Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Intolerable Pain

Pain tolerance refers to the amount of pain that an individual can withstand before physical and/or emotional collapse (whereas pain threshold is the minimum stimulation need to produce the initial pain).

People often falsely believe that repeated exposure to pain increases a patient_s pain tolerance. However, the opposite is true:
Repeated exposure to pain increases the patient’s responsive to painful stimuli.
Intense pain makes the cells more responsive even to minor pain stimulation in the future.
Victims of physical trauma, in acute pain, should be relieved of pain as soon as possible to prevent pain sensitization.

Men have higher pain thresholds and greater pain tolerances than women. Having someone who provides passive or active emotional support during the trauma reduces the experience of pain.

That said, there is the false belief among many chronic pain patients that they can never tolerate their pain should not be forced to do so. They reason that narcotics should never be titrated or withheld if it would clearly
block the pain. The patients reason that “if the medication exists, I should be given it at the levels I determine.”

The fallacies in that concept are obvious to us, but not to the patient.

I had the unique experience of having a patient tell me that _soon after I settle my (workers_ compensation) case, and I know the family is okay, I am going to kill myself rather than live with this pain. Twelve years later, he was still quite alive and surprisingly active. Not long thereafter, his younger brother was injured and became a patient of mine. The brother said _if I have to live with the pain my brother has had, I will kill myself._

Patients do not know their own capacity for pain tolerance, and there is much we can do to insure they maximally manage their pain.

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