Forget Tylenol, Try Passion: A Journey into Pain Management

From the sudden agony of stepping on a Lego block to persistent aching from chronic conditions, everyone experiences pain. Sometimes we know the pain will subside quickly and we can just tough it out, but other times it’s more than we can (or want to) handle on our own. The quest for pain relief has led humans to explore a vast array of treatments, from traditional painkillers to alternative therapies like massages and ice packs. Pain is an essential evolutionary mechanism, serving to ensure our survival and reproduction. Even so, I’m sure most people would opt to take an Advil to stop a headache rather than worrying about the growth of our family tree.      

In this blog post, I delve into the fascinating world of research in pain management, focusing on how distraction and the flow experience can influence pain perception positively, and how this fascinating research can be used to develop more effective and personalized pain management techniques.

The power of distraction and the pleasure-pain trade-off

Distraction has long been recognized as a powerful tool used to lessen the sensation of pain. People often find that when they are engaged in an activity, particularly one that demands their full focus and attention, they experience a reduction in pain perception. 

Studies have shown that memory tasks that require intense concentration can effectively tune out other sensory stimuli, like pain. However, research has shown that people do not typically enjoy these types of tasks, and the cognitive effort involved in them can lead to a different form of suffering—mental pain. Some studies indicate that people may even be willing to trade cognitive effort for physical pain! This finding shows that not all pain-relief methods are created equal and highlights the importance of considering pleasure in pain management activities.      

Over the last year, I have had the pleasure of working as a research assistant in the Roy Pain Lab at McGill University, where researchers, like postdoctoral fellow Zoha Deldar, investigate the psychology of pain. What part of the brain is responsible for pain, and what motivates us to withstand it? What allows us to be distracted by pain and reduce its unpleasant feeling? 

The magic of flow and passion

The concept of the flow experience, often referred to as being “in the zone,” involves complete immersion in and focus on a task that is meaningful and rewarding. When in the flow state, people “become one” with the activity, forgetting about their worries and self-consciousness. Achieving a flow state requires a balance of challenge and skill, with the task being neither too easy nor too difficult. Immediate feedback on progress, like the number of mistakes or successes, further enhances the flow experience.

Moreover, passion and flow are naturally linked, with passion fueling the likelihood of experiencing the flow state. When people are passionate about an activity, they become fully engaged and motivated, effortlessly immersed in the task. This state of flow not only provides a lot of enjoyment but also boosts productivity, making it a potential game-changer in pain management.

Harnessing flow for pain management

So, if distraction is able to relieve pain, then surely utilizing the power of the flow experience to cope with pain would be even better. By engaging in activities that spark passion and create a state of flow, people could potentially redirect their attention away from pain, acting as a natural painkiller. 

I’ve had the chance to work on Zoha Deldar’s study, which focuses on expert chess players and explores how achieving the flow state during chess games can influence their perception of pain. The study includes both chess puzzles and a memory task in order to investigate how varying levels of challenge and enjoyment determine the efficacy of the flow state in relieving pain. 

The first step of this project is a behavioral study to examine the relationship between flow experience, chess, and pain modulation. The second step is a neuroimaging study to gain insights into the underlying brain activity associated with pain reduction and the experience of flow.

Chess players were chosen as participants since chess is a brain-twisting puzzle that fits neatly in a lab setting. For chess enthusiasts, chess can easily lead to a state of flow because of their passion and expertise.

To measure the flow experience, we use three types of chess puzzles: easy puzzles, flow puzzles, and difficult puzzles. Each puzzle is calibrated to the players’ skill level. This is to ensure a balance of challenge and engagement. Additionally, a memory task is incorporated as a control to measure the participants’ preference for chess-related activities over tedious exercises. We expect that pain perception would be higher during the memory task.

An experimental task of this complexity requires a lot of prep on the participants’ side. We need to calculate each person’s pain threshold, through a sensory calibration, to ensure that the pain is not beyond what they are willing to accept. To do so, we apply heat of varying temperatures to different locations on their inner forearm, and they rate how painful (or not) the stimulation is. 

We also calibrate their cognitive abilities for the memory task. Participants complete the same task over and over, while we vary its difficulty. How well they do allows us to determine the optimal level of difficulty for the memory task in the main experiment. Then, we can start the main task where the participants play the chess puzzles and do the memory task, all while receiving the calibrated pain.

Preliminary analyses of the study have shown promising results: participants experienced the least amount of pain while playing the flow chess puzzles. Imagine custom pain management techniques tailored to your passions. Chronic pain? Meet your match!

As mentioned, the second step of this ongoing study is a neuroimaging one! We want to uncover the underlying neural mechanisms responsible for pain inhibition through intrinsic motivation and flow. The same expert chess players will be doing a very similar experimental task—one with chess puzzles, memory tasks, and pain—but in an fMRI scanner! 

We want to see the activation of two brain regions: the nucleus accumbens (NAcc) which is involved in reward processing and the dorsolateral prefrontal cortex (DLPFC) which is responsible for cognitive modulation of pain. So, we expect to see more activation in the NAcc during the flow puzzles, and that both the chess puzzles and the memory task activate the DLPFC. 

The future of pain management     

So, what’s the grand finale? Pain management that’s as exhilarating as acing a chess game. Imagine joyfully battling pain, one passionate pursuit at a time. With flow and passion as your secret weapons, pain doesn’t stand a chance. As we stride forward, pain relief might just be the next mind-bending puzzle we crack. Get ready for a future where passion is the magic potion and pain is the dragon we conquer!

Vanessa Krohn is a third-year undergraduate student in Honours Psychology with a minor in Neuroscience at McGill University. She’s been a research assistant at the Roy Pain Lab for a year and a half, where she’s worked on projects that looked at ways in which we can reduce the perception of pain. In those studies, she’s used fMRI to look at the brain activation of various regions to uncover the underlying mechanisms of different pain-relieving interventions.

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