Contextual factors can transform how we experience pain, particularly if pain is associated with other positive outcomes. Here, we test a novel meaning-based intervention. Participants were given the opportunity to choose to receive pain on behalf of their romantic partners, situating pain experience in a positive, prosocial meaning context. We predicted that the ventromedial prefrontal cortex (vmPFC), a key structure for pain regulation and generation of affective meaning, would mediate the transformation of pain experience by this prosocial interpersonal context.
We studied fMRI activity and behavioral responses in 29 heterosexual female participants during (1) a baseline pain challenge and (2) a task in which participants decided to accept a self-selected number of additional pain trials to reduce pain in their male romantic partners (“accept-partner-pain” condition).
Enduring extra pain for the benefit of the romantic partner reduced pain-related unpleasantness (t = −2.54, p = .016) but not intensity, and increased positive thoughts (t = 3.60, p = .001) and pleasant feelings (t = 5.39, p < .0005). Greater willingness to accept the pain of one's partner predicted greater unpleasantness reductions (t = 3.94, p = .001) and increases in positive thoughts (r = .457, p = .013). The vmPFC showed significant increases (q < .05 FDR-corrected) in activation during accept-partner-pain, especially for women with greater willingness to relieve their partner's pain (t = 2.63, p = .014). Reductions in brain regions processing pain and aversive emotion significantly mediated reductions in pain unpleasantness (q < .05 FDR-corrected).
The vmPFC has a key role in transforming the meaning of pain, which is associated with a cascade of positive psychological and brain effects, including changes in affective meaning, value, and pain-specific neural circuits.
From the Department of Anesthesiology (López-Solà), Cincinnati Children's Hospital, Cincinnati, Ohio; and Institute of Cognitive Science (López-Solà, Koban, Wager), Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado.
Address correspondence to Marina López-Solà, PhD, Department of Anesthesiology, Cincinnati Children's Hospital, 3333 Burnet Ave, MLC2 7031 Pain Research Center, Location R8 Office 547, Cincinnati, Ohio 45229. E-mail: firstname.lastname@example.org
Received for publication August 1, 2017; revision received April 17, 2018.