Between biologists, psychologists, and anthropologists it has been said that pain is one of the very few universal learned behaviors across age and culture. Despite the varying ways in which it is perceived, expressed, and controlled in different cultures, it is universally experienced (Free, 2002). However, instances of incredibly high pain tolerance have been cited globally in injured athletes, and cultural rituals. Whether these high pain tolerances are influenced by the context of the pain or chemical reactions to moderate the experience of pain may vary and both may be at play.

We’ve all heard of athletes making headlines for playing through broken bones, or bleeding limbs. Gregory Campbell continued playing for over a minute after breaking his right fibula during a Stanley Cup final game in 2013. Do these athletes have a superior pain tolerance than others? Not necessarily. Adrenaline is known to kick in in times of danger or fear, allowing humans to ignore or avoid pain in order to flee or make quick decisions without focusing on the pain they feel. While adrenaline is, of course, at play here as a chemical response to pain, other contextual factors may be coming into play as well.

In modern medicine, researchers find that often times, the effect of a placebo pill can help manage pain tolerance, which suggests that to a certain extent, this pain is fabricated in the experience and not just a nerve response. While the placebo effect of pills is widely known, the definition of placebo is much more inclusive than just medication. Placebo can result from “an inert substance, or of a sham physical treatment such as sham surgery, along with verbal suggestions (or any other cue) of clinical benefit” (Benedetti et al., 2011). Therefore, the effect is caused by the psychosocial context surrounding the inert substance or procedure. Placebo analgesia is a common response to an acute and strong sense of pain that can be caused by varying psychosocial contexts playing into the expectation of clinical benefit, including cultural contexts shaped by probability and trust (Fuente-Fernández, 2009).

In the Sasak culture in Lombok, healers practice medical treatment through jampi, an oral tradition of short, memorized recitations in response to a memorized set of symptoms. They believe that true healing comes from these words and that biomedical care merely facilitates a quicker recovery (Hay et al., 2008). While the neuroanthropologist who studied this tradition focused primarily on the healer’s memory systems, the patients in this culture may be healing through a culturally-enhanced placebo effect. The cultural emphasis on the faith in this tradition places trust and a history of probable success in jampi, which may influence the effect of a placebo healing. This system of placebo analgesia is known to be related to the activation of the endogenous opioid system, for opioid antagonists block placebo analgesia (Benedetti et al., 2011). Thus, the human body is naturally producing a chemical pain management response cultivated by the psychosocial effect produced by culture. However, not all cultural pain tolerances can be explained simply through placebo.

Hindu devotees in Thaipusam, India engage in an annual festival of elaborate and painful body piercings that demonstrate a faith-driven suffering for their god, Subramaniam. The painful procession of men and women dragging other humans by hundreds of hooks in their backs and rods through their cheeks/tongues must be fueled by some other cognitive system involving religion and faith that compensates for the neurological reaction to pain. What kind of system could have the power to conquer the effect of a pain reaction? Perhaps members of this culture develop tolerance through experience. Perhaps their neurological circuits were wired differently through development, resulting in established circuits that allow the pain to be masked by other stimulation in the context of the religious rituals.

These theories are likely to be supported by research that shows that the pain response may be linked to another powerful pathway in the human brain. Researchers at UCSF determined that pain itself elicits pain relief, and it does so through the reward pathway. They found that the reward pathway activates pain relief through the release of opioids and dopamine, both acting through the same system that elicits pleasure. Thus, the painful stimulus or experience may itself be experienced as rewarding (Gear et al., 1999). This would support that the painful Hindu rituals in Thaipusam, though justified through spiritual sacrifice, may truly be endured through the pain’s stimulated pleasure response. Where these rituals are frequent and expected throughout development, members of these communities may develop and strengthen neuronal connectivity between the pain response and the pleasure response, providing a cultural tolerance to an unbearable amount of pain.

The same phenomenon can be seen in a Mauritian Hindu community that engages in collective fire-walking rituals. Research studying the heart rates and affective states of both fire-walkers and observers in this community pre- and post-ritual showed higher heart rates and greater happiness in those who participated compared to those who observed (Fischer et al., 2014). Perhaps the linked neurological pleasure response to pain, mediated by spiritual motivation, gave the fire-walkers the tolerance to endure the painful experience.

Can the same be said for Gregory Campbell and his love for hockey? Perhaps the simultaneous response of adrenaline, reward activation, and motivation could have given him the strength to power through play with a broken limb. It is plausible that one form of response is more powerful than others and that it may vary across cultures. However, while pain is considered a universal learned behavior, it seems that some cultures may stimulate and strengthen connectivity between the learned pain response and a connected pleasure response, allowing the neurological manifestation of one culture’s pain to be far more tolerable than another’s.

 

 

References:

Benedetti, F., Carlino, E., & Pollo, A. (2011). How Placebos Change the Patient’s Brain. Neuropsychopharmacology, 36(1), 339–354. http://doi.org/10.1038/npp.2010.81

de la Fuente-Fernández, R. (2009). The placebo-reward hypothesis: dopamine and the placebo effect. Parkinsonism Relat Discord 15(3): S72-4.

Fischer, R., Xygalatas, D., Mitkidis, P., Reddish, P., Tok, P., Konvalinka, I., (2014). The Fire-Walker’s High: Affect and Physiological Responses in an Extreme Collective Ritual. PLoS ONE 9(2): e88355. doi:10.1371/journal.pone.0088355

Free, M.M.(2002). Cross-cultural conceptions of pain and pain control. Baylor university Medical Center Proceedings, 15(2): 143-145.

Gear, R.W., Aley, K.O., Levine, J.D. (1999) Pain-Induced Analgesia Mediated by Mesolimbic Reward Circuits. The Journal of Neuroscience, 19(16): 7175-7181.

Hay, M.C., Weisner, T.S., Subramanian, S., Duan, N., Niedzinski, E.J., & Kravitz, R.L. (2008). Harnessing experience: Exploring the gap between evidence-based medicine and clinical practice. Journal of Evaluation in Clinical Practice, 14: 707-713.

 

Link to the Thaipusam ritual article:

http://travel.cnn.com/singapore/play/highlights-thaipusam-2010-700793/