Physical/Social Pain Overlap Theory

In their paper Why It Hurts to Be Left Out: The Neurocognitive Overlap Between Physical and Social Pain (or see this later version if you prefer), Eisenberger and Lieberman present the pain overlap theory which proposes that social pain, the pain that we experience upon social injury (when social relationships are threatened, damaged or lost), and physical pain, the pain that we experience upon physical injury, share parts of the same underlying neural circuitry and computational processes. They review evidence from the animal lesion and human neuroimaging literatures suggesting that the anterior cingulate cortex plays a key role in the physical-social pain overlap. And they present evidence for the four corollary hypotheses derived from pain overlap theory:

• hypothesis #1: physical and social pain share a common phenomenological and neural basis
• hypothesis #2: physical and social pain rely on the same computational mechanisms
• hypothesis #3: inducing or regulating one type of pain similarly influences the other
• hypothesis #4: trait differences relating to (a heightened sensitivity to) one type of pain relate to the other type as well

In conclusion, they say, accumulating evidence is revealing that physical and social pain are similar in experience, function, and underlying neural structure. Continuing to explore the commonalities between physical and social pain may provide us with new ways of treating physical pain and new techniques for managing social pain. Having a better understanding of the physical-social pain overlap may help to grant social pain the same status that physical pain has achieved in the medical and clinical communities, as evidenced by the amount of time and attention dedicated to its treatment and prevention.

The authors insist that social connection is a need as basic as air, water, or food and that like these more traditional needs, the absence of social connections causes pain. Indeed, they propose that the pain of social separation or social rejection may not be very different from some kinds of physical pain, and they highlight that the anticipation and experience of being socially excluded has been shown to have damaging psychological, behavioral, and physiological effects. Damages must be especially large, I would say, when the pain is chronic. I am thinking of those socially wounded mass killers in schools, or other ‘terrorists’, and I reiterate that question raised in a previous post: how shall we manage chronic social pain in our societies?

We may relate also social pain to Wilkinson’s social suffering (see that post). What is the difference or similarity between pain and suffering? Eisenberger and Lieberman speak of “the evolution of a social pain system that piggybacked onto the physical pain system”. By analogy, a converse suggestion could be made : suffering is a basic mind-brain phenomenon to which sensory pain got “hardwired”, and from which it can be sometimes disconnected. What is pain without unpleasantness? What is unpleasantness if not suffering? Hopefully, the day is approaching when a new terminology will allow things to be referred to unequivocally in the field of pain-and-suffering research.

I want to thank Tony Cole who drew my attention to the pain overlap theory, first in the Wikipedia article on suffering, and then in his Pain Blog, which I was allowed to find when the ever commendable Gary Rollman mentioned it on October 6 in his Psychology of Pain Blog.