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The consequences of pain: The social and physical pain overlap on
psychological responses
PAOLO RIVA
1
*, JAMES H. WIRTH
2
AND KIPLING D. WILLIAMS
3
1
Department of Psychology, University of Milano-Bicocca, Italy;
2
Department of Psychology, University of
North Florida, USA;
3
Department of Psychological Sciences, Purdue University, USA
Abstract
Current theories suggest that social and physical pain overlap in their neurological and physiological outcomes. We investigated
how social and physical pain overlap in their psychological responses by testing the hypothesis that both social and physical
pain would thwart satisfaction on four human needs, worsen mood, and increase desire to aggress. In Experiment 1, recalling
an experience of social or physical pain produced overlapping effects in the form of thwarted self-esteem and control needs and
increased negative affect and desire to aggress. In Experiment 2, we induced social (Cyberball ostracism) or physical pain (cold
pressor) within the laboratory session, and found that both pain types produced feelings of being ignored and excluded, and
thwarted belonging, self-esteem, control, and meaningful existence. Our results provide further support to pain overlap theories
and indicate that social and physical pain cause common psychological consequences, resulting in new ways to understand and
manage pain. Copyright © 2011 John Wiley & Sons, Ltd.
There is growing evidence in the literature showing that phys-
ical pain, the pain caused by a physical injury, and social pain,
the pain caused by the threat or actual loss of a social connec-
tion (MacDonald & Leary, 2005), share a common neural sys-
tem. Yet, it is still unclear whether the physiological overlap
between the pain types also implies an overlap in their psycho-
logical responses. The present paper aims to fill this gap. We
examined whether the social/physical pain overlap results in
common psychological responses as well.
The physiological overlap underlying physical and social
pain was initially proposed by Panksepp (1998). Panksepp
found that, besides reducing the experience of pain, the admin-
istration of an opiate also reduced crying behavior in animals
that were socially isolated (Panksepp, Herman, Conner,
Bishop, & Scott, 1978). Following Panksepp and colleagues’
early suggestion, several authors investigated whether similar
neural brain circuitries are delegated to detect, process, and reg-
ulate both social and physical pain in social animals and humans
(DeWall et al., 2010; Eisenberger, Lieberman, & Williams,
2003).
Eisenberger et al. (2003) found those ostracized during a
ball-toss game (Cyberball) experienced activation of the dorsal
anterior cingulated cortex (dACC) and right ventral pre-frontal
cortex—brain regions known for their role in processing the
unpleasantness of physical pain (Rainville, Duncan, Price,
Carrier, & Bushnell, 1997). This pattern of results, which has
been replicated in numerous subsequent studies (e.g., Eisenberger,
Gable, & Lieberman, 2007; Krill & Platek, 2009; Onoda et al.,
2010), represents the first empirical evidence that social threats
may be detected and processed similarly to physical pain in
humans.
Following the study by Eisenberger et al. (2003), several
authors added a variety of evidence to the hypothesis that
physical and social pain rely on shared neurological substrates.
For instance, Way, Taylor, and Eisenberger (2009) found that
sensitivity to social and physical pain is linked by a common
gene (OPRM-1). DeWall et al. (2010) found a common phys-
ical pain suppressant (i.e., acetaminophen) lowered hurt feel-
ing and reduced dACC activation in response to social
exclusion. Based on the evidence for a neurological overlap,
Eisenberger and Lieberman theorized the Pain Overlap Theory
(2004; see also MacDonald & Leary, 2005). The authors sug-
gested that social pain piggybacked onto the existent pain cir-
cuitry developed to signal a bodily threat or harm; sending a
warning to keep close to one’s kin.
Do Social and Physical Pain Overlap on Psychological
Responses?
Despite the considerable amount of research that suggests a
physiological overlap between social and physical pain, to
date little research has investigated whether or how social
and physical pain overlap at the psychological level. As a
matter of fact, a neural overlap does not necessary imply that
social and physical pain would lead to overlapping psycholog-
ical responses as well (Amodio, 2010; Cacioppo et al., 2003;
*Correspondence to: Paolo Riva, Department of Psychology, University of Milano-Bicocca, Piazza Ateneo Nuovo, 1, 20126 –Milano (Italy).
E-mail: paolo.riva1@unimib.it
European Journal of Social Psychology,Eur. J. Soc. Psychol. 41, 681–687 (2011)
Published online 28 July 2011 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/ejsp.837
Copyright © 2011 John Wiley & Sons, Ltd. Received 7 March 2011, Accepted 21 June 2011
Poldrack, 2006). Therefore, an investigation over the psycho-
logical overlap between social and physical pain would pro-
vide strong convergent validity to the idea of a shared social
and physical pain alarm system.
Preliminary evidence supports the idea that common psy-
chological responses could result from experiencing both
types of threats. Eisenberger, Inagaki, Mashal, and Irwin
(2010) found that exposure to proinflammatory cytokines in-
creased feelings of social disconnection and depressed mood.
Furthermore, moving from the notion that extreme physical
pain can lead to temporally analgesia of further physical pain
(Gear, Aley, & Levine, 1999), DeWall and Baumeister
(2006) found that pre-living an extreme social pain condition
(i.e., a life alone) resulted in emotional numbness (a form of
analgesia). Thus, it is possible that physical pain may affect
the psychological equilibrium in a way that mirrors reactions
to social exclusion.
At this regard, given its high degree of aversiveness, the
psychological responses of ostracism (being ignored and ex-
cluded)—a form of social pain—have been extensively inves-
tigated. Williams (2001) found that ostracism causes a rapid
decrease in the satisfaction of belonging, self-esteem, control,
and meaningful existence. Although ostracism might represent
a particularly severe threat of basic needs (Williams, 2009), re-
search on rejection, social exclusion, and loneliness found
similar outcomes (Gerber & Wheeler, 2009). In addition to
the threat to basic needs, past research showed that experienc-
ing instances of social pain, like ostracism (Williams, 2009),
rejection (Gerber & Wheeler, 2009), or loneliness (Cacioppo
& Hawkley, 2003) often result in increased negative affect.
Finally, past research found aggression as a common response
for those who experience the pain of ostracism and rejection
(Twenge, Baumeister, DeWall, Ciarocco, & Bartels, 2007;
Wesselmann, Butler, Williams, & Pickett, 2010).
Hypothesis
Overall, past research highlights a specific set of core psycho-
logical responses to social pain (i.e., ostracism) in the form of
reduced satisfaction of four basic needs, increased negative af-
fect, and greater desire to aggress. Considering the physiolog-
ical evidence for common brain responses to physical and
social pain (Eisenberger & Lieberman, 2004), the present
study investigated whether these two forms of pain induce
common psychological responses. Specifically, we hypothe-
size social pain and physical pain will both lead to thwarted
basic need satisfaction, worsened mood, and increased desire
to aggress compared with feeling no pain.
EXPERIMENT 1
Method
Participants
One-hundred and fifteen students (42 women; M=19.49 years
SD=1.54; 64% Caucasian) at Purdue University participated
in exchange for course credit.
Procedure and Design
Similar to the procedure of Chen, Williams, Fitness, and Newton
(2008), participants were randomly assigned to recall either a
past socially painful experience or a past physical painful ex-
perience that occurred within the last 5 years of their lives.
We included the no pain control condition of reliving a typical
Wednesday afternoon. The participants were asked to recall
the experience by writing in detail what had happened and
how they felt. Following recalling one of these experiences,
the participants reported their physical pain, their satisfaction
of basic needs, their affect, and desire to aggress based on
how they felt during the event they recalled.
Dependent Variables
The participants completed the Numerical Rating Scale (NRS-
11; Hartrick, Kovan, & Shapiro, 2003) that assessed pain in-
tensity (“How much pain did you feel?”) and pain unpleasant-
ness (“How unpleasant was the pain you felt?”). Similarly, the
Short-Form McGill Pain Questionnaire (SF-MPQ-2; Dworkin
et al., 2009) measured physical pain discomfort (e.g., “sharp
pain”,“shooting pain”).
Next, the participants filled out the Need-Threat Scale
(Williams, Cheung, & Choi, 2000) that assessed the partici-
pants’feelings of belongingness (e.g., “I felt rejected”), self-
esteem (e.g., “I felt liked”), control (e.g., “I felt I had control”),
and meaningful existence (e.g., “I felt invisible”). In addition,
we assessed how negative the participants felt (e.g., sad; anger;
happy (reverse scored positive items)). Responses to all these
measures were recorded on a 1 (Not at all)to5(Extremely)
scale and were averaged together to create overall indexes.
Finally, to assess the desire to aggress, the participants
completed a measure evaluating their aggressive behavior
inclinations (Buckley, Winkel, & Leary, 2004) indicating
how tempted they would be to do aggressive behaviors (e.g.,
“Humiliate the person,”“Slapping the other person”)towards
a person they might interact with after completing the task.
Responses to this measure were recorded on a 1 (Not at all
tempted)to9(Very tempted) scale and averaged to create
overall index.
Following the completion of these measures, the partici-
pants provided demographic information, were debriefed,
and thanked for their participation.
RESULTS
Multivariate analysis of variance (MANOVA) revealed a sig-
nificant multivariate effect for experimental manipulation
(F(16,210)=17.09, p<.001, Wilk’sl=.18;
p
2
=.560) on the
set of dependent measures. There was a significant effect of
the experimental manipulation on NRS-11 (F(2,112) = 47.85,
p<.001,
p
2
=.46), SF-MPQ-2 (F(2,112)=14.36, p<.001,
p
2
=.20), belonging (F(2,112)= 52.68, p<.001,
p
2
=.48),
self-esteem (F(2,112)=59.93, p<.001,
p
2
=.51), control (F
(2,112)=36.74, p<.001,
p
2
=.39), meaningful existence (F
(2,112)=23.80, p<.001,
p
2
=.29), negative affect (F(2,112)=
63.42, p<.001,
p
2
=.53), and desire to aggress (F(2,112)=
32.04, p<.001,
p
2
=.36).
682 Paolo Riva et al.
Copyright © 2011 John Wiley & Sons, Ltd. Eur. J. Soc. Psychol. 41, 681–687 (2011)
Post-hoc analyses (Bonferroni, correcting for multiple
comparisons) demonstrated the participants recalling social
or physical painful events reported a higher level of pain
response (NRS-11 and SF-MPQ-2) than did those in the
control condition (ps<.001; see Table 1 for descriptives and
univariate ANOVAs). Examining the basic needs combined,
those recalling either social or physical pain experienced less
basic need satisfaction than recalling a typical Wednesday
afternoon (ps<.001). This pattern was true for the individual
needs of control (ps<.001) and self-esteem (ps<.001).
However, for belongingness and meaningful existence, there
were significant differences between the control and social
pain conditions (ps<.001), but not between the control condi-
tion and physical pain (ps>.53). Negative affect was higher
for those who recalled a social and physical pain episode
compared with those who recalled a daily routine (ps<.001).
Finally, the participants who recalled a painful episode—either
social or physical—reported having greater desire to aggress
than those in the control condition (ps<.001).
DISCUSSION
Experiment 1 provided preliminary evidence of the common
psychological responses of social and physical pain, show-
ing that both types of pain can thwart self-esteem and con-
trol needs and increase negative affect and desire to
aggress. The fact that physical pain failed to significantly
thwart belonging and meaningful existence needs might be
linked to the specific task we adopted (i.e., recalling an ear-
lier painful event). Previous research showed that physical
pain is harder to relive than social pain (Chen et al.,
2008), leading us to question whether the effects on all four
basic needs would emerge for currently inflicted physical or
social pain.
EXPERIMENT 2
In Experiment 2, we sought to replicate and extend the find-
ings of Experiment 1 using manipulations that currently
inflicted social and physical pain. Similar to Experiment 1,
we tested the hypothesis that both social and physical pain
can threaten basic need satisfaction and increase both negative
affect and desire to aggress. Moreover, to further explore the
commonalities in the psychological responses, we considered
feelings of ostracism (i.e., feeling ignored and excluded) as a
common response to social and physical threats. Feelings of
ostracism have been shown to derive from the detection of so-
cial threats (Williams, 2009), yet, based on the extent social
and physical pain overlap in the brain, they may be a common
psychological response of pain.
Method
Participants
One hundred undergraduate students (53 women; M=19.02
years, SD=.27; 59% Caucasian) received course credit for par-
ticipating. The participants were randomly assigned to a 2
(Pain Induction: Yes versus No)2 (Type of Pain: Social
versus Physical) between-subjects design.
Procedure and Materials
Social Pain Manipulation
To manipulate social pain, the participants played a virtual
online ball-tossing game—Cyberball (Williams et al., 2000).
The participants believed they were playing with two others,
who were actually computer-controlled confederates. The par-
ticipants were either included, receiving the ball about a third
Table 1. Means, standard deviation, and univariate Fvalues and their associated p-values. Experiment 1.
Social pain (n=40) Physical pain (n=38) Control condition (n=37)
NRS pain index (α=.87) 5.76 (2.80)
a
6.30 (2.71)
a
1.14 (1.88)
b
F(2,112)=47.85, p<.001
McGill pain quest. (α=.96) 2.57 (2.38)
a
3.49 (2.16)
a
.93 (1.72)
b
F(2,112)=14.36, p<.001
Overall needs index (α=.92) 2.15 (.83)
a
2.98 (.62)
b
3.96 (.78)
c
F(2,112)=56.06, p<.001
Belonging (α=.86) 2.42 (1.11)
a
4.20 (.85)
b
4.50 (.72)
b
F(2,112)=52.68, p<.001
Control (α=.89) 1.53 (.83)
a
1.48 (.78)
a
3.04 (1.06)
b
F(2,112)=36.74, p<.001
Self-esteem (α=.92) 1.65 (1.01)
a
1.86 (.81)
a
3.82 (.89)
b
F(2,112)=59.93, p<.001
Meaningful existence (α=.91) 2.97 (1.24)
a
4.36 (1.00)
b
4.48 (.94)
b
F(2,112)=23.80, p<.001
Negative affect (α=.93) 2.91 (.85)
a
2.57 (.76)
a
.86 (.87)
b
F(2,112)=63.42, p<.001
Desire to aggress (α=.94) 5.17 (1.93)
a
4.27 (1.29)
b
2.45 (1.15)
c
F(2,112)=32.04, p<.001
Notes. Different letters indicate statistical differences, according to the Fisher’s Least Significant Difference test (p<.05). Standard deviations appear in
parenthesis.
NRS, Numerical Rating Scale.
Common social and physical pain consequences 683
Copyright © 2011 John Wiley & Sons, Ltd. Eur. J. Soc. Psychol. 41, 681–687 (2011)
of the time throughout, or ostracized, receiving the ball once
from each computer controlled player at the beginning and
then never again. We adopted a shortened version of the game
(21 throws), so it would last the same amount of time as parti-
cipants who were asked to submerge their hand in water (i.e.,
1minute).
Physical Pain Manipulation
To induce feelings of physical pain, the participants completed
a standard pain induction manipulation (e.g., Mitchell,
MacDonald, & Brodie, 2004). The participants were ran-
domly assigned to place the non-dominant hand up to their
wrist into a bucket of water maintained either at a cold temper-
ature (5C–6C; the physical pain induction) or room temper-
ature (24C–26C; the physical pain control). Subjects were
told they could remove their hand at any time if the distress
of the experience became too intense. However, in order to
standardize the amount of physical stimulation, the partici-
pants were asked to try to keep their hand inside the cold water
for 1minute (equal to the Cyberball duration).
After completing either the social or the physical task, the
participants completed all of the same measures used in Exper-
iment 1 with the addition of items assessing feelings of ostra-
cism (“I felt ignored”and “I felt excluded”) assessed on a 1
(Not at all)to5(Extremely) scale.
RESULTS
Scores on the dependent measures were examined using a 2
(Pain Induction: Yes versus No)2 (Type of Pain: Social ver-
sus Physical) MANOVA. Supporting the main hypothesis of
the present study, Wilk’slrevealed a significant effect of Pain
Induction, F(10,87)=22.68,
p
2
=.72. An effect of Type of
Pain was also present (F(10,87)=10.805,
p
2
=.55) as well as
an interaction between Pain Induction and Type of Pain, F
(10,87)=7.57,
p
2
=.46.
Univariate analyses, using a Bonferroni adjusted alpha
level of .005, revealed that each of the considered dependent
variables contributed to the overall multivariate effect of Pain
Induction. First, the participants in the pain conditions
reported higher pain intensity on the NRS-11 and SF-MPQ-2
than the participants assigned to the no pain induction condi-
tions (F(1,96)=190.19, p<.001,
p
2
=.66 and F(1,96)=73.
95, p<.001,
p
2
=.44, respectively). See Table 2 for means
and standard deviations.
Then, as hypothesized, the Pain Induction had a significant
effect on the basic needs overall (F(1,96) = 108.52, p<.001,
p
2
=.53). For each need individually, the participants in the
pain conditions, compared with the no pain induction condi-
tions, felt a threatened sense of belongingness (F(1,96)=
59.71, p<.001,
p
2
=.38), self-esteem (F(1,96)= 58.31,
p<.001,
p
2
=.38), sense of control (F(1,96)= 26.54, p<.001,
p
2
=.22), and meaningful existence (F(1,96) = 64.31, p<.001,
p
2
=.40)
Furthermore, compared with control conditions, pain in-
duction increased negative affect, F(1,96)=169.38, p<.001,
p
2
=.64. Additionally, the participants in the pain conditions
had a higher desire to aggress than the participants in the no
pain induction conditions, F(1,96)=18.66, p<.001,
p
2
=.17.
Finally, feelings of being ignored were higher in the pain
conditions compared with the no pain induction conditions,
F(1,96)=51.04, p<.001,
p
2
=.35. A similar pattern emerged
for feelings of being excluded: individuals in the pain condi-
tions felt more socially excluded than individuals in the no
pain induction conditions, F(1,96)=71.44, p<.001,
p
2
=.43.
This pattern of results provides further evidence of the overlap
between social and physical pain: individuals who experienced
either social or physical pain reported higher levels of
ostracism.
Univariate analyses on Type of Pain revealed that physical
pain had a greater effect than social pain on pain measures
(NRS-11 and SF-MPQ-2; smallest Fwas for NRS-11,
F(1,96)=15.11, p<.001,
p
2
=.13). Yet, social pain had
greater impact than physical pain on each of the remaining de-
pendent variables (except for negative affect (p=.78); smallest
Fwas for desire to aggress, F(1,96) = 6.58, p= .012,
p
2
=.06).
Table 2. Means and standard deviations for pain induction. Experiment 2.
Manipulation
Pain induction No pain induction
Cyberball Ostracism (n=25) Cold water (n=26) Cyberball inclusion (n= 23) Warm water (n=26)
NRS pain index (α=.97) 4.84 (2.3) 7.63 (2.5) 1.20 (.54) 1.26 (.47)
McGill overall index (α=.98) 2.55 (1.8) 5.13 (2.1) 1.21 (.44) 1.41 (.62)
Overall needs index (α=.91) 1.84 (.64) 2.88 (.56) 3.44 (.49) 3.68 (.57)
Belonging (α=.86) 2.09 (1.0) 3.51 (1.1) 4.26 (.85) 4.33 (.74)
Self-esteem (α=.79) 1.77 (.61) 2.07 (.81) 2.75 (.68) 3.34 (.79)
Control (α=.66) 1.34 (.46) 2.16 (.71) 2.31 (.80) 2.70 (.87)
Meaningful existence (α=.89) 2.14 (.97) 3.76 (.96) 4.43 (.77) 4.34 (.82)
Negative affect (α=.92) 2.45 (.69) 2.64 (.68) 1.04 (.44) 0.93 (.53)
Ignored 4.24 (1.2) 2.65 (1.3) 1.78 (1.0) 1.77 (1.0)
Excluded 4.36 (1.1) 2.46 (1.2) 1.70 (0.9) 1.62 (.85)
Desire to aggress (α=.92) 4.29 (1.2) 3.49 (.99) 3.16 (.78) 2.99 (.56)
Notes. Standard deviations appear in parenthesis.
NRS, Numerical Rating Scale.
684 Paolo Riva et al.
Copyright © 2011 John Wiley & Sons, Ltd. Eur. J. Soc. Psychol. 41, 681–687 (2011)
Consistently, univariate analyses of the interaction effect be-
tween Pain Induction and Type of Pain showed that—when pain
was inducted—physical pain had a greater effect on NRS-11 and
SF-MPQ-2 (ps <.001) whereas social pain had a greater
effect than physical pain on basic needs overall (p<.001)
sense of belonging (p<.001), meaningful existence (p<.001),
and feelings ignored (p<.001) and excluded (p<.001). By
contrast, no significant effect emerged for self-esteem,
control, negative affect and desire to aggress (all ps>.097).
DISCUSSION
In Experiment 2, by using minimal manipulations of pain on
healthy volunteers, we provided experimental evidence
that—in keeping with responses to social pain—physical pain
can also threaten satisfaction of belonging, control, self-esteem,
and meaningful existence and raise negative affect and desire to
aggress. In addition, we found that both social and physical pain
produce feelings of being ignored and excluded; previously,
only social pain was found to lead to these effects. Therefore,
it appears that the common psychological responses between
social and physical pain might mirror their physiological
overlap.
GENERAL DISCUSSION
Many studies now demonstrate that social and physical pain
overlap in their physiological consequences. Neurological ev-
idence (e.g., DeWall et al., 2010; Eisenberger et al., 2003,
2007; Krill & Platek, 2009; Onoda et al., 2010) and genetic ev-
idence (Way et al., 2009) support the Pain Overlap Theory
(Eisenberger & Lieberman 2004; MacDonald & Leary,
2005), which contends social pain piggybacked onto the exist-
ing circuitry used to detect physical pain. Until this point, im-
portant converging evidence, in the form of common
psychological responses, has been missing. Common psycho-
logical responses between social and physical pain would pro-
vide further evidence for an overlapping evolution of these
two forms of pain.
We tested the hypothesis that both social and physical
pain—even in a short-term episode—could reduce satisfaction
of basic human needs and increase both negative affect and de-
sire to aggress. Experiment 1 showed that recalling a past
physical pain episode can be associated with memories of
low self-esteem, poor control, and increased negative affect
and desire to aggress, akin to recalling a socially painful epi-
sode. In Experiment 2, a currently inflicted experience of pain
resulted in lowered satisfaction on all the needs tested for both
physical and social pain. Furthermore, social and physical pain
increased negative affect and produced higher desire to
aggress than the control conditions.
Taken all together, these results suggest that even minimal
inductions of physical pain threaten the individual’s psycho-
logical equilibrium, going far beyond the mere perception of
physical discomfort. Thus, from a theoretical standpoint, our
results showed for the first time that social pain is not unique
in its ability to affect needs satisfaction and mood, and to
induce feelings of ostracism. The latter effect is particularly
striking: Experiment 2 extended our investigation to explore
feelings of being excluded and ignored among the set of com-
mon psychological responses of pain, ultimately demonstrat-
ing that even physical pain can lead to feelings of ostracism.
This represents the first experimental evidence that physical
pain can lead an individual to report feeling more excluded
and ignored than an individual who did not receive pain.
Within an evolutionary account, we posit that feelings of
ostracism (being excluded and ignored) during the experience
of physical pain might serve to elicit immediate help seeking
from allies and thus could potentially be a survival advantage.
This would be consistent with the adaptive function of other
similar processes that have been designed to offer the pain suf-
ferer a chance to get support from her social environment. In-
deed, the mere existence of the facial expression of pain is
thought to be the result of adaptive evolutionary forces aimed
at providing the sufferers with the opportunity to translate a
pain state into an observable message that can be perceived
by someone in the environment (A. Williams, 2002). In a com-
plementary way, past research shows that—when social sup-
port or help are anticipated (Maner, DeWall, Baumeister, &
Schaller, 2007)—feelings of ostracism increase the desire for
social connections. Thus, in a similar way in which a child
looks for her caregivers after falling and being hurt, individuals
in physical pain are likely to increase their odds of survival by
feeling an urgency to seek social connections that can provide
immediate aid, support, and protection from further threats
and damages.
Our findings dovetail nicely with recent findings indicating
that inflammatory processes increase feeling of social discon-
nection (Eisenberger et al., 2010). The current work offers a
novel extension to this previous work by showing that physi-
cal pain affects a broad set of psychological responses that
were previously noted to only be produced by the experience
of social pain. Furthermore, the notion that physical pain is re-
lated to the feeling excluded and ignored seems coherent with
studies that show that social support buffers the perception of
physical pain (Master et al., 2009). As a matter of fact, if feel-
ings of ostracism represent a common response to physical
pain, fulfilling the social needs might counteract some of the
aversive psychological effects of physical pain, thus increasing
the pain tolerance. On one hand, natural selection might have
selected observable pain behaviors (e.g., the facial expression
of pain) aimed to attract potential helpers and, on the other
hand, emotional responses that lead the physically injured
individuals to seek support from their kin.
Implications for Pain Management
Understanding of the common psychological responses of
social and physical pain have important implications for pain
management. First, studies have repeatedly found that obser-
vers tend to doubt the pain reported by sufferers showing
psychological distress (Tait, Chibnall, & Kalauokalani, 2009).
The tendency to attribute pain complaints to psychological
distress—rather than the opposite—might lead healthcare
professional to disregard the severity of patients’pain or their
analgesic needs because of the idea that pain complaints result
from the experience of psychological distress, rather than the
Common social and physical pain consequences 685
Copyright © 2011 John Wiley & Sons, Ltd. Eur. J. Soc. Psychol. 41, 681–687 (2011)
pain itself (Wallis, Lord, & Bogduk, 1997). Conversely, the
present findings showed that psychological distress—in the
form of threatened human needs—intrinsically follows even
very minimal inductions of pain. Adopting experimental
manipulations, the present findings extend early correlational
studies that reported resolution of psychological distress after
pain relief in patients with chronic pain (Haythornthwaite, Sieber,
& Kerns, 1991; Wallis et al., 1997).
Second, our study brings support to the bio-psychosocial
approaches of health and disease. In several healthcare settings
of western society, pain management still tends to take a bio-
medical approach, which often concentrates on the organic
origin of pain, regarding it mostly as a potential diagnostic tool
and therefore undervaluing its psychological and psychosocial
consequences (Bendelow & Williams, 1995; Kugelmann,
2003; Scarry, 1994). Several investigations noted that the
bio-psychosocial model is only partially adopted with—at
best—attention given to cognitive and behavioral factors, but
with no consideration of the social implications of pain and
disease (e.g., Harding, Campbell, Parsons, Rahman, & Under-
wood, 2010). More than three decades after its first proposal
(Engel, 1977), the translation of the bio-psychosocial approach
into practice seems still to be problematic. Practitioners still
anchored to a bio-medical view might benefit from consider-
ing the social and psychological vulnerability of people in
pain. Showing that physical pain decreases one’s satisfaction
of belonging, self-esteem, control and meaningful existence,
our findings could support healthcare professionals in appreci-
ating why and how they can take the “social”component of
the bio-psychosocial model into consideration. Our findings
add to Engel’s (1977) claim that the ultimate criteria for the
patients’well-being are psychosocial, even when the complaint
is physical in origin (e.g., pain).
Third, the present findings provided insight into the likely
underestimation of the damaging effects to individuals’psycho-
logical well-being caused by numerous pain conditions, includ-
ing chronic pain disorders, or pain arising from life-threatening
diseases (e.g., cancer). We found that one-minute inductions of
social or physical pain can threaten need satisfaction. However,
this effect is likely to extend beyond acute episodes to indivi-
duals experiencing chronic social and physical pain. Support
for this hypothesis arises from the commonalities that emerged
comparing the experiences of persistent social (Zadro, 2004)
and physical pain (Walker, Sofaer, & Holloway, 2006). There-
fore, future research should consider the shared experiences of
social and physical chronic pain within the theoretical frame-
work of pain overlap theories.
Limitations and Future Directions
Nevertheless, it should be noted that converging evidence of
physiological and psychological commonalities does not im-
ply that social and physical pain are equivalent constructs,
with identical psychological features and consequences. In-
deed, distinctions between the two painful experiences have
been pointed out in past research. Chen et al. (2008) showed
that social pain can be relived and re-experienced more readily
than physical pain. Moreover, several researchers used physi-
cal pain to investigate the specificity of the effects of social
exclusion, finding social pain to be uniquely able to lead to a
deconstructed state and impair cognition and self-regulation
(e.g., Baumeister, DeWall, Ciarocco, & Twenge, 2005).
Consistent with this literature, we found lower basic needs
satisfaction for the participants who experienced social com-
pared with physical pain. In Experiment 1, the intensity of pain
associated with episodes of social and physical pain did not
differ; nevertheless, social pain was associated with lower
needs satisfaction than physical pain. In Experiment 2, even
though the participants in the physical pain condition reported
higher pain scores than those in the social pain condition,
social pain still had a greater impact on basic needs. Critically,
there was no difference in negative affect between social and
physical pain, suggesting negative affect cannot explain
worsened basic needs satisfaction for those in social compared
with physical pain. Although comparisons in Experiment 2
should be interpreted with caution as social and physical pain
were induced with two different manipulations, the results
similarly suggest social and physical pain are not equivalent
constructs.
We note that our findings are mostly based on measures that
were created and framed to assess psychological variables
threatened by instance of social pain such as ostracism, social
exclusion, and loneliness. Thus, future research should further
compare the strength of social and physical pain induction in
frustrating the psychological equilibrium by considering a larger
set of basic human needs (e.g., “safety”or “predictability”)and
a larger variety of psychological responses (e.g., ego depletion).
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