Mindfulness and the Pain Threshold
Two people can have the exact same injury and have completely different pain experiences. Why?
Because pain is not as simple as tissue damage = ouch.
Let’s say you stub your toe. The nerves in your toe register a potential threat to their homeostasis. They send this memo to the boss upstairs, aka your brain. Your brain receives this information, then outputs pain to bring this potential threat to your consciousness. This is the basic explanation of what we tend to think of as pain, more specifically the type of pain mechanism called nociception (more on other pain mechanisms to come in future posts). However, there’s so much more to it than that. There are all sorts of pit stops this message makes from the point of toe-stubbing to the point of pain output from the brain. At these pit stops, the message can be modified to become stronger or weaker, therefore altering the eventual intensity of pain.
Stress levels (and whether they are acute or chronic), previous injury to the area, chronicity of symptoms in that area, environmental context, how well you slept the night before, genetics, psychological state, presence of early childhood trauma, substance use, and so much more can impact how much stimulus is needed at the site of the tissues in order for the brain to output pain. We have a way of measuring this and it is called the pain-pressure threshold or PPT.
To measure someone’s PPT in a specific area, we use an apparatus that quantitatively measures the amount of pressure applied before the individual reports a shift in sensation from pressure to pain. I will add that just because someone has as low PPT (ie more sensitive to stimulus) in one area does not indicate that they overall have a low pain threshold. Additionally, having a low PPT can be beneficial in a lot of circumstances. We all know what it’s like to stub your toe two days in a row, right? Or to bite your tongue in the same area you already bit it a few minutes prior? We want our injured tissues to be more sensitive in order to remind us to care for them while they heal. On the flip side, having a chronically low PPT can be problematic as your nervous system might continue to detect threats even after tissues have healed.
Hopefully you can see how your PPT is not set and can be altered in all sorts of ways, and mindfulness has been shown to increase the PPT. Long term meditators require significantly higher levels of noxious stimuli to report parallel pain levels to matched controls. However, you don’t need to take up residency at a monastery to reap the benefits. One study found that participants’ pain threshold increased significantly after just 20 minutes of mindfulness practices for four consecutive days.
From a neuroscience perspective, we have some ideas as to why mindfulness helps increase the pain threshold:
Mindfulness decreases activity in the parts of our brains related to negative emotions, threat-detection, and activation of fear-related behaviors. So, when that threat message reaches the brain the conversation the brain has with itself about just how loud of an alarm it needs to sound to keep us safe occurs with much more clarity.
It decreases atrophy (shrinking) of the areas responsible for impulse control, decision making, emotional regulation, interoception (ability to detect what’s happening inside your body), and empathy. This helps us take more appropriate action based on the reality of the events unfolding.
It decreases the negative effects of stress and pain on the brain areas responsible for emotion, memory, learning, and motivation. We cannot untangle stress and pain from one another (more on that to come). Mindfulness helps us appraise stressful events more appropriately, therefore decreasing their negative effects.
From a qualitative standpoint, mindfulness:
enhances our ability to observe and acknowledge unpleasant sensations without judgment. It helps us be aware of exactly what is happening at the present moment without getting lost in anticipation of pain or the emotions that come with a pain experience. We therefore feel empowered to respond to pain with compassion and even gratitude.
helps us regulate our emotional response to unpleasant experiences by enabling us to observe. It allows us to respond rather than react. This way, we can make the best choices for ourselves.
gives us tools in the moment that we can use to regulate our nervous systems, bringing down our fight-or-flight activity and increasing our rest-and-digest activity. Slow, deep breathing and body scanning can activate this relaxation response, reducing stress and subsequently increasing the pain threshold.
increases body awareness. This helps us recognize early warning signs of a flare-up as well as tension holding patterns that come with pain, emotions, or psychological states.
If you are interested in learning more about mindfulness or mindfulness and pain, check out my Mind(ful) Over Matter course or reach out to me directly. There is so much more where this came from!
References:
•Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014;94(12):1816-1825. doi:10.2522/ptj.20130597
•Kabat-Zinn J. Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical Psychology: Science and Practice. 2003;10(2):144-156. doi:10.1093/clipsy/bpg016
•McManus C. Mindfulness-Based Biopsychosocial Approach to the Treatment of Chronic Pain. Lecture presented at the: 2018; Samuel Merritt University.
•Shapiro SL, Siegel DJ. Good Morning, I Love You: Mindfulness + Self-Compassion Practices to Rewire Your Brain for Calm, Clarity + Joy. Boulder, CO: Sounds True; 2022.