Winning Pain Relief Engages Endogenous Pain Inhibition

Doubling Your Payoff: Winning Pain Relief Engages Endogenous Pain Inhibition | eNeuro

When in pain, pain relief is much sought after, particularly for individuals with chronic pain

the seeking of pain relief in a motivated state might increase the experience of pain relief when obtained.

I find it almost impossible to believe there is a way of seeking pain relief that isn’t motivated. Perhaps they are referring to people who take opioids just to get high?  

We tested this hypothesis in a psychophysical experiment in healthy human subjects, by assessing potential pain-inhibitory effects of pain relief “won” in a wheel of fortune game compared with pain relief without winning, exploiting the fact that the mere chance of winning induces a motivated state.

This is a very strange experiment and I’m not sure I entirely understand how this applies to real-world scenarios.

The results show pain-inhibitory effects of pain relief obtained by winning in behaviorally assessed pain perception and ratings of pain intensity.

These results provide evidence that pain relief, when obtained in a motivated state, engages endogenous pain-inhibitory systems beyond the pain reduction that underlies the relief in the first place

Consequently, such pain relief might be used to improve behavioral pain therapy, inducing a positive, perhaps self-amplifying feedback loop of reduced pain and improved functionality.

Significance Statement

For individuals with chronic pain, pain relief can be an all-dominant goal.

Pain is one of the strongest and most unpleasant signals our body can give us, so “motivated pain relief” is redundant because I can’t think of any other kind.

Although it is clear that pain relief is a fundamental motivator, it is unknown whether pain relief gained in a motivated state alters the perception of the remaining pain. It is demonstrated here that pain relief that is obtained in a motivated state engages endogenous pain inhibition compared with pain relief unrelated to individuals’ behavior.

High novelty seeking as a personality trait was associated with more endogenous pain inhibition.

It’s interesting that they just throw this in here without further explanation. How does novelty seeking affect motivation to have pain relieved?

This knowledge is highly relevant for pain therapy as it could be used to create a self-sustaining and perhaps self-amplifying positive feedback loop of pain inhibition and improved functionality.

Discussion

In this study, we show for the first time that pain relief that is gained in a motivated state induces endogenous pain inhibition, thereby augmenting pain relief.

Exploiting the fact that the mere chance of winning induces motivated states even with purely random outcomes, we used a wheel of fortune task to induce such a motivated state.

The amount of endogenous pain inhibition was related to the personality trait of novelty seeking: the higher participants scored on novelty seeking, the more their pain was decreased when they won pain relief compared with the control condition.

The present results demonstrate clearly that pain relief, when obtained in a motivated state, engages endogenous pain-inhibitory systems beyond the pain reduction that underlies the relief in the first place

Individuals who are more reactive to reward might benefit more from pain relief in terms of endogenous pain inhibition.

Participants were more aroused when they played the wheel of fortune game (test trials) compared with the control trials of the game, which is indicated by the higher skin conductance responses

Endogenous pain inhibition induced by pain relief gained in a motivated state occurred over and above the well known effects of

  • distraction,
  • offset analgesia, and
  • stimulus controllability

Distraction reduces short-term pain to such a degree that it is used in clinical settings

That’s right. Distraction is good for only short-term because we cannot remain distracted while our chronic pain persists.

Offset analgesia describes the phenomenon that pain reduction is consistently reported as bigger than suggested by the actual change in nociceptive input

Stimulus controllability is associated with reduced pain perception

This is important! Having at our disposal a known effective way to relieve the pain (which are opioids for many) makes the pain controllable.

I find it much easier to tolerate pain when I know I can “turn it down” with an opioid if it gets much worse.

Reinforcement is an important principle that is already used successfully in operant pain therapy.

Using reinforcement to improve health behavior and to reduce maladaptive pain behavior results in substantial and long-lasting improved functionality and reduced clinical pain in chronic pain patients (for review, see Flor and Diers, 2007; Gatzounis et al., 2012)

In summary, our results indicate that pain relief gained in a motivated state induces endogenous pain inhibition and that the amount of this pain inhibition depends on an individual’s degree of novelty seeking

To further expand the present findings and to allow their implementation in pain therapy, future studies should investigate whether chronic pain patients show similar responses to pain relief obtained in a motivated state.

Chronic pain patients are NEVER unmotivated to get pain relief!

2 thoughts on “Winning Pain Relief Engages Endogenous Pain Inhibition

  1. Rose

    What a weird study. Ok I’ll just play wheel of fortune before I get my medication. So if I lose…I still get it but I’m unmotivated so it will work less well?! I think you should send your post to the paper authors and see what they have to say in reply!!

    Liked by 1 person

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