A person’s pain threshold is essentially the amount of pain they are able to tolerate. And there are some surprising variables that determine our personal pain thresholds.
There is a very good reason why understanding pain tolerance and pain thresholds is important for many pain sufferers, and that is the surprising fact that our ability to tolerate pain is closely linked to the likelihood we will suffer with chronic pain during our lifetime.
One hundred and fifty years of twin research has categorically proven that most human traits are heritable. Yet genetic factors are only half the story. Environmental causes are of equal or greater importance, but not the home or family environment. The interesting finding from twin studies is that family environment has a negligible effect on gene expression. This essentially affirms that our genes combine with our individual lifestyles to determine where our bodies end up. And pain is no exception to this.
The cold pressor test is a simple and validated test in which the test subject immerses one hand or foot into ice water for 1–3 min while blood pressure and heart rate are monitored. This method has been used for a broad range of research applications with often surprising results. It turns out you can accurately predict the likelihood of an individual developing high blood pressure later in life based on their tolerance to having their hand in cold water, for example.
The cold pressor test enabled researchers to gain great insights into factors that influence pain tolerance. By comparing pain tolerance within groups of individuals and those with other groups, it is possible to untangle the factors that influence pain tolerance.
On average genetic factors appear to account for a little over half of our pain tolerance. While the household we grow up in and our immediate family culture have a negligible effect. Fascinatingly, there is a very strong correlation in pain tolerance between close friends. So you are more likely to share a pain tolerance with your friends than your siblings. But only if you are male. Female friend groups don’t demonstrate any statistical similarities in terms of pain tolerance. And nobody knows why.
A 2018 study looked closely at psychological and cultural factors that determine pain tolerance. The authors identified female gender, Asian race, catastrophizing, and fear of pain as risk factors for decreased tolerance to pain. But as interesting as all this is, there is far more important research finding for the average pain sufferer to digest.
A 2016 study found that tolerance to the cold pressor test predicted the likelihood of chronic pain after surgery in women receiving surgery. Thus a pre-existing sensitivity to pain appears to be a significant factor in determining the likelihood we will have pain in the future.
This study also strongly suggests that our ability to tolerate pain is closely tied to our resilience to physical trauma (in this case, surgery). When taken in the context of other research findings, it indicates that the likelihood of us experiencing pain is determined by a combination of our genes and our prior life experiences.
If you want to manage chronic pain successfully, you have to deliberately inflict pain on people in order to activate their body’s healing responses. The pain of remedial care is an unavoidable fact of life. If you want to break up tracts of scar tissue, mobilize chronically stiff joints, or strengthen wasted muscles, pain is an inevitable consequence.
Years of inflicting pain on the public has given clinicians an excellent opportunity to observe how different individuals handle pain. And there is a massive variance in how much people are able or willing to tolerate. One interesting pattern that seems to surprise a lot of people is that, in keeping with the research, cultural background is one of the easiest ways to predict a person’s willingness to handle the pain of treatment. There is a strong tendency towards people from certain cultures to be willing to handle a lot more pain than others, which may well be a neon signpost pointing towards some profound truths about our individual relationships with pain.
Even our belief systems play a part in determining how we handle different types of pain. It is a well-known fact that Japanese mothers navigate the pain of labour in a vastly different way from Western mothers. For example, it is virtually unheard of for a Japanese mother to request pain relief drugs during labour. Researchers believe that differences like these are driven by differing attitudes and beliefs about the entire birthing process.
But there is more to pain resilience than cultural conditioning. Other types of conditioning play a key role in determining our pain thresholds.
The most pain-tolerant person I have ever met stands out a mile. His name is Craig, and he is utterly impervious to pain in a way that is hard to comprehend. Craig is a tough, good-natured, hard-working family man with a very interesting ‘pain resume’. I have worked with him as his clinician, as his colleague and as his friend, so I have had many opportunities to observe his unique superpower.
I first realized that Craig wasn’t in the normal range when we were working together. A mischievous patient prank-gifted him a bag of homegrown ghost chilis. Telling him that they were a very mild and sweet variety, ideally used as a raw garnish. The gag backfired.
It turned out that despite sweating quite a bit, Craig did, in fact, enjoy using 5 of the chillies as a raw garnish on his dinner. Although he did concede that they were ‘spicey’. If you’ve ever tried a lentil-sized piece of raw ghost chilli, you will understand what an unusual nervous system this story points to. For most people, five raw ghost chilis are about as enjoyable as actual chemical burns; because that’s exactly what they deliver. The active ingredient in question is capsaicin, which is what police use in pepper spray.
Craig’s other feats of pain tolerance are too many and often too harrowing to be worth retelling. But safe to say that we are dealing with someone whose tolerance for being kicked in the shins during kickboxing matches, performing knuckle press-ups on needles sharp ‘shakti mats’ and pushing through painful rehab sessions that would break 99.9% of us is legendary. Craig does experience pain, yet his ability to endure it is otherworldly.
The most pain-tolerant person I have ever met stands out a mile. His name is Craig, and he is utterly impervious to pain in a way that is hard to comprehend. Craig is a tough, good-natured, hard-working family man with a very interesting ‘pain resume’. I have worked with him as his clinician, as his colleague and as his friend, so I have had many opportunities to observe his unique superpower.
I first realized that Craig wasn’t in the normal range when we were working together. A mischievous patient prank-gifted him a bag of homegrown ghost chilis. Telling him that they were a very mild and sweet variety, ideally used as a raw garnish. The gag backfired.
It turned out that despite sweating quite a bit, Craig did, in fact, enjoy using 5 of the chillies as a raw garnish on his dinner. Although he did concede that they were ‘spicey’. If you’ve ever tried a lentil-sized piece of raw ghost chilli, you will understand what an unusual nervous system this story points to. For most people, five raw ghost chilis are about as enjoyable as actual chemical burns; because that’s exactly what they deliver. The active ingredient in question is capsaicin, which is what police use in pepper spray.
Craig’s other feats of pain tolerance are too many and often too harrowing to be worth retelling. But safe to say that we are dealing with someone whose tolerance for being kicked in the shins during kickboxing matches, performing knuckle press-ups on needles sharp ‘shakti mats’ and pushing through painful rehab sessions that would break 99.9% of us is legendary. Craig does experience pain, yet his ability to endure it is otherworldly.
There is something else about Craig that stands out as unusual when you know him. And it is not a coincidental feature. Craig has a giant sheet of deep swirling scar tissue that covers about ⅓ of his body’s surface area.
When he was three years old, Craig was one of those toddlers who was ‘into everything’. Then one fateful day, he managed to pull a whole kettle off a workbench. The kettle in question was freshly boiled, and its entire contents went over his head and body. The horrific pain of that moment was only the very start of the pain he would go through as a result. People who sustain 3rd degree burns over ⅓ of their body without exception suffer for a very long time. With the inclusion of extensive repeat skin grafts, his recovery was measured in years, not months.
At 3 years old, the human nervous system is as pliable as warm putty. At that age, our ability to adapt to different situations and learn is far beyond the neural plasticity of adults. At three years old, Craig’s little brain thus learned to handle pain at a level you would expect from an elite soldier. And it learned to do so in the same way that soldiers learn to handle pain through exposure.
Craig’s mum recalls with painful clarity that he reacted exactly as any child would to the unfathomable trauma of the boiling kettle. But from a few weeks into Little Craig’s rehabilitation, his mum noticed that something had changed. He completely stopped crying about pain.
For the remainder of his burn rehabilitation and his unusually reckless (the kettle incident wasn’t isolated) childhood, Craig’s mum never once knew him to cry or even fuss about physical pain again.
The burns altered Craig’s relationship with pain to such an extent; that his ability to tolerate it as an adult appears vaguely super-human to most of the rest of us. The burn altered his pain threshold.
When it comes to pain thresholds, we are all part of a spectrum. And it’s one that offers an important glimpse of the deep and complex nature of our pain.
At one end of this spectrum – there are people who can endure unthinkable levels of physical punishment. ‘High pain thresholds’.
In the middle of the spectrum is where most of us live – with reasonable pain tolerance. ‘Normal pain thresholds’.
And at the far end of the spectrum – there are people who are highly sensitive to pain. ‘Low pain thresholds’.
Unlike people with genetic disorders, regular folk all experience pain. But we don’t all experience it the same way. And these differing thresholds from person to person reveal variability in our brain function because our level of pain tolerance reflects how we process pain in our brains.
People with good pain tolerance tend to have a robust mindset around pain and/or have experienced a lot of it (like experienced soldiers, for example). These people manage pain well at the brain level. If you have had pain for a long time, it may have turned you into one of these!
At the other end of the spectrum, people with very low pain tolerance tend to be inexperienced with pain and/or feel uneasy about the meaning of pain. These people manage pain poorly at the brain level.
When it comes to pain thresholds, we are all part of a spectrum. And it’s one that offers an important glimpse of the deep and complex nature of our pain.
At one end of this spectrum – there are people who can endure unthinkable levels of physical punishment. ‘High pain thresholds’.
In the middle of the spectrum is where most of us live – with reasonable pain tolerance. ‘Normal pain thresholds’.
And at the far end of the spectrum – there are people who are highly sensitive to pain. ‘Low pain thresholds’.
Unlike people with genetic disorders, regular folk all experience pain. But we don’t all experience it the same way. And these differing thresholds from person to person reveal variability in our brain function because our level of pain tolerance reflects how we process pain in our brains.
People with good pain tolerance tend to have a robust mindset around pain and/or have experienced a lot of it (like experienced soldiers, for example). These people manage pain well at the brain level. If you have had pain for a long time, it may have turned you into one of these!
At the other end of the spectrum, people with very low pain tolerance tend to be inexperienced with pain and/or feel uneasy about the meaning of pain. These people manage pain poorly at the brain level.
So our belief systems around pain and the level of experience we have with pain are both potential determinants of where we land on the pain spectrum. If you have been through a lot of pain and have a strong belief that you and your body can endure painful things, your threshold will tend to be higher. If you have had very little pain and pain holds a lot of fear for you, it’s likely your threshold will be lower.
But there is a hidden factor environmental factor which determines our pain thresholds, and it’s vitally important to understand for many chronic pain sufferers. And may also be the factor that holds the most sway over how we handle all pains, from keeping our hand in cold water through to major physical injuries and their subsequent recovery.
Emotional trauma (including abuse) tends to polarize the pain threshold topic. Adults who suffered trauma as children tend to land at the extreme ends of the spectrum, depending on how they learned to deal with what they went through. Some are unusually impervious to physical pain; others are ultra-sensitive.
For some people, physical and emotional trauma caused them to disassociate from their bodies. This is called ‘hypoalgesia’. They didn’t know how to handle the feelings that were created during the traumatic events, so it became easy to ‘shut off’ from feeling. For others, trauma can trigger them to develop ‘ hyperalgesia’ or a heightened sensitivity to pain, which is a form of hypervigilance. The trauma caused their nervous system to become over-cautious about painful stimuli.
So, in summary. Our pain thresholds are known to be determined by our level of experience with pain. Our belief systems about pain. And our responses to any trauma we may have experienced in life.
You may have noticed that I am guilty of creating a false distinction here because our experiences with pain and our trauma are often one and the same. Yet, not all our experiences with pain are traumatic. And when we are able to grow in our healthy resilience to pain through hardship, it is distinct from when we dissociate or become hypervigilant towards pain. This is the difference between ‘adaptation’ or ‘maladaptation’ to the stress of painful experiences.
Those who have a maladaptive response to pain in either direction (hyper or hypoalgesic) tend to suffer with a lot of chronic pain until they find ways to work effectively with their stored-up trauma.
Pain is a symptom. Symptoms are the feedback that the body generates when it faces problems with its delicate internal balance (homeostasis). Without symptoms like pain, thirst, nausea and fevers, it would be very difficult for us to maintain a healthy body in the same way that it would be hard to drive a car safely with no dashboard display.
John is one of those rare gentlemen who has continued to play competitive soccer well into his late 50s. He is in really good shape, which you need to be to play football at that age—good shape except for his left leg. His left leg is not in good condition at all. In fact, once you get to know his left leg a bit better, it becomes apparent that it’s miraculous that he’s able to run at all, Let alone the type of running required to play competitive soccer against younger men.
The Logic Of Forgiving Your Pain
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