Psychosocial Factors Modulate Pain Perception
Viewing photographs reduces pain ratings in patients with chronic pain.
New findings reported in the Journal of Pain are the first to demonstrate that viewing photographs can decrease pain intensity in patients with chronic pain.1
Previous findings suggest that pain perception is modulated by psychological factors such as emotional state.2,3 Studies that used various methods to induce positive or negative emotions showed that the former reduced pain perception, whereas the latter increased it.4,5 One study found that participants' pain tolerance increased when they viewed pictures they perceived as pleasant vs unpleasant or neutral.6 Other research reported that perceived social support reduced pain ratings during a cold pressor task.7
Merging these findings, a 2009 study observed that "viewing photographs of loved ones primed associated mental representations of being loved and supported and also attenuated experimental thermal pain," as described in the present article.8 However, research in this area has focused solely on experimental vs clinical pain.
In the current study, researchers aimed to address that gap by investigating this phenomenon in 88 patients being treated for chronic pain in an inpatient setting. Participants were at least 18 years old and suffered from a variety of pain modalities, such as neuropathic, postsurgical, and musculoskeletal pain.
During a 4-day period, they viewed digital images in 4 categories: loved ones, strangers, landscapes, and optical illusions (as emotionally neutral stimuli). They rated their pain intensity and other aspects of pain, as well as the valence and degree of arousal associated with viewing the pictures. Valence refers to how positive or negative one's emotional state is, whereas arousal refers to how subjectively calming or exciting that state is.
The findings show that all categories led to reduced ratings of pain intensity and the affective and sensory qualities of pain. However, viewing images of loved ones led to the most substantial decrease in pain intensity, according to a contrast analysis that found significant interactions when comparing photographs of loved ones vs the other categories: strangers [F(1, 72) = 15.28; P <.001; r = .41], landscapes [F(1, 72) = 21.34; P =.000; r = .48], and optical illusions [F(1, 72) = 9.06; P =.004; r = 0.33]. The results further indicate that the link between category and the reduction in pain intensity was mediated by the valence attributed to the pictures, and those of loved ones received the highest positive valence ratings.
The researchers suggest that the pain-reducing effects of viewing photographs may be a result of both the emotional distraction and the attenuating influence of positive emotions on pain perception. They note that this approach could be applied as a supplementary technique in routine pain treatment. "Patients with chronic pain could be advised to focus their attention on pictures of loved ones in stressful situations or in situations that exacerbate their pain," they wrote.
Summary and Clinical Applicability
Although previous research has found that viewing photographs can decrease the intensity of experimentally induced pain, the current study is the first to show a similar effect in patients with chronic pain.
To address some of the limitations presented by the current study, future research in this area should examine how long the pain-reducing effects last and control for participants' mood variance before viewing the photos, and include measures of attention.
- Shaygan M, Böger A, Kröner-Herwig B. Valence and arousal value of visual stimuli and their role in the mitigation of chronic pain: what is the power of pictures? J Pain. 2017;18(2):124-131. doi: 10.1016/j.jpain.2016.10.007
- Kenntner-Mabiala R, Andreatta M, Wieser MJ, Mühlberger A, Pauli P. Distinct effects of attention and affect on pain perception and somatosensory evoked potentials. Biol Psychol. 2008;78(1):114-122. doi: 10.1016/j.biopsycho.2008.01.007
- Roy M, Lebuis A, Peretz I, Rainville P. The modulation of pain by attention and emotion: a dissociation of perceptual and spinal nociceptive processes. Eur J Pain. 2011;15(6):641. doi: 10.1016/j.ejpain.2010.11.013
- Weisenberg M, Raz T, Hener T. The influence of film-induced mood on pain perception. Pain. 1998;76(3):365-375.
- Weisenberg M, Aviram O, Wolf Y, Raphaeli N. Relevant and irrelevant anxiety in the reaction to pain. Pain. 1984;20(4):371-383.
- de Wied M, Verbaten MN. Affective pictures processing, attention, and pain tolerance. Pain. 2001;90(1-2):163-172.
- Roberts MH, Klatzkin RR, Mechlin B. Social support attenuates physiological stress responses and experimental pain sensitivity to cold pressor pain. Ann Behav Med. 2015;49(4):557-569. doi: 10.1007/s12160-015-9686-3
- Master SL, Eisenberger NI, Taylor SE, Naliboff BD, Shirinyan D, Lieberman MD. A picture's worth: partner photographs reduce experimentally induced pain. Psychol Sci. 2009;20(11):1316-1318. doi: 10.1111/j.1467-9280.2009.02444.x