Pain and social context: social, contextual and environmental factors in the perception of acute pain

A number of factors have been identified as generally reliable predictors of individual differences in responses to acute pain (e. g. sex, personality traits and cultural affiliation). These factors constitute relatively stable, long-term characteristics of an individual. However, there is also significant within-individual variation in response to acute pain, suggesting that factors other than individual characteristics also influence pain response. It is known that affective-motivational state is a significant component of pain, and it has been argued also that the process of automatic evaluation effects changes in affectivemotivational state through the activity of limbic structures associated with the detection and processing of emotionally valenced environmental information. This thesis proposes that through this mechanism, qualities of the immediate environment can act as modifiers of pain response.

A series of experiments were conducted to test for the effects of manipulation of social, contextual and environmental features on responses to a mechanical pain stimulus. The results show that manipulation of preparatory information and locus of perceived control within the experimental dyad resulted in significant changes in response to the second of two pain stimuli of identical intensity. Also, both the sex of the assessor and the presence of a negatively valenced feature in the test environment were shown to influence pain response significantly. These results are in line with evidence from research into automaticity and automatic evaluation, and recent evidence concerning the roles of limbic areas in emotional processing and pain.

The results provide further insight into the nature of acute pain, and suggest that individual variation in pain response may be explained in terms of an integrated biopsychosocial model, which includes what is known of the neural bases underlying the sensory and affective-motivational components of pain (the pain matrix), but also acknowledges the roles of socially acquired, long-term cognitive structures relating to individual traits, and the influence of automatic evaluation. The results have significant implications for clinical and research practices as they indicate that qualities of the environment may impact upon clinical and experimental pain measurement. Moreover, they indicate that individuals can be 'primed' for pain by qualities of their environment and as a result, may suffer unnecessarily during acutely painful clinical procedures. However, awareness of these principles may be useful in developing methods of reducing suffering in those situations.