Is it a linguistic coincidence that when our psyche hurts, we use ‘pain’ words to describe how we feel?


The above questions are no longer just for philosophers and poets to entertain. Scientist have answers to the above questions because of the advent of research technology.
Rejection and isolation are painful to our social brains. In fact, compromising any valuable social connection feels “painful”. Dr. Eisenberger from UCLA found that the neural circuitry for physical and social pain overlap (1). His lab demonstrated this overlap from a variety of converging methodologies: behavioral, genetic and neuroimaging.


A physical pain experience has two components (2): a) A sensory component, for example, “having throbbing pain in lower right leg that lasts for a few minutes”. So, it includes location, intensity and duration. The other component is b) an affective component: The emotional side of pain. Being in pain does not 'feel' good and evokes emotions that reflect that inner state, such as sadness, anger, or even fear. It is not surprising that a person suffering from chronic pain might also develop depression and/or anxiety. These secondary conditions such as depression can intensify and prolong the physical pain. But also depression a la carte can induce it is own pain. In other words, depression hurts even in the absence of any preceding physical pain and has been associated with many somatic symptoms, such as general body pain (3).


One way to demonstrate that the body and mind feel pain the same way is to look for shared activation in the brain. Of interest is the second component, the emotional aspect of physical pain. Many fMRI studies have shown that the distressing unpleasant feelings of physical pain are processed in the dorsal anterior cingulate cortex (dACC) and the anterior insula (AI) (4).
The important question presented here is: does social/psychological pain activate these same areas, dACC and AI? That is exactly what Eisenberger’s lab found over a series of studies (5).  But, how did the researchers induce social pain in their participants as they remained still in the fMRI scanner? The participants played a “Cyberball” computer game, tossing a virtual ball to other players. The participant was sometimes included in the Cyberball game and other times excluded.  Similar to being rejected from a social group. Being excluded from the game was associated with increased activation in the dACC and the AI, the very same areas involved in physical pain! Similar results have been shown in other studies conducted in different labs (6).


But, how did the researchers know that the participants indeed felt rejected when they did not get the virtual ball?
Well, they asked them! And the stronger the participant felt social pain (e.g. I felt meaningless), the greater the activity in the brain areas associated with the affective component of physical pain. This positive correlation between greater activity in the dACC and/or anterior insula and greater self-reported social distress in response to social exclusion was also found in subsequent studies (7).


Do different people react differently to social pain? Are some people more sensitive? 
 
Absolutely!
                   How much social support is available during a socially painful event, reduces activity in these brain pain-related areas (8). Another study showed an increased sensitivity in dACC and AI to social distress in people who crave acceptance and who look out for cues that signal any possible chance of rejection (anxious attachment style) (9).
There are also individual differences that stem from genetic variations in processing physical pain. For example, a polymorphism in an opioid receptor gene has been shown to be associated with physical pain sensitivity. Individuals who carry the rare G allele have a higher sensitivity to physical pain and require more pain medication to deal with pain (10).


So, are carriers of the G allele also more sensitive to social pain? 

That is exactly what a study found! Participants who carry the G allele score higher on a measure of sensitivity to rejection AND show greater activation in the dACC and AI to social exclusion game compared to those who do not carry the G allele (11).


Yes, social pain is real pain.
 
This explains why people under social distress might self-medicate with alcohol, prescription medications, illicit drugs or even unhealthy inclusive relationships. In fact, in one study researchers found that when participants took Tylenol over a three-week period, they reported less hurt over that period compared to those who took a placebo. Moreover, participants who took Tylenol showed less activation in the dACC and AI to social rejection in fMRI study compared to those who took a placebo (12).

This shared brain circuitry for social and physical pain has implications for education, work and relationships. When children are bullied by exclusion and rejection, they are truly in pain. When co-workers frequently exclude office-mates from lunch invitations, it does hurt. Receiving rejection feedback at work, school or from parents really hurts. Children might medicate by the natural reaction to protect themselves, aggression against attacker. And of course, the aggression might be turned inward and manifest as a mental illness. Unfortunately, some minorities are rejected from mainstream society as a byproduct or belonging to a low socioeconomic class. And they remain in pain...