Expectation of tissue-damage & Experience of pain?

Reference:Arntz A, Claassens L. The meaning of pain influences its experienced intensity. Pain. 2004 May;109(1-2):20-5.

In this Dutch study published in the journal Pain, healthy university students volunteered to have an extremely cold rod (-25� C) placed for one second on the back of their necks. (Yes, the study had passed medical ethics review to ensure the cold rod did not cause any tissue damage!).

Prior to the application of the cold rod, half were told the truth which was that the rod would be extremely cold, however the other half of the innocent volunteers were misled and told that a very hot metal rod would be placed for a second on the back of their neck.

What’s the difference? The thought and anticipation of a cold rod in the back of your neck may send shivers up your spine and make you feel chilly at best. On the other hand, the thought and anticipation of a very hot rod in the back of your neck would inevitably conjure up images of skin burn or a blister and hence increase potentially tissue-damaging thoughts.

So does an expectation of tissue damage influence our pain experience?

YES! Subjects who were falsely told that the bar was hot rated their experience as significantly more painful than those who were told the truth.

Study Conclusion: The intensity of experimentally induced pain on healthy subjects is to significantly determined by their expectation of potential tissue-damage.

Clinical Relevance: Let’s say a patient with neck pain has been told they have DDD based on their x-ray. Thereafter, the slightest twinge in their neck will be interpreted as the “arthritis damage and disc degeneration must be worsening”.

Let’s say a patient with shoulder pain is told that they have a supraspinatus tear based on their ultrasound. Thereafter, the slightest twinge in their shoulder will be interpreted as the tendon tearing further.

Let’s say a patient with pelvic pain is told that their “pelvis is out of alignment”, they will keep seeking passive treatments to have their pelvis “put back in” …which drives me crazy!!

What should have been a short-lived benign pain experience regrettably becomes a prolonged magnified pain experience …no thanks to the inaccurate thoughts of potential tissue damage …provided by health care providers.

Personal Comment:I have had patients (and PTs as patients) who have shown me their radiology results on their iPhone. They have the image of how bad their spine is at their fingertips and carry it with them wherever they go (almost as proof of their pain). I have suggested deleting the images from their phone and their brain, but unfortunately for some personalities it’s not that easy to do.

Posted on: June 20, 2012


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