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The nature and prevalence of
pain in dreams
Antonio L Zadra PhD1, Tore A Nielsen PhD1,2, Anne Germain PhD(c)1, Gilles Lavigne DMD MSc1,3, DC Donderi PhD4
Although pain has been reported to interfere with sleep
(eg, 1), little is known about the prevalence of pain in
dreams. Anecdotal accounts from the 19th century suggest
that although painful sensory stimuli can affect dream con-
tent, pain sensations are not directly incorporated into the
dream narrative (2,3). Saint-Denys (4) documented several
cases demonstrating extreme sensitivity to slight physical
sensations while dreaming. However, he believed that
dreams were completely unable to reconstitute the exact
character of past pain and that, consequently, pain could not
Pain Res Manage Vol 3 No 3 Autumn 1998 155
AL Zadra, TA Nielsen, A Germain, G Lavigne, DC Donderi.
The nature and prevalence of pain in dreams.
Pain Res Manage 1998;3(3):155-161.
BACKGROUND:Littleisknownaboutthefrequencyandnature
ofpainindreams.Severalauthorshavesuggestedthatpainmaybe
beyond the representational capability of dreaming.
OBJECTIVE: To obtain more detailed information on the nature
and prevalence of pain in a larger sample of everyday dreams col-
lected through home logs. To examine the context within which
dreamedpainoccursandto assessparticipants’retrospective recall
of past experiences of pain in dreams.
METHOD:One hundred andeighty-five participants completed a
battery of questionnaires and recorded their dreams for two con-
secutive weeks.
RESULTS: Retrospective responses to the questionnaire indicate
that close to 50% of individuals report having experienced pain in
their dreams at least once. A total of 3045 dreams were reported in
the home dream logs. Eighteen of these dreams contained unambi-
guous references to the subject experiencing pain.
DISCUSSION: Pain sensations in dreams are reported as being
realistic,localized to a specific area of the body, typicallyresulting
from violent encounters with other characters and often accompa-
niedby intense affect. A model is proposed to explain how sensory
experiences such as pain can be produced in the dream state.
CONCLUSION: Cognitive systems that contribute to the repre-
sentation of pain imagery are sometimes functional during
dreaming.
Key Words: Dreams, Pain, Sensory imagery
La nature et prévalence de la douleur dans
les rêves
CONTEXTE THÉORIQUE : On a très peu d’information sur la
fréquence et la nature de la douleur dans les rêves. Plusieurs auteurs
ont suggéré que la douleur est en deçà de la capacité représentation-
nelle du rêve.
BUTS: Obtenirde l’informationplus détailléesur lanature et la préva-
lence de la douleur dans un plus large échantillon de rêves recueillis à
lamaison. Examiner le contexte dans lequel la douleur se produit dans
le rêve et évaluer le rappel rétrospectif d’expériences antérieures de
douleur dans les rêves des participants.
MÉTHODE : Cent quatre vingt-cinq participants ont complété une
batteriede questionnaires et rempli des agendas de rêves pendant deux
semaines consécutives.
RÉSULTATS : Les réponses rétrospectives au questionnaire in-
diquent que près de 50% des individus rapportent avoir ressenti au
moins une fois de la douleur dans leurs rêves. Un total de 3045 rêves
ontété rapporté dansles agendas derêves. Dix-huit de cesrêves conte-
naientdes référencesindiquant quele sujetavait ressentide ladouleur.
DISCUSSION : Les sensations de douleur dans les rêves sont rap-
portéescomme étant réalistes, localisées dans un endroit spécifique du
corps; elles résultaient le plus souvent de rencontres violentes avec
d’autres personnages et s’accompagnaient d’un affect intense. Un
modèle est proposé pour expliquer comment les expériences sensori-
elles comme la douleur peuvent être produites dans l’état onirique.
CONCLUSION : Les systèmes cognitifs qui contribuent à la
représentation onirique de la douleur sont parfois fonctionnels durant
le rêve.
1Hôpital du Sacré-Coeur, Centre d’étude du sommeil; 2Département de Psychiatrie, Université de Montréal; 3Faculté de Médecine Dentaire,
Université de Montréal; 4Department of Psychology, McGill University, Montreal, Quebec
Correspondence and reprints: Dr Antonio Zadra, Hôpital du Sacré-Coeur, Centre d’etude du sommeil, 5400 boul Gouin Ouest, Montréal, Québec
H4J 1C5. Telephone 514-338-2222 ext 3013, fax 514-338-2531, e-mail zaz@ego.psych.mcgill.ca
Received for publication March 12, 1998. Accepted August 13, 1998
ORIGINAL ARTICLE
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be experienced. In his extensive review of the scientific lit-
erature on dreams, Freud (5) cited several examples of nega-
tive dream content (eg, being scalped, being tortured on the
rack or standing on intolerably hot ground) that were attrib-
uted to the effects of unpleasant sensory stimuli. Freud ar-
gued that somatic stimuli, including pain, were never the sole
causeof the dream but served onlyto instigate specific dream
images.
Contrary to these anecdotal accounts, our laboratory
study found that pain sensations were mentioned in approxi-
mately 30% of rapid eye movement (REM) dream reports
collected subsequent to the administration of long-duration
pressure stimulation of the leg (6). We also noted that when
pain occurs in dreams, it is relatively realistic and is often ac-
companied by intense negative affect. In a follow-up study
we found that ramped pressure stimulation of the hand dur-
ing REM sleep did not result in subjects reporting pain
dreams (7). Both studies, however, showed that unambigu-
ous pain dreams can occur during nonstimulated REM peri-
ods, indicating that actual painful stimuli need not be present
for pain to occur in dreams.
Just as the information on the effects of painful stimuli on
dream content is sparse, little is known about the nature of
pain dreams that occur in the absence of any painful or un-
comfortable stimuli. Case studies of individuals who repeat-
edly experience violent dream imagery, including images of
destruction of or penetrating wounds to the body, rarely con-
tain references to dreamed pain as part of the experience
(8-12). In fact, some subjects report being surprised by the
absence of pain during such dreams (eg, 12). Studies of large
samples of dreams (13-15) do not mention dreamed pain.
One study of 180 REM dream reports that were scored spe-
cifically for references to sensory events found no instances
of pain (16). More recently, we presented a preliminary re-
port of responses of 125 normal adults (28 men and 97
women) to a question about past experiences of pain in
dreams, as well as response on the prevalence of pain from
2204 home dream reports (17). Fifty-nine of the 125 subjects
(47.2%) indicated that they remembered having experienced
sensations of pain in their dreams at some point in their lives.
Content analyses of the home dream diary reports showed
that dreams containing pain were rare, occurring approxi-
mately once in every 157 dream reports and in one of 10 sub-
jects.
The primary goal of the present study was to obtain more
detailed information on the nature and prevalence of pain in a
larger sample of everyday dreams collected through home
logs. Secondary goals were to examine the context within
which dreamed pain occurs and to assess participants’ retro-
spective recall of past experiences of pain in dreams.
PARTICIPANTS AND METHODS
One hundred and eighty-five participants (48 men, 137
women) with a mean age of 34.6 years (SD=11.8) were in-
cluded in the study. Mean age of men was 32.8 years
(SD=11.5) and of women was 35.3 years (SD=11.8). Partici-
pantswere randomly selected from a largergroup of 241 non-
paid volunteers (64 men, 177 women) who had been
recruited through media advertisements for participation in a
series of studies on the relation between dream content and
measures of well-being.
After indicating interest, participants were contacted by
telephone and asked to attend an information meeting. At the
meeting, the research was briefly explained, the role of the
participants was clarified and two research protocols were
distributed. Signed consent forms were obtained from all par-
ticipants. The procedures had been approved by the McGill
University ethics review committee.
Participants’ health and retrospective accounts of
pain dreams
The first research protocol required participants to complete
not only a battery of questionnaires designed to measure psy-
chological well-being (18), but also a 68-item Sleep/Dream
Questionnaire. Several items from these questionnaires were
examinedto assess potential pain-related conditionsand their
possible relationship to reported dream pain. Items included
five pain-related items from the Symptoms Checklist-90-
Revised (SCL-90-R) (19) (ie, how much have you been both-
ered by: headaches; pains in heart or chest; pains in lower
back;nausea or upset stomach; soreness ofyour muscles) and
three questions from the Sleep/Dream Questionnaire (is the
participant is currently under the care of a physician and if so,
for what reasons?; list any current or past medical conditions;
and specify any over-the-counter or prescription medications
being taken).
The Sleep/Dream Questionnaire included one question
thatasked “Have you ever experiencedsensations of physical
pain in your dreams? If so, please describe”. Answers to this
question were tabulated and the descriptions categorized ac-
cording to, first, the actions that led to the participants feeling
pain and, second, the body area(s) where the dream pain was
localized.
Self-reporting of pain dreams in home logs
The second protocol required participants to record all
dreams that they could remember on awakening for 14 to
21 consecutive days. These dreams were written in a booklet
of record sheets kept by the bed. The record sheets also
prompted participants to record the theme, emotions (includ-
ingintensity ratings on a five-point scale)and clarity of recol-
lection associated with each remembered dream. Addition-
ally, participants specified the date of the dream and the
elapsed time between waking and recording the dream. Be-
cause the evaluation of pain sensations in dreams was not the
focus of the original series of investigations, participants
were not asked to take special note of pain sensations in their
dreams.
Dream reports from the first two weeks of the home dream
logs were scored by two independent judges for unambigu-
ous references to pain experienced by the dreamer. Dream re-
ports that described vague or unpleasant sensations (eg,
feeling queasy) and reports in which pain was suggested but
156 Pain Res Manage Vol 3 No 3 Autumn 1998
Zadra et al
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not explicitly stated (eg, “I was punched in the stomach and
doubled over”) were not scored as pain dreams. Dream re-
ports were also scored for positive and negative affect ac-
cording to Hall and Van de Castle’s (14) Emotions Scale.
RESULTS
Retrospective accounts of pain dreams
Ninety-one of the 185 participants (49.2%) indicated on the
Sleep/Dream Questionnaire that they had experienced pain
in their dreams at least once. When results were broken down
by sex, 22 of 48 men (45.8%) and 69 of 137 women (50.4%)
reported having had a pain dream at some point in their lives.
This difference was not significant (c2[1] = 0.35, P>0.05).
Table 1 presents the dreamed actions that were most fre-
quentlyreported as leading to painfeelingsfor these 91 retro-
spective accounts. The category “Not specified” includes
dreamsin which actions related to thepain were not specified
or for which the thematic content could not be determined.
The thematic content for four of the five categories for which
an action could be specified involve pain resulting from ag-
gressive actions explicitly directed by an agent towards the
dreamer. A fifth category (ie, being injured in an accident)
involved violent and potentially aggressive acts.
Seventy-two of these 91 participants (79.1%) wrote that
the dream pain had been localized to one or more body parts
for a total of 84 references to specific body areas. These ref-
erences include those from nine participants who described
two (or in one case, three) areas of the body in which they felt
pain. A frequency distribution of body areas where dreamed
pain was reported to have occurred is presented in Table 2.
The three most frequently implicated regions were the abdo-
men,legs and head or face; these threetogether accounted for
49% of the references.
Home dream reports
During the two-week period of home dream recording, par-
ticipants reported a mean of 16.5 dreams each (SD=7.3) for a
total of 3045 dreams. Women reported a mean of 17.7
dreams (SD=7.5) and men a mean of 15.9 dreams (SD=6.8).
This difference was nonsignificant (t[183] = 0.60, P>0.05).
Sixteen participants (five men and 11 women) (8.6%) re-
ported a total of 18 pain dreams; two of these female partici-
pants each reported two pain dreams. There were no signifi-
cant sex differences in the relative proportions of men and
women who reported no pain dreams or at least one such
dream during the study (c2[1] = 0.26, P>0.05).
In 15 of the 18 pain dreams reported, an agent was de-
scribed as being clearly responsible for the subject’s pain.
The pain sources for these 15 dreams were very sore feet be-
cause of uncomfortable shoes; having one’s legs stuck under
an immense steering wheel; stomach pains due to a difficult
pregnancy (the subject was not in fact pregnant); having
one’s pubic hair ripped out by an assailant; burning skin on
one’s arm due to an allergic reaction; having one’s arm and
shoulder run over by a bus; having one’s hand burned by a
hot coal; being speared in the rib cage; having an assailant
dig his fingers deep into the rib cage; having an assailant
squeeze and twist the waist; pressing a baby’s mouth
forcefully against the breast; being shot in the back; having a
window fall on the back; receiving electrical shocks from a
cattle prod; and receiving electrical shocks from car wires.
The remaining three pain dreams consisted of having a tooth-
ache, having a pain under the breast and feeling pain in the
abdomen. Three of the 18 reports described very intense pain
with words such as “excruciating” or “unbearable”. Edited
transcripts for nine of the 18 dreams containing references to
pain appear in Table 3.
Eight of the 18 pain dreams (44.4%) involved the subject
being chased and/or attacked. Only two of the dreams in-
volved being stabbed and only one involved being shot.
These findings contrast with the relatively high frequency of
armed violence compiled from the Sleep/Dream Question-
naire responses (16.6% versus 38.2%).
Pain Res Manage Vol 3 No 3 Autumn 1998 157
Pain in dreams
TABLE 2
Areas of the body where pain was localized in
questionnaire dream reports (84 references to specific
body areas)
Body part n ( %)
Abdomen 15 (17.9)
Legs 14 (16.7)
Head or face 12 (14.3)
Back 9 (10.7)
Chest 8 (9.5)
Hands 8 (9.5)
Arms 7 (8.3)
Throat 4 (4.8)
Ears 2 (2.4)
Neck 2 (2.4)
Feet 2 (2.4)
Shoulder 1 (1.2)
Total 84 (100.1)
Percentages do not add up to 100 due to rounding
TABLE 1
Actions most frequently reported on questionnaire as
leading to pain in dreams (n=91)
Action n (%)
Being stabbed or cut 19 (20.9)
Being shot 16 (17.6)
Being injured in an accident 10 (11.0)
Being attacked by an unarmed assailant 8 (8.8)
Being bitten by an animal 5 (5.5)
No apparent reason 4 (4.4)
Not specified 29 (31.9)
Total 91 (100.1)
Percentages do not add up to 100 due to rounding
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158 Pain Res Manage Vol 3 No 3 Autumn 1998
Zadra et al
TABLE 3
Edited transcripts of nine pain dreams collected from home dream logs
Subject A (41-year-old female): I’m listening to a colleague and I begin to scratch my left forearm. It’s itchy and it burns. I look at my
left arm and I see that I have many ‘pimples’. I try not to scratch my arm but it’s really burning. I think that maybe it’s not poison ivy
but a really bad allergic reaction. When I woke up I turned on the light to look at my arm.
Subject B (38-year-old male): A young man, unknown to me, confronted me. His nose was very wide – like that of a boxer. He
challenged me to hit him with my best shot, then he would do the same to me. Afraid, I refused. If I didn’t put him away, he would
murder me. After more challenges, and more refusals, I felt his fingers digging deep into both sides of my rib cage. The pain was
unbearable. Then I took a long bladed knife and stabbed him between the ribs near his heart. He let go. There was lots of blood.
Subject C (19-year-old female): I hold a tiny premature baby in my hands. It is red, wrinkled and naked. It is screaming so hard that its
little face is all contracted and shrivelled up like a Cabbage Patch Kids. I feel quite disgusted and annoyed. I know the only way to
make it shut-up is to breast-feed it, so I press its mouth against my nipple, so hard that it hurts me. The baby still wriggles and kicks,
so I squeeze it even harder against my breast. My breast hurts but after a while, it stops moving and I enjoy a few minutes of peace.
I release my hold but still the baby remains immobile. Curious, I pull it away from me – its face is completely blue and purple, its
eyes shut hard, its body limp.
Subject D (28-year-old male): I dreamt that I had been in a train crash. Most people had died and I was stuck in an unknown wooded
area. The woods are really thick and I couldn’t find a path. A group of ‘primitive’ people (loin clothes, painted faces) start yelling at
me. They grab me and tie me down to the ground with my hands above my head. One of the men takes this long spear with a metal
arrow on its end and holds it over my chest. I’m really scared that they’re going to kill me. I start to plead with them but then he
plunges it into my ribcage and begins to twist it. I scream in pain and beg them to stop. The pain is just excruciating and I try to wiggle
around but it doesn’t help. The man just keeps on twisting and pushing in further. I can’t stand it anymore and beg them to just kill
me but they won’t. My wife then woke me up saying that I was making moaning and grunting noises. When I woke up I was
surprised and relieved to note that the pain, which had been absolutely horrible, had completely disappeared.
Subject E (32-year-old female): I find myself in the house where I grew up when I was a kid. I’m with my dad and it’s very nice. This
house is no longer ours and I feel as if we were there like thieves. The owners realize that we are there, other people arrive and a big
brawl ensues. I escape but I see that I have a hand in my hands (from the fight). It’s a women’s hand. I try to keep the hand intact so
that a doctor can sew it back if we find the person it belongs to. Then, the hand splits itself in half lengthwise. I panic thinking that
maybe this is my daughter’s hand. I run to the car, but in the dream, I don’t know how to drive. The wiring from the accelerator or
the brakes unwinds and attacks me. I get out of the car but the wires keep on attacking by giving me electrical shocks. It hurts. The
wires keep attacking and they’re also crawling on my legs. I woke up still frightened.
Subject F (30-year-old male): I’m in a hotel and I take the elevator to the main floor. Two FBI-type agents and a lady come in and
they’re talking about a murderer on the 14th floor. I want to see this. The door opens on the 14th floor but everything is quiet. The
agents, myself and the lady, who transforms herself into a man, get off the elevator. I then realize that the murderer has left. I take
the emergency stairs down to the 13th floor. I see a small woman. She’s very pale with red hair. She’s standing very stiff. I whisper
into her ear “Where is he?” but she can’t answer. He is in the room. Then a man with a lab coat approaches me. It’s him. He talks to
me and knows that I know. There are cadavers on the floor. He takes a liking to me and I try to help him in a way so that he doesn’t
lose control. Suddenly, he grabs me by the neck and throws me to the floor. He rips out my pubic hair without even taking off my
pants. I don’t understand how he’s doing it but it really hurts. I understand why he’s doing it and tell him “You will put them on
some girl’s vagina to simulate rape”. I see the small red-haired lady. She will be his victim. I feel my pubic hair being ripped out – like
needles. I wake up.
Subject G (40-year-old female): I have a terrible toothache and I’m lying down on my bed. It’s so bad I’m crying. A pleasant, nice
young girl comes to console me. She tells me that I should be doing theatre with them. Outside my room there is a theatre troupe
that will be performing all day. This young girl tells that I could play my own role and even remain in my bed, or lie down on the
stage.
Subject H (34-year-old male): I’m walking down this pretty street in an old European town. A young man approaches me and asks me
if I would be interested in buying one of his paintings. He tells me that they look like holograms but that they’re made on a regular
canvas. He invites me to see them and takes me down this side road that goes behind his house. A group of men step out from
behind these wooden stairs. One of them is carrying hot coals in his hands. They tell me that I must hold one of the coals in my
hand. Somehow this is all part of the exhibit. I say that I don’t really want to but they assure me that it won’t hurt. One man grabs a
coal and holds it firmly between his hands. He grins and says “See, no problem. Besides, you don’t have a choice.” I try to close my
hand but they just pry my fingers open. Then they put a hot coal in the palm of my hand. It really burns and I yell “No, Stop! Stop!”
To my surprise they stop and remove the coal. My hand still hurts and I can see that my skin is burned. The man holding the coals
starts looking straight into my eyes and then I woke up. The pain was so intense that I was amazed when I awoke that it existed only
in the dream.
Subject I (21-year-old female): I’m hiding from the Gestapo with my family in my closet. We finally manage to escape through a
window on the second floor. As I’m climbing out the window, it falls down on my back. I get very scared and my back hurts.
I manage to twist myself, open the window again and jump down. I see an SS that spots me so I run as fast as I can towards a wall to
hide. I’m hiding and trying to catch my breath. I wonder where the SS is and if I’m going to be safe here. The pain is starting to
spread towards my upper back. I wake up with a sore back and it keeps me from falling back to sleep.
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In 16 of the 18 dreams, the pain was described as being lo-
calized to a specific area of the body. The most frequently
mentioned area was the chest (n=5), followed by arms/shoul-
ders (n=2), abdomen (n=2), back (n=2), legs (n=1), feet
(n=1), hand (n=1), teeth (n=1) and the groin (n=1).
With respect to affective content, 16 of the 18 pain dreams
(88.9%) were described as containing only negative affect,
whereas two (11.1%) were rated as containing both positive
and negative emotions. For pain dreams with only negative
affect, fear was most commonly cited (n=8), followed by
confusion (n=4), frustration (n=2), disgust (n=1) and anger
(n=1). The two pain dreams containing both positive and
negative emotions began as pleasant dreams and turned into
anxiety dreams. In both cases, the dream was described as
having become quite unpleasant before any reference to pain
was made. Pain intensity was rated on a five-point scale; in
11of the 18 pain dreams(61.1%) the intensity of the negative
affect rated 5, in five dreams (27.8%) intensity rated 4 and in
two (11.1%) intensity rated 3.
Three of the 16 participants noted in their logs that the
pain, which had been intense in what they described as night-
mares, had completely disappeared upon awakening (see re-
ports by subjects D and H in Table 3). Conversely, one
participant wrote that she woke up with severe stomach
cramps following a dream in which she had experienced pro-
longed pain in her stomach. Another participant noted that
her back pain was still present when she awakened and that it
prevented her from falling back to sleep (see report by par-
ticipant I in Table 3).
Seven of the total sample of 185 participants noted a total
of nine dreams in which pain would have been expected (eg,
after being shot) and spontaneously indicated that they had
been surprised in the dream that no pain had been felt or that
they had experienced only an uncomfortable hot flash or
mild tingling sensations. Six of these nine dreams were de-
scribed as containing negative affect, two contained both
positive and negative emotions, and one was rated as affec-
tively neutral. Regarding the emotional intensity of the six
negative dreams, only one dream was rated (out of 5) as 5;
one dream rated as 4, three as 3 and one as 2. Numerous other
dreams in which pain might have been expected (eg, being
stabbed) were reported, but no spontaneous statements about
its absence were given.
Pain dreams and physical health
Six (four women and two men) of the 185 participants re-
ported on the Sleep/Dream Questionnaire that they were cur-
rently under the care of a physician for a pain-related condi-
tion or that they took prescription or over-the-counter
medications for a pain-related ailment. The specific condi-
tions reported were migraines (n=2), back pain (n=2),
menses-related abdominal pain (n=1) and arthritis (n=1).
Only one of the six reported a pain dream on the dream logs,
but the localization of the dream pain (abdomen) was unre-
lated to her condition (migraines). There was no clear rela-
tionship between the content of the 18 pain dreams collected
and the physical health of the 16 participants who reported
them as assessed by the pain-related items of the SCL-90 and
the Sleep/Dream Questionnaire. Three of the 16 participants
reporting pain dreams indicated that they had been bothered
“quite a bit” or “extremely” by one or more of the pain-
related items on the SCL-90. In only one case, however, was
there a link between the pain dream reported and the partici-
pant’s physical health. In this case, the participant reported
being bothered “quite a bit” by “pains in the lower back” and
had a dream in which she reported experiencing back pains
(see report by subject I in Table 3).
DISCUSSION
Results from the retrospective responses to the questionnaire
indicate that close to 50% of individuals report having expe-
rienced pain in their dreams at some point in their lives. That
the vast majority of these participants had no obvious past
history of pain-related conditions suggests that many healthy
subjects likely remember having had a dream with pain at
least once in their lives. The thematic content of these retro-
spectively recalled pain dreams (see Table 1) differed from
that in the pain dreams collected from home logs. From the
retrospectiveresponses, themes of being stabbed or shotwere
the most frequently reported dreamed actions leading to pain,
accounting for approximately 38% of all pain dreams.
Moreover, approximately 80% of the pain dreams for which
a source was specified involved aggressive actions directed
towards the subject. By contrast, only three of the 18 pain
dreams (17%) in home logs involved being stabbed or shot,
and only half contained aggressive acts directed towards the
subject.
There may be at least two reasons for these differences.
First, retrospective responses to the questionnaires involved
participants’ recalling pain dreams that had probably oc-
curred months if not years before the study. It is reasonable to
assume that more ‘dramatic’ pain dreams (eg, dreams in
which the person is stabbed, shot or otherwise attacked) are
more salient and disturbing than relatively mundane pain
dreams (eg, having sore feet or a painful itch), and will, there-
fore, be more easily remembered over long periods of time.
Second, it is possible that for at least some of their retrospec-
tively recalled dreams participants attributed sensations of
pain when pain would normally be expected to occur even
though no pain sensations had been dreamed. That is, partici-
pants may have inferred that pain was present in dreams in
which they were shot or stabbed because such actions would
result in feelings of pain. The frequent occurrence of sponta-
neously reported dreams without pain (where it would have
been expected) is consistent with this possibility.
Over 80% of the participants who reported pain dreams on
the questionnaire wrote that the pain had been localized to a
specific area of the body. A tabulation of these areas of the
body (see Table 2) indicates that the distribution of dreamed
pain across body parts is likely unrelated to the amount of
cortex devoted to the somatosensory representation of these
areas (20). Thus, pain in dreams does not appear to result
from random activation of the somatosensory cortex. Nor
does dreamed pain seem to vary systematically as a function
Pain Res Manage Vol 3 No 3 Autumn 1998 159
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of self-reported pain conditions. Thus, the precise psycho-
logical and physiological determinants of pain location re-
main unknown.
Of the 3045 dreams reported in the home dream logs, 16
participants reported a total of 18 dreams that contained ref-
erences to the subject experiencing pain. These findings indi-
cate that the prevalence of dreams containing pain is very
low, occurring once in every 169 dream reports and in one of
every 12 subjects. Nevertheless, in a majority of cases where
pain occurs, it is integrated into the dream narrative; specific
episodes of pain typically result from sudden and/or violent
encounters with other characters or objects. Pain sensations,
however, do not appear to be an inevitable consequence of
such encounters or of expectations about feeling pain. For in-
stance, one participant in the present study reported a dream
inwhich someone used a bladeto cut the palm of hishand but
he “was surprised that it didn’t hurt at all – all there was some
cringing of the skin and then a feeling of warmth where the
cut had been made”. Another participant reported a dream in
which he was hit directly in the head by a fast moving base-
ball. He wrote that “I remember thinking ‘I’ve just been hit by a
baseball,so my head should hurt’ but Ididn’tfeel any pain”.
The types of pain reported in the home logs are quite di-
verse and are not restricted to one area of the body. As with
the pain dreams reported on the questionnaire, most pain
dreams collected from home logs describe a specific area of
the body where the pain had been localized. However, the
frequency distribution for body areas in the sample of home
dreams differs from that in the questionnaires. For example,
pain in the chest area was reported in 28% of home pain
dreams and in only 6% of the pain dreams reported on the
questionnaire. Conversely, the most frequently cited areas
for dream pain reported on the questionnaire (ie, abdomen,
legs, and head or face) were rarely cited in the home pain
dreams. The relatively small sample size of home pain
dreams and the fact that home dreams were recorded upon
awakening while the dreams collected on the questionnaire
were reported long after their occurrence, may account, in
part, for these differences. Over long periods of time, mem-
ory of pain localization may be less accurate than memory of
the presence or absence of pain.
All of the 18 home pain dreams were described as con-
taining negative affect; two also contained positive emo-
tions. In our previous study of the association of pain dreams
to pressure stimulation of the legs (6), almost half of the pain
dreamscollected contained strong negative affect. Anger, the
most frequently cited emotion, occurred in five of 13 reports
(38.5%). By contrast, fear was the most commonly cited
emotion in the home pain dreams, while only one pain dream
contained anger. This difference may result from the condi-
tions under which the pain dreams occurred. In the home
dreams, pain occurred for reasons that were generally be-
yond the subject’s perceived control and the emotions re-
ported (eg, fear, confusion or frustration) were appropriate
for the dream’s content. In the laboratory dreams, six of the
13reports contained direct references to the stimulating pres-
sure cuff and half made references to the experimenter of the
study; in all but one, pain was localized in the subject’s legs.
One may infer from these observations that, in at least some
of the laboratory dreams, participants specifically associated
their experiences of pain with the fact that they were partici-
pating in an experiment in the sleep laboratory. In other
words “anger may have been produced...because the pain
source was both known to and potentially controllable by
subjects” (6).
In the present study, three participants reported in their
logs that the intense sensations of pain present in their dreams
had completely disappeared upon awakening from the dream
(see reports by subjects D and H in Table 3). Similar findings
were noted in two laboratory studies that found that unambi-
guous pain dreams can occur during nonstimulated REM pe-
riods (6,7). These observations suggest that the cognitive
systems that contribute to the representation of pain imagery
are sometimes functional during dreaming and that actual
painful stimuli need not be present for pain sensations to oc-
cur in laboratory or home dreams. Similarly, such examples
illustrate that arguments that nociception (ie, neuronal activ-
ity in the pain-mediating nervous system) is neither a neces-
sary nor sufficient condition for the subjective experience of
pain (eg, 21), apply to dreaming as well as waking states.
The lack of data on the relationship between the content of
pain dreams and physical health precludes us from drawing
firm conclusions on this topic. Results from the dream logs,
however, indicate that pain dreams can be experienced by
healthy individuals. In only one case were the pain sensations
in a dream (ie, lower back pain that spread towards the upper
back) associated with a waking pain-related condition (ie,
frequent back pains). Interestingly, this participant (see re-
port by I in Table 3) noted that the back pain in her dream was
still present when she awakened. This suggests that real pain
sensations may influence the process of dream construction.
A study is currently underway in our research group to exam-
ine such processes in the dreams of individuals with chronic
or acute pain.
The present findings indicate that unambiguous refer-
ences to pain sensations occur in approximately one of every
170 home dreams. However, this may be an underestimate of
the true prevalence. First, the reports came from a study on
the relation between dream content and well-being – the par-
ticipants were not aware of our interest in pain dreams. Fur-
thermore, participants did not receive any instructions about
noting particular physical sensations in their dreams, and the
pain-related questions that appeared on the questionnaires
were imbedded in a large questionnaire battery. Thus, the
participants were not sensitized to reporting pain sensations
in their dream logs, and some participants may not have re-
ported them. Such dreams would not have been scored as
pain dreams given our strict criteria for scoring unambiguous
references to pain as experienced by the dreamer.
Second, our sample comprised individuals who were very
interested in dreams and whose rates of dream recall were ap-
proximately three times that of the general population (22).
How well these findings generalize to the general population
remains to be determined.
160 Pain Res Manage Vol 3 No 3 Autumn 1998
Zadra et al
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Our results on the prevalence of pain sensations in dreams
add to information from other studies that have reported on
theoccurrence of other sensory modalities (eg, auditory, gus-
tatory,olfactory and kinesthetic sensations) inlaboratory and
home dream reports (eg, 16,23,24). However, to our knowl-
edge, no model or theory has been proposed to explain how
sensory experiences such as pain can be produced in the
dream state in the absence of external stimuli.
One possibility is that self-experience during dreaming is
governedby a mechanism similar tothe ‘neuromatrix’ postu-
lated by Melzack (25) to govern bodily experience while
awake.The function of the neuromatrix is revealed by the oc-
currence of phantom body parts (limbs, breasts, genitals,
bladders, etc) following surgical removal or denervation of
the actual body part (eg, 26-28). The intense reality of phan-
tom body parts presumably stems from a brain process that
underlies the experience of the body when it is intact. Simi-
larly, during dreaming these brain processes may be acti-
vated and thus produce a variety of realistic sensations in-
cludingpain. Thus, in dreams we typicallyexperience a sense
of self (or a ‘phantom body’) that sometimes includes vivid
kinesthetic sensations and occasionally any of a myriad of
sensory experiences (eg, from orgasm to pain), affective
states and cognitive elements such as language, memory and
self-reflectiveness. Melzack’s model, as applied to dreams,
also accounts for how erotic dreams with orgasm are some-
times reported by quadriplegics with a complete spinal break
(29). Thus, pain and other intense sensory experiences may
for some individuals become encoded in the neuromatrix in
such a way that they will, when circumstances permit, be re-
produced in imaginal form during dreaming states.
ACKNOWLEDGEMENTS: This research was supported by the
Medical Research Council of Canada and by the Social Sciences
and Humanities Research Council of Canada.
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