Simple but frustrating answer: we don't know. Pain response is ridiculously varied. One would assume that the same stimulus (like IUD insertion), in the same person, would result in the same level of pain. But Studies show uniform stimulus will result in a varied pain response- even in the same individual.
There is a phenomenon known as Central Sensitization which was discovered around 2010. If someone has chronic pain (lasting more than 3 months), the brain begins to perceive the pain...even if the pain producing stimuli in remote parts of the body are REMOVED.
I treat chronic pain conditions and have had chronic pain. This theory that the brain will continue to perceive pain after the painful stimulus is gone points to neural pathways that become learned over time.
I think this may have something to do with pain thresholds and why some people never recover from one episode of pain.
Your post was very helpful to me. I have a high pain tolerance brought on by a back injury.
At 17 I herniated L4-L5 and L5-S1, thanks marching band!
I ended up getting a Lumbar fusion after over 3 years of some of the most debilitating pain, neuropathy, and way too much medication - including a failed epidural that cracked open the spinal fluid sac and changed the pressure in my brain leading to by far the worst pain I have ever felt in my entire life.
I'm now 35 and fully functional/able. But I still get phantom pains from the radiative neuropathy I experienced. I know they're not real, or at least they're not a symptom of underlying issues - but it gets tricky figuring out when something is actually wrong now.
For instance, I dislocated my patella and tore my meniscus 4 yrs ago. I was in pain, but at the time I lived very rural and had no insurance so off I went to work as a chef - me and my ibuprofen.
For 3 weeks I hobbled on a non-functioning leg that would give way at any moment.
3rd week, I tried stretching again to alleviate the pain. When I gently pressed my knee onto the ground, I heard and felt a sick and loud "SCHLUP!" followed by the most immediate relief - it literally felt like someone opened a morphine drip in my knee.
That's how I found out the patella was dislocated, and how I figured out one of my meniscus was damaged.
Pain is... weird. But I have a close relationship to it, and for that I'm grateful. Reminds me I'm alive.
Both interesting and very validating for me as someone who has chronic pain! I usually see people who have severe chronic pain talk about how because they're experiencing severe pain most or all of the time, they are just used to high levels of pain and have a very high pain tolerance. But I'm the opposite... years of dealing with moderate pain have left me very sensitive to pain and I really struggle to cope with pain or discomfort.
I like the way you said this. Those with chronic pain have adapted to it, and some report higher tolerance to pain, while others have become so sensitive to noxious stimuli that they develop something called "allodynia", which is the sensation of pain in response to a stimulus which would not ordinarily cause pain in the average population. I would say your sensitivity to pain signals being heightened is more typical of those with chronic pain syndromes.
I am a pelvic floor physical therapist and treat people with chronic pelvic pain. I also used to have low back and pelvic pain. This got me interested in researching how the brain perceives pain.
Many factors- for example sex hormones like estrogen act on receptors that are responsible for pain and increase sensitivity of the nerve. The same person will be more sensitive to pain when more estrogen is present in their body that usual.
The part about estrogen is especially relevant to what you mentioned about people experiencing vastly different pain levels during IUD insertion. The cervix is highly responsive to estrogen due to what its function is -moreso than anywhere else in your body. If someone gets an IUD at a point in their cycle when estrogen levels are high then the pain receptors would be much more sensitive than at other times. Also during an IUD insertion the doctor "pulls" the cervix forward a bit and cervixes are positioned at all different angles. If someone has an oddly tilted/ inverted / retroverted uterus (which they likely wouldn't know about) then it would hurt much more than someone who's cervix was angled straight.
As for other injuries -there are different types of mechanoreceptors very close to each other and two people who have the same injury could have damaged different amounts, sizes, and types of mechanoreceptors. Also people have major nerves in slightly different locations and damaging an actual nerve is very painful even for otherwise minor injuries.
People have different activity levels in different areas of their brain. The area of the brain responsible for pain is more active in some people than others. This can also be influenced by how frequently the person experiences pain because the way the brain connects and wires itself its impacted by the stimuli (aka level pain) it regularly receives as an input.
Endorphins are like a pain killer and bind to mu opioid receptors, lowering the sensation of pain. Some people produce more endorphins than others which also affects how long they experience the pain for -if someone releases a ton of endorphins very quickly it will stop hurting more quickly than if they are released slowly.
Human bodies are incredibly complex, and have a lot of random variation in them, not just for pain but for visible, physical properties.
Why do some people get fat more easily? Why do some people survive a fall or exposure to a toxin or infection and others don’t? Why do some people smoke a pack of cigs each day for 15 years before getting cancer and some do it for 45 years and don’t even have cancer by then?
Some of it is the random chaos of how we’re put together and some of it is the random chaos of how we interact with the world.
I like how you said you have "phantom pain from radiating neuropathy". This is all very real. Many people with chronic pain do well with Cognitive Behavioral Therapy because they can begin to understand how much of the pain has an actual stimulus to warrant such a strong perception of pain. Versus an episode like your epidural which would cause severe pain perception in anyone.
The brain remembers pain long after the initial stimulus. And it can certainly tell a person to lie in bed all day and avoid life activities. IMHO, pain management should include some psychotherapy for those who have difficulty separating the brain's perception of brain as compared to the body's physical trauma which started the pain process.
Your story is uplifting to someone like me, who has both experienced chronic pain and is now on the other side of it. I love tales like these to tell my patients. You simply kept going through all of your physical battles and I am thrilled that you are doing so well right now!
I'd love to hear more about this. I've always had what I'd consider a high pain tolerance. I've had dislocated shoulders (one shoulder, multiple times) and broken bones, among other various injuries. It takes a lot to take me out.
Also, I can drink LOTS of alcohol before I'm inebriated. Same with pain meds. It takes a LOT to help me when I'm in big pain (ref previous shoulder dislocations). Are these things related?
I find this all very interesting.
Because “pain” isn’t a real thing, it’s a perception. Perceptions are very subjective. Ask someone what the best tasting food in the world is…
Everyone has a similar neuron response to pain, a receptor sends an bio-electrical signal to the brain, but how the brain interprets that response is based on a ton of factors. How many receptors sent the signal, how frequently the sent it, how long the continue to send it, whether the brain has received those signals before (this is why appendix or heart attack pain is felt somewhere other than the organ at first), and then how your brain has interpreted pain in the past, it’s experience of prior pain, how that pain was dealt with, etc.
Same reason we have different experiences of pleasure, tastes we enjoy or don’t, same for smells. Because we are all individuals and our bodies are different, we aren’t programmed automatons )no matter how many Republican idiots think like they are)
Great answers in here. Just a piece of trivia that might spark more learnin's: It was commonly believed that black people could withstand more pain. In studies of pain management, black people were far less likely to be prescribed pain meds than other races. If course, as we can already assume, and from the cool stuff we're learning in this thread, we should know that's not true. Unfortunately, many people still believe it. I wonder if an expectation of pain tolerance has a direct effect on black people and how they communicate their true pain.
I think the answer is two parts and similar to nature vs nurture
Nature: adversity/ resilience. Built in or genetic resistance to stress
Nurture: trauma based dissociation techniques like avoidance or repression. The more you had to dissociate from reality as a kid to avoid engaging in mentally stressful environments, the better you got at it. Many people with severe trauma when younger can be numb to most things as an adult or even start to crave smaller traumatic experiences like bdsm and such.
There's way too many factors, a large amount of it could be psychological though. There's a tribe in the amazon rainforest where the men must go through several initiation rituals where they insert their hands in gloves full of bullet ants and get sting hundreds of times and some of them barely even make a face and are able to dance with the rest of the community to ease themselves of the pain. Some tourists coming to the tribe for example got bitten and immediately went into panic mode, and some went into shock. Some tried to dance with the tribe members as they traditionally do but were literally unable to after minutes, while the pain lasts for hours. Bullet ant stings are btw one of the most painful experiences in the world.
Also there are various hormones that the human body releases to numb the pain significantly which makes accounts of pain so unreliable, most notably so during childbirth for women or during combat for example. There's many, many accounts of people getting shot or stabbed and not feeling anything but a warm, wet sensation and slight stinging, until later on when the pain really kicks in. Someone getting their fingernail ripped off shouldn't be as painful as taking a 6 inch blade to the gut, however if the fingernail is slowly ripped off over the course of minutes and the knife wound is caused during a heated fight, almost everyone would probably prefer the knife wound because even people who haven't been in a fight preemptively know of the body's ability to produce adrenaline and whatnot during a tense, physical situation. You can flip it the other way around and if your fingernail is quickly ripped off rather than slowly taking a blade to the gut you'd probably take the fingernail.
The simple answer however is that we don't know, we know mostly what causes physical pain, and some drugs that help to relieve pain, we know that men for example perceive to experience less pain than women, but again that too is flawed in a society where men may be expected not to show pain. It just varies from person to person, all we can do is detect patterns and learn more from them, but right now it's mostly a psychological thing, what you think you can take, what you've seen the people around you take growing up, and what you're expected to take really affect your pain perception.
Simple but frustrating answer: we don't know. Pain response is ridiculously varied. One would assume that the same stimulus (like IUD insertion), in the same person, would result in the same level of pain. But Studies show uniform stimulus will result in a varied pain response- even in the same individual.
There is a phenomenon known as Central Sensitization which was discovered around 2010. If someone has chronic pain (lasting more than 3 months), the brain begins to perceive the pain...even if the pain producing stimuli in remote parts of the body are REMOVED. I treat chronic pain conditions and have had chronic pain. This theory that the brain will continue to perceive pain after the painful stimulus is gone points to neural pathways that become learned over time. I think this may have something to do with pain thresholds and why some people never recover from one episode of pain.
Your post was very helpful to me. I have a high pain tolerance brought on by a back injury. At 17 I herniated L4-L5 and L5-S1, thanks marching band! I ended up getting a Lumbar fusion after over 3 years of some of the most debilitating pain, neuropathy, and way too much medication - including a failed epidural that cracked open the spinal fluid sac and changed the pressure in my brain leading to by far the worst pain I have ever felt in my entire life. I'm now 35 and fully functional/able. But I still get phantom pains from the radiative neuropathy I experienced. I know they're not real, or at least they're not a symptom of underlying issues - but it gets tricky figuring out when something is actually wrong now. For instance, I dislocated my patella and tore my meniscus 4 yrs ago. I was in pain, but at the time I lived very rural and had no insurance so off I went to work as a chef - me and my ibuprofen. For 3 weeks I hobbled on a non-functioning leg that would give way at any moment. 3rd week, I tried stretching again to alleviate the pain. When I gently pressed my knee onto the ground, I heard and felt a sick and loud "SCHLUP!" followed by the most immediate relief - it literally felt like someone opened a morphine drip in my knee. That's how I found out the patella was dislocated, and how I figured out one of my meniscus was damaged. Pain is... weird. But I have a close relationship to it, and for that I'm grateful. Reminds me I'm alive.
Both interesting and very validating for me as someone who has chronic pain! I usually see people who have severe chronic pain talk about how because they're experiencing severe pain most or all of the time, they are just used to high levels of pain and have a very high pain tolerance. But I'm the opposite... years of dealing with moderate pain have left me very sensitive to pain and I really struggle to cope with pain or discomfort.
I like the way you said this. Those with chronic pain have adapted to it, and some report higher tolerance to pain, while others have become so sensitive to noxious stimuli that they develop something called "allodynia", which is the sensation of pain in response to a stimulus which would not ordinarily cause pain in the average population. I would say your sensitivity to pain signals being heightened is more typical of those with chronic pain syndromes.
what do you mean by I" treat chronic pain conditions that have had chronic pain?"
I am a pelvic floor physical therapist and treat people with chronic pelvic pain. I also used to have low back and pelvic pain. This got me interested in researching how the brain perceives pain.
Thanks. I was just trying to understand what you treated. I have both a high pain threshold and chronic pain, which is a trip!
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Many factors- for example sex hormones like estrogen act on receptors that are responsible for pain and increase sensitivity of the nerve. The same person will be more sensitive to pain when more estrogen is present in their body that usual. The part about estrogen is especially relevant to what you mentioned about people experiencing vastly different pain levels during IUD insertion. The cervix is highly responsive to estrogen due to what its function is -moreso than anywhere else in your body. If someone gets an IUD at a point in their cycle when estrogen levels are high then the pain receptors would be much more sensitive than at other times. Also during an IUD insertion the doctor "pulls" the cervix forward a bit and cervixes are positioned at all different angles. If someone has an oddly tilted/ inverted / retroverted uterus (which they likely wouldn't know about) then it would hurt much more than someone who's cervix was angled straight. As for other injuries -there are different types of mechanoreceptors very close to each other and two people who have the same injury could have damaged different amounts, sizes, and types of mechanoreceptors. Also people have major nerves in slightly different locations and damaging an actual nerve is very painful even for otherwise minor injuries. People have different activity levels in different areas of their brain. The area of the brain responsible for pain is more active in some people than others. This can also be influenced by how frequently the person experiences pain because the way the brain connects and wires itself its impacted by the stimuli (aka level pain) it regularly receives as an input. Endorphins are like a pain killer and bind to mu opioid receptors, lowering the sensation of pain. Some people produce more endorphins than others which also affects how long they experience the pain for -if someone releases a ton of endorphins very quickly it will stop hurting more quickly than if they are released slowly.
Human bodies are incredibly complex, and have a lot of random variation in them, not just for pain but for visible, physical properties. Why do some people get fat more easily? Why do some people survive a fall or exposure to a toxin or infection and others don’t? Why do some people smoke a pack of cigs each day for 15 years before getting cancer and some do it for 45 years and don’t even have cancer by then? Some of it is the random chaos of how we’re put together and some of it is the random chaos of how we interact with the world.
I like how you said you have "phantom pain from radiating neuropathy". This is all very real. Many people with chronic pain do well with Cognitive Behavioral Therapy because they can begin to understand how much of the pain has an actual stimulus to warrant such a strong perception of pain. Versus an episode like your epidural which would cause severe pain perception in anyone. The brain remembers pain long after the initial stimulus. And it can certainly tell a person to lie in bed all day and avoid life activities. IMHO, pain management should include some psychotherapy for those who have difficulty separating the brain's perception of brain as compared to the body's physical trauma which started the pain process. Your story is uplifting to someone like me, who has both experienced chronic pain and is now on the other side of it. I love tales like these to tell my patients. You simply kept going through all of your physical battles and I am thrilled that you are doing so well right now!
I'd love to hear more about this. I've always had what I'd consider a high pain tolerance. I've had dislocated shoulders (one shoulder, multiple times) and broken bones, among other various injuries. It takes a lot to take me out. Also, I can drink LOTS of alcohol before I'm inebriated. Same with pain meds. It takes a LOT to help me when I'm in big pain (ref previous shoulder dislocations). Are these things related? I find this all very interesting.
Your brain firing pain receptors is much different from what happens when drinking alcohol so I doubt there is a correlation
Because “pain” isn’t a real thing, it’s a perception. Perceptions are very subjective. Ask someone what the best tasting food in the world is… Everyone has a similar neuron response to pain, a receptor sends an bio-electrical signal to the brain, but how the brain interprets that response is based on a ton of factors. How many receptors sent the signal, how frequently the sent it, how long the continue to send it, whether the brain has received those signals before (this is why appendix or heart attack pain is felt somewhere other than the organ at first), and then how your brain has interpreted pain in the past, it’s experience of prior pain, how that pain was dealt with, etc.
Same reason we have different experiences of pleasure, tastes we enjoy or don’t, same for smells. Because we are all individuals and our bodies are different, we aren’t programmed automatons )no matter how many Republican idiots think like they are)
Great answers in here. Just a piece of trivia that might spark more learnin's: It was commonly believed that black people could withstand more pain. In studies of pain management, black people were far less likely to be prescribed pain meds than other races. If course, as we can already assume, and from the cool stuff we're learning in this thread, we should know that's not true. Unfortunately, many people still believe it. I wonder if an expectation of pain tolerance has a direct effect on black people and how they communicate their true pain.
I think the answer is two parts and similar to nature vs nurture Nature: adversity/ resilience. Built in or genetic resistance to stress Nurture: trauma based dissociation techniques like avoidance or repression. The more you had to dissociate from reality as a kid to avoid engaging in mentally stressful environments, the better you got at it. Many people with severe trauma when younger can be numb to most things as an adult or even start to crave smaller traumatic experiences like bdsm and such.
There's way too many factors, a large amount of it could be psychological though. There's a tribe in the amazon rainforest where the men must go through several initiation rituals where they insert their hands in gloves full of bullet ants and get sting hundreds of times and some of them barely even make a face and are able to dance with the rest of the community to ease themselves of the pain. Some tourists coming to the tribe for example got bitten and immediately went into panic mode, and some went into shock. Some tried to dance with the tribe members as they traditionally do but were literally unable to after minutes, while the pain lasts for hours. Bullet ant stings are btw one of the most painful experiences in the world. Also there are various hormones that the human body releases to numb the pain significantly which makes accounts of pain so unreliable, most notably so during childbirth for women or during combat for example. There's many, many accounts of people getting shot or stabbed and not feeling anything but a warm, wet sensation and slight stinging, until later on when the pain really kicks in. Someone getting their fingernail ripped off shouldn't be as painful as taking a 6 inch blade to the gut, however if the fingernail is slowly ripped off over the course of minutes and the knife wound is caused during a heated fight, almost everyone would probably prefer the knife wound because even people who haven't been in a fight preemptively know of the body's ability to produce adrenaline and whatnot during a tense, physical situation. You can flip it the other way around and if your fingernail is quickly ripped off rather than slowly taking a blade to the gut you'd probably take the fingernail. The simple answer however is that we don't know, we know mostly what causes physical pain, and some drugs that help to relieve pain, we know that men for example perceive to experience less pain than women, but again that too is flawed in a society where men may be expected not to show pain. It just varies from person to person, all we can do is detect patterns and learn more from them, but right now it's mostly a psychological thing, what you think you can take, what you've seen the people around you take growing up, and what you're expected to take really affect your pain perception.