Why emotions can feel so painful and what it means for painkillers

A new understanding of the link between emotions and physical pain is helping identify the root causes of our pain, and why physical and emotional pain so often coexist

By Helen Thomson

FEAR that makes you vomit, the sting of a rejection, paralysing grief – emotional pain can manifest in many physical symptoms. And while writers and musicians have spun tales and crafted songs intertwining physical and emotional pain for centuries, scientists have found it more difficult to describe the relationship between the two.

Now, recent breakthroughs are shedding light on the shared mechanisms that underlie both kinds of pain, offering an explanation as to why one leads to the other and providing avenues for treating some of our most debilitating conditions.

While senses like vision and hearing have nerve pathways that can be traced from the eyes and ears to a distinct brain region, brain activity in response to pain is more complex. It incorporates thoughts and emotions, which is why a good book can lessen a toothache, for instance, or the pain from a hot probe hurts more when you feel sad.

But emotions do more than just modulate existing pain symptoms. Distress from grief or embarrassment can lead to pain that may have no physical cause, but is no less real. Brain scans show similar activity in the pain network, which includes areas such as the insula, thalamus and anterior cingulate cortex that consistently respond to painful or attention-grabbing stimuli, when people are feeling psychological pain like social rejection and when they have physical pain.

Understanding the emotional aspects of pain could help tackle certain mental health conditions. Some studies have suggested that up to 75 per cent of people with chronic pain also experience anxiety and depression. “Having a predisposition for one of the conditions may make it more likely that you will …