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Julie Chen, M.D.

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Does Pain Affect Our Behavior Toward Others?

Posted: 10/26/11 12:32 PM ET

When you are in pain, does it ever seem like nothing else matters except you and your pain? Well, you may not be alone in this feeling.

In my clinic, I have a large patient population of chronic pain patients, and it is common to have the chronic pain issues overwhelm these patients' lives. When I ask most of these patients what is their biggest stressor in their life, they usually will answer that the pain is what demands most of their time and energy and affects them the most.

When people have overwhelming medical issues, it is usually all-encompassing and has a significant impact on overall functioning and may even dictate how their life changes in many very real ways. It can frequently impact family, social, financial and work life to a significant degree; and usually the impact is negative, because diseases can restrict our life such that what brought us pleasure before no longer can be achieved based on physical limitations.

So it would make logical sense to assume that major diseases affect not just our body, but the very core of our life and interactions with others. Now there are studies that actually establish such a correlation, because it seems that bodily states and diseases can affect higher order behavioral interactions, potentially at the level of neuronal networks.

Based on a study published in Plos One on Oct. 12, 2011 by researchers in Rome, Italy, it seems that people suffering from pain exhibited a greater self-centered perspective aimed at maximizing self-gain. What's interesting about this study is that it suggests that physiological states may play a significant role in higher order interpersonal behavior and social interactions.

Within this study, their results showed that the "feeling of pain makes an individual less inclined to behave according to social norms that regulate most social and economic interactions." This study is consistent with the findings of a previous study from the Iowa Gambling Task looking at chronic back pain patients, and there was an association of greater intensity of pain being associated with higher rate of egocentric bias and reduction of the capacity to react emphatically toward others.

However interesting these findings are, it is not to suggest that all pain-sufferers tend to be egocentric or self-centered. The important point that this study and the Iowa Gambling Task study showed is that there is an association between physiological bodily states and our social and economic higher order behavioral states.

When we take this important point to heart, it helps us both as sufferers of pain and as loved ones of sufferers of pain to more thoroughly understand why people with various diseases may behave one way or another. In hopes of creating understanding and patience with loved ones with various disease states, these studies help us all to understand that there are indeed neurological implications to diseases that, at first glance, may not seem to have a direct impact on the brain.

In prior studies, there appears to be evidence that fairness-directed conducts, such as mutual cooperation with partners or altruistic behavior, are related to neuronal activation of the mesolimbic dopaminergic system. But, how this is specifically affected by chronic pain and acute pain requires further studies to determine whether various bodily states such as acute and chronic pain alter these areas of neuronal functioning in regards to correlates of induced social preferences and behavior.

My caution for readers who are now aware of these study findings is not for you to just assume people with chronic pain or other diseases will behave a certain way and to judge them based on that. But rather, it is to have an openness of mind to understand and accept that there is indeed a neuronal association between diseases and our brain such that their behavior may be significantly altered.

With such understanding, it may be easier for us to accept our loved ones and ourselves as they or we are, but to also work within that framework to ensure that interpersonal relationships remain strong. There may even come a time where it is necessary to utilize unbiased third-parties to help maintain strong interpersonal relationships as we all deal with various diseases and its impact not just on our body, but to our relationships as well.

Various therapeutic methods may be especially helpful, such as cognitive behavioral therapy, to help patients and their loved ones to adjust to a new dynamic so as to regain and then maintain strong healthy relationships and interactions.

As I see many patients go through various stages in their life, both with and without active disease, I also see a level of pliability in how these patients maintain relationships in their life that are important to them. So, regardless of the finding of this study, even if there is a level of increased tendency toward egocentric bias or self-centered gains, what I have noticed most in my patients with chronic pain and other diseases is perseverance toward maintaining the integrity of relationships and situations that are important to them.

When it comes down to it, living with pain or any active disease state requires inner strength and courage, and most of my patients have those qualities in abundance. And if the bodily state of the disease alters their neuronal status toward some behavioral changes, most of what I see is that they continue to protect the relationships that are important to them.

So, take the findings of this study as a forewarning that diseases may alter your own behavior or that of your loved one afflicted with pain or disease... but that the relationships you cherish do not have to suffer when you are aware of what you are dealing with and are willing to fight for what is important to you.

References:

1. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0026008

2. Singer T, et al. (2006) Empathic neural responses are modulated by the perceived fairness of others. Nature 439: 466-469.

3. Apkarian AV, et al. (2004) Chronic pain patients are impaired on an emotional decision-making task. Pain 108 (1-2): 129-136.

 

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