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Neck painful - cervical spine skeleton x-ray, 3D illustration.You might be surprised to learn that pain is not merely a biomechanical phenomenon. In fact, social and environmental factors have an impact on a person’s experience of pain. Let’s dive into this fascinating topic:

The experience of pain is known to have two distinct neural pathways. In the first, the pain signal comes from any part of the body and activates a part of the brain associated with the perception of pain. Different people respond differently to this stimulation because the sensation is determined by the activation of the second pathway involving other parts of the brain. The medial prefrontal cortex and nucleus accumbens are associated with motivation and emotion. Furthermore, there are non-physiological factors that inform the perception of pain. Here’s a look at a few of them and how they enter into the equation:


One particular response to pain that may be predictive of its severity is catastrophic thinking. This refers to “an exaggerated negative mental set brought to bear during actual or anticipated pain experiences.” People who are prone to this way of thinking tend to hold on to maladaptive beliefs, including overgeneralization, mental filter, jumping to conclusions, and emotional reasoning.


How much pain patients feel is also rooted in the concept of self-efficacy, locus of control, involvement in the sick role, and the placebo/nocebo effect. Self-efficacy refers to one’s idea of how well one can execute on a task necessary to deal with a prospective situation. Locus of control is the degree to which a person believes that they have control over the outcome of events in their lives, as opposed to external variables outside of their control.

An individual might be stuck in the sick role when they adhere to the specifically patterned social role of being sick. The placebo response occurs when a generic treatment proves to be as effective as an antidote when executed by someone who believes it will work. If the patient’s beliefs inadvertently increase their anxiety and expectations of pain, it’s documented as having a nocebo effect.

Sociocultural Variables

Science has evolved a great deal since we first began studying pain. For instance, we now understand that there are differences within cultural groups that may affect their pain experience. These might include generation, acculturation, socioeconomic status, ties to the mother country, primary language, degree of isolation, and residence in ethnic neighborhoods. These factors indicate some degree of relationship between culture and pain.

Emotional Reactivity

People experiencing pain may grapple with fear, sadness, guilt, self-denigration, and shame. However, anger is the most prominent emotion in individuals with chronic pain. Anger can take the form of a current mood state or a general predisposition toward feeling angry. People with anger management issues may have trouble with empathy.

How might this knowledge inform your response to working with clients dealing with chronic or acute pain? If you’re interested in learning more about this dynamic topic, we invite you to listen to our Pilates Elephants podcast which explores the factors that influence how we experience pain.