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Social Pain, Physical Pain, and the Brain

Overlapping Brain Regions Involved with Emotional and Physical Pain

Social relationships and social networks are vital to the evolutionary survival of our species. When we experience social loss, such as the death of a loved one or the breakup of an important relationship, we feel emotional (social) pain.

As we know all too well, humans also experience many types of physical pain. When we sprain an ankle or crack a rib, it hurts. When we get stung by a bee, ouch! As we age, many of us experience joint pain and other physical discomfort related to arthritis.

Are these two types of pain - social pain and physical pain - related? Naomi Eisenberger, a psychologist at UCLA, recently published a paper entitled “The pain of social disconnection: examining the shared neural underpinnings of physical and social pain” in Nature Review's Neuroscience. This fascinating and provocative paper addresses the relationships between these two types of pain. The following discussion is based largely on information from this paper.

It turns out that physical pain has two components. One is called the sensory component and is related to the physical characteristics of pain, such as the location of the pain, the type of pain (pinprick versus a burn, for example), and the intensity of the pain. The second component of physical pain is an “affective component,” which involves our interpretation of the pain, including how bothersome we perceive it to be. This affective component motivates us to take action to try to alleviate the pain and largely reflects an emotional reaction to pain in which we attach meaning to what we have experienced.

Various neuroimaging techniques have been used to visualize the functioning of the human brain in real time. These types of studies have lead to a substantial amount of information about the regions of the brain involved in different types of pain. The brain regions involved in the sensory components and the affective components of physical pain are different. Two brain regions that appear to be critical in the affective aspects of physical pain are the dorsal anterior cingulate cortex (dACC) and the anterior insula (AI). It turns out that these two brain regions are also critically involved in the emotionally painful feelings associated with social distress.

It seems reasonable to hypothesize that these two brain regions play similar roles in processing the affective components of physical pain and in processing social pain. Eisenberger points out that if this hypothesis is true, it leads to certain predictions. One prediction is that people who are very sensitive to social pain are likely to have increased sensitivity to physical pain. Another prediction is that conditions that influence one type of pain should have similar influence on the other kind of pain. In her paper, Eisenberger reviews published research that supports these two predictions. As examples, she reviews data showing that social support helps decrease physical pain and that medications for physical pain may also be helpful in diminishing social pain.

This description of the brain regions involved in physical and social pain is likely to be overly simplistic in that complex cognitive, emotional, and motivational experiences involve coordinated activity in parallel but integrated brain networks, and do not simply reflect the activity of one or two isolated brain regions. As brain imaging techniques continue to develop, increasingly detailed information about the functioning of specific brain regions and brain networks involved in specific tasks will be available. Such knowledge could suggest new and different treatments for pain, including the integration of medications with social and cognitive interventions aimed at attention and information processing. Hopefully, such integrated treatments will be safer and more effective than some of the currently available treatments for various types of pain. These approaches, particularly cognitive interventions, may also be beneficial for treating the pain associated with major psychiatric disorders such as depression.

This column was co-written by Eugene Rubin MD, PhD and Charles Zorumski MD.