupuncture treatment. It’s the “hurts so good” kind of pain that triggers endorphins.

Using pain to treat pain also gives us a sense of control. Uncontrollable pain can leave us feeling trapped and helpless. Being able to shift our attention to sensations of our own choosing, ones we know and expect, can go a long way in reducing the intensity of the pain we don’t choose.

Margee Kerr and Linda Rodriguez Mcrobbie are the authors of Ouch! Why Pain Hurts and Why It Doesn’t Have To, out now (£18.99;

Bloomsbury)