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Last updated: Wed, Jul 31, 2024
Expectation is closely related to attention. Melzack and Wall state that If a person's attention is focused on a potentially painful experience, pain will tend to be perceived more intensely than normal....the mere anticipation of pain is sufficient to raise the level of anxiety and thereby the intensity of perceived pain.
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Let me start by saying that I don't dispute the studies on which this statement was based. I do dispute the interpretation.
This quotation, I think, illustrates a pitfall of behavioral research, the tendency to introduce ill-defined, uncontrolled and unstudied factors (in this case, anxiety) into the interpretation of results. Although it makes sense to me that "level of anxiety" might be involved, I'm not at all sure just what that is or how one might measure it in an experimental context. Nor is it at all clear how this "level of anxiety" would be involved in pain outside of the laboratory. It is a different thing to suggest an explanation than to establish an explanation that is both correct and useful.
Distraction, on the other hand, tends to lessen perceived pain. Melzack and Wall (who seem far more sympathetic to chronic pain sufferers than many researchers) say:
Every sufferer of chronic pain has learned to force himself to concentrate on activities that become so absorbing that pain is not felt or is greatly diminished. A well-known actress, for example, reports that her intense arthritic pain vanished the moment her part begins on stage and returns as soon as it is over. People who suffer severe pain after brachial plexus lesions...report that the most effective way to reduce their pain is to absorb themselves in their work.2
I see another pitfall in this last quotation, this time involving pain that is not felt or is greatly diminished.
If pain, in this condition, is really not felt,
or even if it is merely greatly diminished,
then we have another cure for pain. If, on the other hand, the sufferer has merely shifted attention away from it, the situation is different. In the latter case, the sufferer is not so intensely aware of a process that nevertheless is ongoing (Pain Phenomena Involving the Brain). I don't intend this as a criticism of Melzack and Wall, whom I highly respect, but as another instance of how non-scientific (non-rigorous, untested) ideas find their way into pain medicine.
The same authors report on an experiment in which subjects were subjected to the “cold pressor test,” in which an arm is immersed in ice water. When the subjects were given the opportunity to listen to white noise or music during this test, they not only listened, but tapped their feet, sang, and fiddled with the volume control.3
The ability to be distracted from pain seems to me best seen as another adaptive feature of the nervous system. It's not hard to envision fight-or-flight scenarios in which this ability would be critical. I haven't encountered any studies, unfortunately, that estimate the limits of this ability--how much pain can be blocked, and for how long? (That is, if we are capable of distracting ourselves from severe pain for extended periods, it may provide the basis for a useful pain-control technique. If not, the prospects for such techniques are much less positive.)