The Nuance

The Fascinating Brain-Pain Connection

How expectation, emotion, and other neurocognitive factors affect our perception of pain

Markham Heid
Elemental
Published in
6 min readMar 18, 2021

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Illustration: Kieran Blakey for Elemental

Imagine that you’re about to have a tooth pulled. Your dentist tells you that, unfortunately, the tooth’s roots are infected, and so the procedure is going to hurt. A lot. It can’t be helped.

Now imagine an alternate scenario. You still need that tooth pulled, but this time your dentist says nothing — one way or the other — about the pain you may feel.

In both of these scenarios, the painful stimulus is the same. The same tooth is going to be pulled, and it will probably hurt either way. But would you experience the same amount of pain? Almost certainly not. Your dentist’s comments — not to mention your mood, stress levels, and other factors — are capable of shifting your perception of pain in one direction or the other.

“What we experience — second to second, moment to moment — is an interaction of what’s coming in from the outside but also top-down processes from the cortex of the brain,” says Irving Kirsch, PhD, director of the Program in Placebo Studies at Harvard Medical School and Beth Israel Deaconess Medical Center.

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Markham Heid
Elemental

I’m a frequent contributor at TIME, the New York Times, and other media orgs. I write mostly about health and science. I like long walks and the Grateful Dead.