The Impact of Context on Pain and Sensation
As I was reading Louis Gifford’s Aches and Pains (a truly splendid exploration of pain science and making sense of pain), I came across a passage that I really wanted to mull over. In summary, Gifford explains how our pain is assessed and interpreted based on the context of the signal. For example, if you are having a wonderful day and you’re engaged in your favorite activity with one of your best friends—I’m picturing myself hiking on a mountain with my husband and dog—and you stub your toe, that would feel different than if you stubbed your toe on a day you got let go from your job, it was your least favorite weather, and you had just broken your favorite mug. In these two scenarios, if you stubbed your toe in the same spot with the same amount of force, how your body receives and interprets the pain would be very different.
Gifford goes on to say that this contextualization works for a multitude of sensory effects. As someone who thinks about pain professionally quite a bit, I’ve run through this stubbed toe example with clients regularly, but Gifford explains that this contextualization of sensory information doesn’t stop with pain. His fabulous example goes like this: if someone brushes your leg and you have a romantic interest in them, that brush feels very different than if someone brushes your leg and it is an unwanted romantic overture. Again, let’s imagine this brush happens with the same speed, pressure, and duration; these two experiences are processed and interpreted very differently in the body.
This struck me as very important because, when we experience things, we often like to think of our senses as providing us scientific, factual information about the world. We can sense hot and cold, pressure vs. vibration, sweet vs. salty, or pain vs. pleasure. However, these “facts” are always being sent up in a system rife with memory, experience, and biases that change how you might experience something. From a clinician's standpoint, this makes me wonder how much a person's environment, memories, and experiences might change how pain is perceived in their brains.
As I was pondering these concepts, my husband and I made a weekend trip to Lake Michigan. We got out of the car around 4 p.m. on a humid July day, but there was cloud cover in abundance. We made our way to the shore where I immediately stripped down to my bathing suit and waded into the water. I made it up to about knee level before the slap of the waves left me with the deep-seated notion that continuing my venture into the lake would be cold to the point of discomfort. Down the beach we went with just our toes getting lapped at by the waves. After 20 minutes or so, we turned around. At this point, the cloud cover had begun to clear and the sun had unfettered access to us. After another 10 minutes of walking, I was feeling quite warm and decided to go for a second attempt into the water. This time, the cool water was inviting, and though I may have gasped a bit when I submerged my head, the warning that this was going to be unpleasant was not present (or perhaps I just ignored that part of my nervous system). After I emerged and walked up the dune to the parking lot, I recalled to my husband that despite my very different experiences, the water temperature had remained the same. So much for my carefully honed senses being able to calibrate what “cold” is.
So, the next time you’re wondering why an exercise hurts one day but didn’t hurt the day before, or why you’re tired even though your sleep monitor says you got the same quality of sleep, or why you’re feeling like your blood is going to boil in heat that didn’t bother you yesterday, remember: context always matters. How you experience anything will always be affected by what is going on around you.
Reference: Gifford, L. (2013). Aches and Pains. CNS Press.