How words impact on pain.

Alexander Ritter,Marcel Franz,Thomas Weiss,Wolfgang H R Miltner

doi:10.1002/brb3.1377

Abstract

IntroductionThe wording used before and during painful medical procedures might significantly affect the painfulness and discomfort of the procedures. Two theories might account for these effects: the motivational priming theory (Lang, 1995, American Psychologist, 50, 372) and the theory of neural networks (Hebb, 1949, The organization of behavior. New York, NY: Wiley; Pulvermuller, 1999, Behavioral and Brain Sciences, 22, 253; Pulvermüller and Fadiga, 2010, Nature Reviews Neuroscience, 11, 351).MethodsUsing fMRI, we investigated how negative, pain‐related, and neutral words that preceded the application of noxious stimuli as priming stimuli affect the cortical processing and pain ratings of following noxious stimuli.ResultsHere, we show that both theories are applicable: Stronger pain and stronger activation were observed in several brain areas in response to noxious stimuli preceded by both, negative and pain‐related words, respectively, as compared to preceding neutral words, thus supporting motivational priming theory. Furthermore, pain ratings and activation in somatosensory cortices, primary motor cortex, premotor cortex, thalamus, putamen, and precuneus were even stronger for preceding pain‐related than for negative words supporting the theory of neural networks.ConclusionOur results explain the influence of wording on pain perception and might have important consequences for clinical work.

Highlights

The wording used before and during painful medical procedures might significantly affect the painfulness and discomfort of the procedures
Because such priming effects may exert a persistent impact on the nervous system (Cave & Squire, 1992), wording prior to or during medical procedures is of crucial impor‐ tance for the perception and discomfort of pain
To test whether the processing of noxious input in the brain might become differentially modulated by different types of verbal primes, we conducted a functional magnetic reso‐ nance imaging experiment where subjects were exposed to painful electrical stimuli that were preceded either by pain‐related, non‐pain‐related negative, or neutral words (Figure 1a)

Summary

| INTRODUCTION

Identical noxious stimuli to the skin are not always perceived uniformly painful and unpleasant. Patients report more pain and discomfort in response to a medical procedure when the preceding explanation of the procedure addresses the painful‐ ness of the procedure by using pain‐related wording (Dutt‐Gupta, Bown, & Cyna, 2007; Ott, Aust, Nouri, & Promberger, 2012; Wang et al, 2008) This impact of preceding verbal information might be explained by the motivational priming theory (Lang, 1995) positing. Rhudy and colleagues (Rhudy, McCabe, & Williams, 2007; Rhudy, Williams, McCabe, Russell, & Maynard, 2008), for example, found evidence for the motivational priming theory when individuals saw unpleasant as compared to neutral pictures prior to noxious stimulation They found increased heart rate, nociceptive flexion reflex, and skin conductance re‐ sponses to physically identical noxious stimuli when negative as compared to positive pictures were shown. To test whether the processing of noxious input in the brain might become differentially modulated by different types of verbal primes, we conducted a functional magnetic reso‐ nance imaging (fMRI) experiment where subjects were exposed to painful electrical stimuli that were preceded either by pain‐related, non‐pain‐related negative, or neutral words (Figure 1a)

| MATERIALS AND METHODS

| Experimental procedure

Findings

| DISCUSSION