We fear what we perceive is painful

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5. We fear pain and discomfort

This seems obvious enough. Would you look forward to giving a speech to people who hate you or running a marathon in the middle of a desert? Of course not; we know it would be painful and uncomfortable.

Also obvious - how pain and discomfort relate to our survival - what is painful or uncomfortable is more likely to:

be something we're not good at where we have a higher tendency to struggle: e.g. the first time climbing up a mountain to gather herbs vs an experienced climber
have elements that are harmful to us: imagine chasing trying to hunt a buffalo with a sprained ankle or going into a debate with your boss when you have a headache.

It is unsurprising then, that fear and pain often go hand-in-hand. When we feel pain or perceive that pain is going to come, we also feel fear, which heightens our senses and tries to warn us, "Hey this is dangerous. You shouldn't be doing this."

Ok, Captain Obvious. Thanks for wasting my time reading this bollocks. I already know all this because... it's freaking obvious. Why waste my time?

As it turns out, just like how we might wrongly interpret fear, we are also prone to misinterpreting pain. Let's take a look.

Nailed with Pain

In 1995, a builder stumbled and stepped onto a nail. The 15-cm nail pierced right through his boot.
He was in extreme pain. Every little movement caused him to scream and tremor. The short trip on the ambulance was almost unbearable.
When he got to the hospital, he was in such agony that doctors sedated him with 2 drugs - fentanyl and midazolam
With the builder sedated, doctors got onto extracting the nail. They removed his boot, only to realise something extraordinary.
The nail had penetrated between the builder's toes. He was completely unharmed, except in his imagination.

Source: Birtish Medical Journal 1995 (210;70)

Stabbed in the hand (oh wait it's not mine)

This is an oft-repeated experiment with many different variations.
In this version, a person sits with both hands on the table. Beside his left hand, there is a mannequin hand - a realistic and life-like model. The fake hand and the mannequin hand are divided by a cardboard wall.
The experimenter strokes both the participant's actual left hand as well as the mannequin hand, in exactly the same way (using the same brush at the same rate of stroking).
The participant is asked to only look at the mannequin hand.
The experimenter continues stroking for some time.
And then suddenly, a second experiment jumps in AND STABS THE MANNEQUIN HAND WITH GREAT FORCE.
As the video shows, the participant withdraws his left hand in pain.

Wait a minute. Why does this happen?

The participant knows it is a fake hand. He can see that it is a fake hand. But as both hands get stroked in the same exact way, he feels the sensation on his real hand while his eyes see the brush on the exact same point on the fake hand. The brain becomes confused by the 2 sets of information - from his sense of touch and his sense of sight. Bit by bit the brain starts thinking that the fake hand is also real.
(another fascinating area of study, phantom limbs - highligh recommend Phantoms in the Brain: Probing the Mysteries of the Human Mind" by the great V. S. Ramachandran)

This gives us some insight - pain is a bit more complex than the sensation we feel at the area of injury. In fact, when your hand gets injured, the concept of pain is manufactured, literally, in your head.

How exactly does pain work?

There are damage-sensing sensors called nociceptors on nerve cells all over your body. These cells activate when they detect a threat or a potential threat to you.
If enough of these cells activate, a signal is fired to your brain.
Primarily, the signals end up at a part of your brain that works as a salience network, which decides what you should pay attention to.
Since these signals could potentially be very dangerous to your body, your brain usually decides to produce pain, to warn you - hey! pay attention to this, there ould be something dangerous.
In other words, while the signal is detected by nociceptors, pain is determined by the brain.
This means, besides what is actually happening, factors occurring in you brain also shapes your perception of pain:
- your emotional state
- your memories of previous pain experiences
- your beliefs and expectations towards different things

This helps us to understand why the same incident can cause different levels of pain and trigger different pain reactions among different people:

if you had been hit in the face by a stray basketball, you develop a fear of basketballs because of the experience of pain.
even though the waiting time might be exactly the same, waiting for a cab is much more painful than waiting for an uber (also check out our fear from lack of control)
if your previous experience of a marathon was incredibly painful, just thinking about running can cause you to feel pain and fear.
if you are currently stressed out by poor relationships with backstabbing colleagues, you might feel hurt by a joke from a new colleague (when you would have seen the funny side normally)

Your brain produces pain when it receives signals of danger or potential danger. But like everything that your brain assesses, context matters. Experience matters. Memories matter. Whatever the incident, it is ultimately your brain that decides how much pain to attach to something.

And when it is stressed, when it is uncomfortable, when it remembers something similar that happened in the past, your brain is wired to take a safety-first approach. It reminds you, Hey! You should avoid this! You might get hurt!

Is it more painful when it is intentional

Imagine you are on the train. Someone loses his balance and steps on your toes with a force of 100 units. Arghhh... it's painful.

You get to the work, you are taking the lift up to the office. As the lift was about to close, a colleague whom you know really dislikes you rushes in. As he does so, he steps on your toes with the same force - 100 units. You were standing quite far away from the door, and there seemed to be enough space for him to get in without touching you. "Sorry", he says, but he said this with a smirk on his face and no sign of guilt.

The force applied on your toes is the same in both cases - 100 units. But is it possible that you felt more pain based on the intention of the person who caused it?

You probably already have the answer in your head. And it's true: Harvard researchers Kurt Gray and Daniel Wegner found that we experience greater pain when we perceive it to be deliberately inflicted, rather than by accident. (You can read more about the experiment design here)

Gray suggests an evolutionary reason for this difference: “The more something hurts, the more likely we are to take notice and stop whatever is hurting us. If it’s accidental harm, chances are it’s a one-time thing, and there’s no need to do anything about it. If it’s intentional harm, it may be the first of many, so it’s good to take notice and do something about it. It makes sense that our bodies and brains might amplify our experience of pain when we know that the pain could signal threats to our survival.”

These findings suggest that pain extends beyond physical harm to psychological despair. And we might all have experiences of this. If there is a negative event where we were cheated, betrayed, or lied to, it tends to hurt much more and for longer. The malice that was behind these acts seem to transfer from the person harming us to our hearts, staying there and leaving a mark. This also explains why torture is so excruciating. It is not just the physical pain that the victim has to deal with, but knowing that the torturer meant to inflict pain and would do so, again and again, creates an agony beyond the flesh.

Can we accurately tell how much pain we feel?

You might have heard of Daniel Kahneman, one of the pioneers in behavioural economists, and one half of the dynamic duo behind "Thinking Fast and Slow". Kahneman was fascinated by how our memory works, and in doing so, gave us deeper understanding into how we perceive our own pain. It starts... quite literally... at the end, with a colonoscopy.

Subjects were patients undergoing colonoscopies. (for the avoidance of doubt, these are real patients who really had to go through a colonoscopy!)
Depending on each patient's case, the colonoscopy lasted anywhere between 4 mins and 75 mins.
Every minute, the experimenter would ask the patient - "On a scale of 1-10, how much pain are you feeling now?"
At the end of the entire colonoscopy, patients were again asked to rate their overall pain experience.

The graph above shows us some fascinating results:

Patient A's colonoscopy lasted 8 minutes, while Patient B's colonoscopy lasted 24 minutes (3 times longer)
Because of the length of time, Patient B experienced far more overall pain.
Both patients had the same peak pain intensity at about 8.

Yet surprisingly, Patient A rated his overall colonoscopy experience as worse than Patient B.

The length of the colonoscopy and the overall pain experienced had no effect on the final result.
What was more important was the ending pain intensity:
- patient A ended at a pain intensity of 6,
- patient B at a pain intensity of 1.

We remember the end of any experience much more clearly than the entire experience (think about movies you watched or books you read or the last date you went on).

Patient B experienced a much worse colonoscopy than Patient A, but Patient A remembered a much more negative colonoscopy experience because A's ending pain intensity was much higher than B's.

This led Kahneman to realise: "there is a Remembring Self and the Experiencing Self. You have the Experiencing Self, the one who lived through the colonoscopy, but the Remembring Self is the one that assigns and keeps a score." And this Remembering Self is affected by the Peak-End Rule - in which people judge an experience largely based on how they felt at its peak (i.e. its most intense point) and at its end, rather than based on the total sum or average of every moment of the experience.

Finally, "it's the Remembering Self that makes the decisions, and it doesn't always do what's best for the Experiencing Self." (We now have a very good understanding of how our memory works. Read more here)

We know that our memories of past experiences help to shape the extent of pain we feel. Just think of a past humiliating experience or a major disappointment. But as we have also seen, our memories of pain are also not always accurate.

What about emotional pain?

At this point, you might be wondering, what about emotional pain? From rejection, from being judged negatively, from being betrayed, from being excluded, from failure, from being misunderstood?

Well, interestingly enough, whether it is physical or emotional, we respond to pain in a very similar manner.
Let's take the example of the colonoscopy above. You feel physical pain from the procedure - and we have learnt above nociceptors sending the signal to a part of our brain (just for interest, it is the parietal lobe - it's not important for our understanding) a different part of your brain - the anterior cingulate - codes the emotional reaction to the physical pain caused.
The anterior cingulate is the same part of your brain that codes for emotional(or social or spiritual) pain.
Since the same anterior cingulate regulates both emotional reactions to physical pain as well as emotional pain itself, it is no coincidence that we use the same language to describe these pains: "I am torn inside out", "I feel ripped to shreds", "My heart is broken".
And just like physical pain, emotional pain or emotional reactions cause our brains warning signals - avoid the experience that could cause pain. There is the same evolutionary root to this - survival: if you avoid something that is painful, you are less likely to be harmed.

This is where things get a bit more complicated. Physical wounds heal. Most injuries, however severe, eventually recover. However, you might still carry a negative emotional reaction even after the pain had gone. For example,

If your fingers were burnt from boiling water, there might not be scars on your hand but there might be scars in your mind - you would probably be much more wary of or even try to avoid handling hot water containers for some time. The pain from the burn has created fear in your mind even after the pain has gone.

Emotional pain carries with it even more layers. Say you had been cheated by a good friend. Again there is emotional pain from this, and just like the example of the burnt hand above, this pain could stay with you for a very long time.
However, as humans, we crave a social company and social validation. We want to make good friends that do not cheat on us.
Here is where the layers of pain build up. First, there is the pain from the initial cheating incident, which causes some fear - I'm afraid of getting cheated again. I have issues trusting someone. Your fear is trying to protect by convincing you to avoid another potentially painful incident.
Except, this is really difficult - because, for most of us, we need to have friends in life we can trust.
So on one hand you have a survival instinct telling you to avoid deep relationships with someone else, and another survival instinct telling you, you need deep relationships for a meaningful life. If you cannot reconcile these opposing forces, you, in turn, develop even more pain - perhaps blaming yourself or your circumstances for the predicament you are in.

Can you create and reduce your own pain?

Alia Crum et al - the Histamine Prick Test

The experiment:

Histamine, a skin irritant, is applied on the arm of participants.
The histamine causes the skin to produce a wheal about the size of a coin (picture above. Don't worry, there is no lasting damage to histamine irritation)
The participants were then divided into 2 groups:
- half of them were told that a doctor would now apply an anti-histamine (would make the rash better)
- the other half were told that a doctor would now apply a histamine agonist (which make the rash worse)
As you would have guessed, it was the same cream applied for both groups.
After a short while, the wheals of the participants were re-measured.

The results:

Even though it was the same neutral cream applied for both groups,
- For those told that the cream would make the rash worse, it actually did get worse; and
- Vice versa, for those told that the cream would make the rash better, it actually did get better.

There are 2 important findings here.

The first: the power of placebos - that is, your expectations alone are sufficient to influence outcomes. In fact, did you know that placebos perform better than about 90% of all drugs? There is a growing body of research on the placebos by some of the best scientific research labs in the world; some of the findings are truly remarkable, you can read more at the "placebos are more than you think page", here.

The second: Have there been examples in our lives where we have made our own pain worse? The dread of Mondays; the belief that aches in some of our joints will only get worse, never better; the increasing anger we build up when we start thinking about how others have wronged or cheated us. How much pain have we felt that have truly been caused by... ourselves?

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The terrific biologist, endrocrinologist, neuroscientist, primatologist Dr Robert Sapolsky - author of "Why do Zebras Not Get Ulcers" and "Behave" - two fantastic books I simply cannot recommend enough.

SO... a quick and painless summary of pain

Pain is a way to signal and draw our attention to danger or potential danger
We know by now that our brains are biologically wired to place survival above all else. Because of this, our brains tend to trigger pain based on a conservative safety-first approach
We also discussed how pain is not objective. It is determined by many other factors, like our emotional state, our memories, our past experiences, and our expectations.
And sometimes these cause our perception of pain to be inaccurate.

Hence, the same incident can cause different perceptions of pain. In fact, at different points in life, the same person might perceive pain differently.

We can control and define the pain we feel

We saw in the histamine example above that when something painful happens, we can control how much pain we actually feel. We can adapt to pain, and become more resilient (as you will see below).
But more importantly, we shouldn't view pain as purely negative. We've heard of popular phrases "no pain, no gain", or "change is painful, but change is necessary". We will all inevitably face pain in our lives.
- Constantly fearing and trying to avoid pain is not a good strategy - we will live so conservatively withn ourselves. There will be no you-nique story written
- And pain could be good for us. All growth has a period of pain - whether it is learning something new, growing stronger, or achieving we want.

We can't always run away from pain. We need to determine what are the things worth going through pain for.

If it is painful, why shouldn't we avoid it?

In a study, 396 women who gave a blood sample and were later told that those samples had been analyzed to identify genes that predispose a woman to breast cancer.
The women were asked if they would like to know if had a predeposition. They simply had to say yes - no further effort required.
169 these women chose not to know.
This is quite staggering; individuals with early knowledge that they are at risk can take precautionary measures to reduce the likelihood of them eventually developing the disease.
Yet 42% of women chose not to receive information that could potentially save their lives, because of they feared how pain the news might be.

Source: C. Lerman, C. Hughes, S. Lemon, et al., “What You Don’t Know Can Hurt You: Adverse Psychological Effects in Members of BRCA1-Linked and BRCA2-Linked Families Who Decline Genetic Testing,” Journal of Clinical Oncology 16 (1998): 1650–54.

Paying is painful, what if you could pay less?

This is a pretty interesting experiment by Dan Ariely, on the pain of paying (read more about the pain of paying here).
Ariely offered his students a unique payment formula for meals:
- Payment is based on how many bites you take
- You can take as large a bite as you like
- You don't need to pay for what you can't finish
Mathematically, this reduced the cost of the meal for his students.
Ariely charged a discounted rate per bite, and students often took huge bites. Small eaters could also pay less.
But were students happier about their meals?
It turns out students were unhappier despite paying less!
They were so concerned with taking larger bites to reduce costs, they didn't enjoy the meal.

This provides us with another important lesson. Sometimes, in our desire to avoid pain, we try to pick a less painful alternative. But this, in turn, brings us other types of pain which we didn't expect. In truth, every path we take in life is likely to have some form of pain or another. Instead of minimising pain, we can think about tin a different way - what if we become better at coping with pain that is worth suffering through? Pain is unpleasant, but is it really something we cannot cope with?

You can adapt to pain

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Dan Ariely and Hanan Frenk - how past pain affected pain threshold and tolerance

The experiment:

40 army veterans were asked to put their hands into hot water
At 48 degree Celcius, the water is hot enough to cause pain to humans.
Veterans were asked to:
- Report as soon as the sensation of heat became painful
- Keep their hand in the water for as long as they could bear (even if it was painful)
After 60 seconds, all veterans were asked to remove their hands (if they haven't already done so).
The veterans were then sorted into 2 groups:
- Those who had suffered severe injuries before, e.g. crushed bones, amputated limbs,
- Those who had suffered only light injuries, e.g. torn ligaments, damaged joints

The results:

Pain tolerance: When do you first feel the sensation of pain?
- For those who had suffered light injuries - after about 4 seconds
- For those who had suffered severe injuries - after about 10 seconds
Pain threshold: When did they remove their hand because they couldn't bear the pain anymore:
- Light injuries - on average about 29 seconds
- Severe injuries - every veteran who had suffered severe injuries lasted the full 60 seconds and had to be instructed to remove their hand.

Even when the stimulus is the same, we've gone through repeatedly that the amount of pain we feel can be very different. We can adapt to pain. We can get better at managing it, so that we don't feel fear

Why does no one give up with 100m to go in a marathon?

Say you're out on a very very very long run.
At some point, you get tired.
Your knees hurt. You feel a stabbing pain your stomach. Your mind is light and your vision is blurry.
You feel like you need to stop.
You soldier on and keep going.
But finally, after struggling on, you stop.
You think to yourself, you can't go on anymore.
Here's the interesting bit though. Can you really not go on anymore?
Even when you are absolutely exhausted and in pain, could you not take just one more step?

What do you think? Could you have taken another step?

And after you have taken that step, what if I told you if you take just one more step, you would have ran the equivalent of a marathon?
And after that step, what if I told you if you could just go one more step after that, you would have exceeded a marathon?

We will all encounter pain in our lives. But most of the time, we can still go on. In our learning from the experiences of others page, you might have read about David Goggins - Goggins might appear extreme to most of us, but he demonstrates, on many occasions, how we often give up too soon.

The neuroscientist Moran Cerf (Cerf is on the cutting edge of neuroscience research, check out his Ted Talks) corroborates this. Interested in what differentiates top athletes and the rest of us, he measured the brain activity of these athletes as they were put through increasingly more challenging physical tasks.

It turns out that pain registers in the brains of top athletes just like everyone else. But the difference is that those top athletes are able to push through the pain barrier to keep going. They would continue to press on even though they faced the same levels of pain.

But is this simply limited to just physical pain?

Although a few people always chose to experience the minimum pain, 70 per cent of the time, on average, participants chose to receive the extra shocks sooner rather than a smaller number later. By varying the number of shocks and when they occurred, the team was able to figure out that the dread of pain increased exponentially as pain approached in time. Similar results occurred in a test using hypothetical dental appointments.

“This study demonstrates that the fear of anticipation is so strong it can reverse the usual pattern of time discounting,” says George Loewenstein, a professor of economics and psychology at Carnegie-Mellon University in Pittsburgh, Pennsylvania. “It’s probably not an exaggeration to say that as much, or more, of the pains of life come from anticipation and memory than from actual experience.”

Researchers from the Institute of Global Health Innovation (IGHI) at Imperial College London and the Wellcome Trust Centre for Neuroimaging at UCL asked 35 volunteers to choose between electric shocks of different intensity occurring at different times.

They found that most people chose to hasten the pain, and would even accept more severe pain to avoid having to wait for it. A smaller proportion preferred to put it off into the future.

Pain is not always negative.
Pain can be a sign we are on the right track

Struggle is necessary because it means progress

Ray Dalio, the founder and co-chairman of the world's largest hedge fund, shares 2 valuable insghts he had gained on pain and suffering.

1) that “Pain + Reflection = Progress”. Pain is a sign of an opporutnity for growth.

"Every time you confront something painful, you are at a potentially important juncture in your life—you have the opportunity to choose healthy and painful truth or unhealthy but comfortable delusion. I saw that to do exceptionally well you have to push your limits and that, if you push your limits, you will crash and it will hurt a lot. You will think you have failed—but that won’t be true unless you give up. The most valuable habit I’ve acquired is using pain to trigger quality reflections. If you can acquire this habit yourself, you will learn what causes your pain and what you can do about it, and it will have an enormous impact on your effectiveness.”

2) that everyone, even those who have found what they wanted to do in life and are successful, deal with pain. Pain is inevitable.

"In my early years, I looked up to extraordinarily successful people, thinking that they were successful because they were extraordinary. After I got to know such people personally, I realised that all of them - like me, like everyone - make mistakes, struggle with their weaknesses, and don’t feel that they are particularly special or great. They are no happier than the rest of us, and they struggle just as much or more than average folks."

"Even after they surpass their wildest dreams, they still experience more struggle than glory. This has certainly been true for me. While I surpassed my wildest dreams decades ago, I am still struggling today. I’m still struggling and I will until I die because even if I tried to avoid the struggles, they will find me.”

The important things in life are worth whatever pain we suffer through

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Viktor Frankl lived through the harshest of conditions as a Jew in a Nazi concentration camp. He observed the deaths of many people and was close to his own demise on multiple occasions. He captured his thoughts on life and death in the tremendously insightful "Man's search for Meaning".

1) Life isn't simply about being happy, but finding meaning.

“Life is never made unbearable by circumstances, but only by lack of meaning and purpose.

2) In the search of meaning, suffering is inevitable. But if something is meaningful enough, we can bear any pain that comes with it.

“If there is meaning in life at all, then there must be meaning in suffering. In some ways suffering ceases to be suffering at the moment it finds a meaning.

Those who have a 'why' to live, can bear with almost any 'how'.”

(You can read more about Ray Dalio, Viktor Frankl, and others at our "Learning from the experiences of others" page here).

As humans, we will all go through many painful moments

Whatever you wish to do, whatever younique story you wish to write, there will be pain along the way. There will be the pain of sacrifices, of not being able to get enough sleep, of not being able to attend functions, of people judging you, of friends not understanding you, of failure, of self-doubt. We know this because as Ray Dalio shared above, everyone struggles, even those who are doing what they like and are successful at it. But we also know as Viktor Frankl shared, that if it is important to us, we can bear any pain that comes with it.

I hope these examples give you strength - to not be fearful of pain and to try and avoid it. That you will be able to find something you want to do and to keep fighting for it.

To find something that is worth the pain to attain.

- How can I find what I want to do in life?

- How can I overcome my fears when there is such deep-rooted biology behind it?

- How can I achieve the goals I have in life?

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Nailed with Pain

Stabbed in the hand (oh wait it's not mine)

Is it more painful when it is intentional

Is it more painful when it is intentional

Can we accurately tell how much pain we feel?

What about emotional pain?

Can you create and reduce your own pain?

If it is painful, why shouldn't we avoid it?

You can adapt to pain

Why does no one give up with 100m to go in a marathon?

Pain is not always negative.
Pain can be a sign we are on the right track

Nailed with Pain

Stabbed in the hand (oh wait it's not mine)

Is it more painful when it is intentional

Is it more painful when it is intentional

Can we accurately tell how much pain we feel?

What about emotional pain?

Can you create and reduce your own pain?

If it is painful, why shouldn't we avoid it?

You can adapt to pain

Why does no one give up with 100m to go in a marathon?

Pain is not always negative. Pain can be a sign we are on the right track

Pain is not always negative.
Pain can be a sign we are on the right track