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It Hurts: How We Biologically Experience Physical and Emotional Pain

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Biology 103
2000 Second Web Report
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It Hurts: How We Biologically Experience Physical and Emotional Pain

Joseph Santini

"Who does it hurt? That's who the story is about." -Harlan Ellison, on writing

Pain is a fascination for me, but increasingly I realize I know only minuscle amounts about how it works biologically. I could go on for hours, despite audience rejection, about hurtin' for my baby; however, where exactly does this emotional pain come from? My heart may be metaphorically cut, but it is not bleeding. The traditional "physical" definition of pain - that pain is, for example, "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" [1] - doesn't always work. I've gotten much more emotional pain from a loved one's rejection than from shoulder dislocation, but the first involves no tissue damage or threat of tissue damage. I discovered I needed to do research on what pain was before I could understand emotional pain.

Don Ranney says in his "Anatomy of Pain" that:

...pain is a perception, not really a sensation, in the same way that vision and hearing are. It involves sensitivity to chemical changes in the tissues and then interpretation that such changes are harmful. This perception is real, whether or not harm has occurred or is occurring. Cognition is involved in the formulation of this perception. There are emotional consequences, and behavioral responses to the cognitive and emotional aspects of pain. [1] uses essentially the same definition, but adds: "Pain is a complex perception that takes place only at higher levels of the central nervous system." [2]

Dr. Pennal pulls from a textual definition in "The Personality of Pain:"

[Pain is] an abstract concept which refers to (l) a personal, private, sensation of hurt; (2) a harmful stimulus which signals current or impending tissue damage; (3) a pattern of responses which operate to protect the organism from harm. These responses can be described in terms which reflect certain concepts, i.e., in neurological, physiological, behavioral, and affective "languages." [3]

The Web version of the Encyclopaedia Brittanica defines pain as:

...a complex experience consisting of a physiological (bodily) response to a noxious stimulus followed by an affective (emotional) response to that event. Pain is a warning mechanism that helps to protect an organism by influencing it to withdraw from harmful stimuli; it is primarily associated with injury, or the threat of injury, to bodily tissues.

It's interesting to notice that of the three definitions, only the Encyclopaedia does not mention "personal, private" or "perception." For the two doctors, pain involves the mind; pain is a perception, and the mind makes a conscious analysis of an event and decides that the individual perception of it means that pain should result from the event. "Cognition is involved in the formulation of this perception." This is interesting, because until now I thought that, vaguely, some neuron or other would float up from my arm and tell my brain that my arm was hurting. These doctors are telling me that this happens, but it is my mind which interprets the situation as pain.

The definitions above, however, are not really enough for me to understand the process of pain. What part of the mind is used to interpret a situation as painful? What is the "noxious stimulus" from the injury to the mind? And, of course, If the mind requires this specific stimulus to experience pain, where does it come from when we ask about emotional pain? This is a really tough question to ask in the face of modern thought, which states that "pain is a totally subjective experience which cannot be simultaneously shared and reported by another individual," and that "clinical pain as we know it is a unique experience peculiar to the human." [3] This frame of thinking is the one I found most common on the Internet and it seemed to preclude any discussion of the actual biological processes involved in pain. While I am happy to view the development of a concern in the medical community for accepting all types of pain on equal terms and not taking physical evidence as the only signifier of extant pain, I am interested in seeing what happens biologically when pain is present, whether psychosomatic or not. The only definition involving physical elements other than the vague term "body tissues" was "central nervous system" from

The reason there is a brevity in the definition and a lack of explanation to the exact physical elements involved is that there is as much difference between different types of physical pain as there is between physical and emotional pain. I will focus here however on a brief analysis of what happens with peripheral pain, then try to compare it with what happens where emotional pain is concerned.

First, peripheral pain. This pain "originates in muscles, tendons, etc., or in the peripheral nerves themselves." [1] The procedure which begins when "danger to tissues" of some sort occurs is this: the amount of pH drops and chemicals are released, called histamines and bradykin. Bradykini seem to be receptor cells of some kind, but I have been unable to discover more than that about them. Histamenes are organic substances stored within and released from cells in response to irritation; they cause contractions in certain body parts, like the stomach or lungs. Small non-myelinated C fibres are sensitive to these chemicals (myelinated fibers specifically perform this purpose, as well as sensing heat.) When they sense histamenes and bradykini, the C fibres send an electrical charge along the spinal cord. It goes to the dorsal horn of the spinal cord, the part of the spine which receives afferent information.

What happens at the dorsal horn is really complex and not fully understood, but it is called the "Pain Gate" by many doctors. From what I as a layman have been able to comprehend, more neurotransmitters are released when the dorsal horn senses the electrical charges sent to it.

From the dorsal horn, pain goes to the brain. But which part of the brain? No specific part, apparently. "Unfortunately there is no discrete centre where pain is recognised. Pain is so important to survival that almost the whole brain is involved. Pain involves cognition, emotion, and behaviour... All of this supports Dennis Turk's claim that "the reign of pain is mainly in the brain". But there is no one centre "in control". Rather we see that pain can be all-pervasive, affecting our thoughts and memories, attitutudes and emotions, movements and behaviour -- and in turn be affected by each and all of them." [1]

It was difficult to find a concrete analysis of emotional pain on the Web. However, on a page called "The biology of emotional disorders with the self help measures," I found this interesting statement:

The toxicosis consists of excess neurotransmitters and other neurochemicals. When this develops in the brain, the neurons cannot release enough neurotransmitter molecules to excite the rest of the nervous system, and symptoms of depression occur. Depression is also caused by the clogging of receptors with endogenous neurochemicals and with substances from the environment such as unmetabolized food substances, drugs, and other toxins. [5]

The paper goes on to say:

But neurons generally do not replace themselves, so when they become toxic a portion of the neuron breaks open and releases the toxins during what might be called a detoxification crisis. A detoxification crisis is an excitatory nervous symptom such as intense anxiety and many other symptoms. During a detoxification crisis excess neurotransmitter molecules and other neurochemicals flood the synapses. These toxins include excessive amounts of the neurotransmitter noradenaline, also adrenaline, dopamine, serotonin, GABA, endorphins and other substances. The excess neurotransmitter overexcites the nervous system causing excitatory nervous symptoms that can range from mild anxiety to mania and to extreme acts of violence. [5]

Depression is a toxic situation built up over time in the brain's neurons, sometimes beginning as early as childhood. The chemicals and neurotransmitters which are affected cannot perform their function well enough to bring the person out of depression. Eventually, the neurons become too toxic and need to detoxify, and they flood the nervous system with neurotransmitters, overexciting what was once underexcited.

This seems to be an extreme case, however. What about temporary grief, rejection maybe from a date, that sort of pain? There doesn't seem to be much literature on the subject - perhaps because it's too difficult to study.

Comparing the two sorts of pain - the analysis of the biology of depression and the analysis of the biology of peripheral pain - opens up some really interesting points for discussion. I find it fascinating how the two sorts of pain seem to react to and interact with each other. Many of the websites I researched on peripheral and physical pain indicate or state directly that the emotions have a direct impact on how the individual experiences pain. And some of the readings I've done on the side state that pain can be used to enhance a person's emotional state. Many people who engage in self-mutilitation, for example, do so because they want to feel emotional pain, not physical pain. Forms of Eastern medicine teach that treating the mind is as important as treating the body - the two interface. So I am left with the distinct impression, not that emotional pain and physical pain are different sorts of pain (after all, biologically they are both the reaction of the brain to neurotransmitters), but that they somehow work together to keep the body in order. We need emotional stability as well as physical safety in order to achieve equilibrium and get rid of pain. This raises even more interesting questions for me. Did this evolve as a survival tactic? Why would emotions be important to survival? Does emotional connectivity resulting in grief at the loss of a loved one, for example, represent a way the body evolved to protect the person, since people working in groups are safer than individuals alone? I was really frustrated by the confusion of materials available online. People seemed afraid to define pain, mostly because they were afraid that defining pain would invalidate forms of pain which didn't fall under their definition. I view this almost as a cop-out, because it allows people to keep going without analyzing each individual type of pain and maybe learning more about the body and about pain as a whole.

Note: The hardest part of this paper was the looking up of every other word in each of the documents I read online. The Encyclopaedia Brittanica was invaluable in helping me do this, but I think this wordiness represents another problem. I never saw a website in all my searches which tried to explain pain to a patient or layman. The assumption is that the patient is always looking for a cure. While this is no doubt true, sometimes it feels good to a patient to know what exactly is happening to their bodies and this needs to be respected.


I e-mailed Don Ranney, whose work I quoted in this paper, and asked him about emotion-caused pain. He sent me the following response:


Dear Joseph,

I have not run across anything that describes neuroanatomical pathways in emotional pain AS DISTINCT FROM physical pain. Emotion is inseparably involved in all pain because the limbic system is always affected to some degree or another in any pain, and the limbic system ( especially the mammillary body, anterior nucleus of the thalamus, cingulate gyrus, amygdala and hypothalamus ) is the say of emotions.

Of course you are asking about suffering due to cognitive processes, ideas that are present in the mind. In this there should not be any activity in the peripheral sensory system. Chemical mediators in the CNS would be active, e.g., serotonin and I don't know what else. But I don't think substances like bradykinin and histamine or even substance P would be released.

All this is not very much but I hope it helps.

Don Ranney, MD, FRCS

This e-mail basically states that there has not been any work done on emotion-caused pain as opposed to physically-caused pain. That would explain the difficulty in finding information. I believe work on emotionally-caused pain needs to be done. It might lead to new understanding of the mind-body balance, for one thing.



[1] Don Ranney, M.D. The Anatomy of Pain.

[2] Aghabeigi: The pathophysiology of pain. at

[3] Billy E. Pennal, Ph.D. The Personality of Pain

[4] The Encyclopaedia Brittanica Online

[5] Van Winkle, Elnora. The biology of emotional disorders: self help for mood disorders, major depression, bipolar depression, manic depression, mental illness, psychosomatic disorders, alcoholism, addiction, and aggressive or violent behavior

other helpful websites not cited in this paper:



Comments made prior to 2007

I direct a Coping Skills 4 Kids emotional health education project that focuses on the subject of understanding brain-based coping capabilities that enable us to safely recover from emotional pain. I noted your interest and wanted to coment upon a recent exchange on your website lamenting the absence of literature on emotional pain as distinct from physical pain.


Our project uses Paul McLean's "Triune Brain Theory." However it is integrated with my own theory of violence and suicide (self-harmful behavior) being linked to how our brain processes emotional pain in the same way as physical pain. Recent brain imaging research (the Journal Science in Oct., 2003) has revealed that both types of pain are processed in the same part of the human brain. Three years earlier I had theorized in my book: "Emotional Honesty & Self-Acceptance: Education Strategies for Preventing Violence." We now can understand how the human brain is so often self-deceiving and acts of violence (whether toward self or others)stem from inner turmoil from "stored," collection of painful incidents until we "explode" by wanting to end our life or punish others for our own pain. As James Gilligan, director of the Harvard Center for the Study of Violence, wrote in his book "Violence" that murder was a "symbolic act." Now that neuroscience and brain imaging can track human emotions in real time, we know that emotional pain, empathy, etc. are real ... Ronald Brill, 25 November 2006


Serendip Visitor's picture

Pain neurophysiology: nociceptive, emotional, existential

First, a compliment: when I go to the net to look for some complex existential issue I have been often pleasantly rewarded by something from Bryn Mawr. Existential discussions may not be where the money is, but they are where life is. So, compliments to your school and its students.

To understand pain we must begin with evolution. The neurophysiological systems that now oversee pain - physical and emotional - began long ago. From the vantage point of this heritage we can understand pain.

We use "pain" words to describe both physical and psychosocial events for a reason - they are interrelated. In evolutionary terms nociception (physical pain sensation) carries both structural and existential implications. For example, why do animals (including us) cry out when we have pain? What is the adaptive utility of this? The answer is defense. In pack animals (including us) reporting pain to others (crying out) has the utility of inviting both support and announcing danger.

Further, injury represents psychosocial as well as physical risk. An injured pack animal may not be able to keep up with the pack - and we all know what happens to the stragglers. So, pain is an existential issue also.

Follow this logic to its biology and you will see how pain works in humans. You will see why both physical and emotional anguish are reported in pain vocabulary. Follow chronic emotional pain to the medical clinic and you will see its role in chronic pain syndromes. You will also see why people gain short-term benefits from opioids for emotional pain, and why it leads them to addiction if used as a coping strategy.

St. Exupery said, "More wisdom is latent in things as they are than in all the words men use." Look carefully at actual human behavior from evolutionary and existential perspectives and you will see that to understand pain you must often look beyond what people say to what they don't say.

John P. Barbuto, MD

Serendip Visitor's picture


I asked someone which they think is worse: physical pain or emotional pain. He thinks physical pain is worse. HIs reasoning is he has been hit before and it hurt worse than everything going on "up there". I feel this reasoning is invalid. I looked up articles about emotional pain vs. physical pain and emailed the links to him, and as far as I know, he did not read them. What do you think?

semela's picture


how can i overcome a pain which was caused by myself
because my wife is treating painfully, because i have done
something that i regret it so she punishes me for that horribley

MJ B's picture

Forgive yourself and move

Forgive yourself and move forward. You can't undo the past. You can only attempt to better yourself at the present. As for your wife - that's your problem how you deal with someone who ovbiously can't forgive or let go either.

Michael Chama's picture

Why does it have to hurt?

Why does it have to hurt?

Michael Chama's picture


Is it really reality that each and every person under the sun has to feel pain? particularly emotional pain. Has emotional pain got good results?
What if I do not want to experience any kind of pain, Is it possible not to experience any form of pain in my life?

Serendip Visitor's picture
also article how emotional pain can really hurt...interesting

Serendip Visitor's picture


Interesting article by Scientific American "What causes chest pain when feelings are hurt?"

I too find this topic interesting, as my fiance died 3 years ago and the emotional pain I have suffered literally causes me physical heartache.

wondering too's picture

I've wondered about this so often

So many people walk around wounded from some past heartbreak, emotional pain is so devastating that people are afraid to love again, afraid to be emotionally vulnerable, afraid to even show any emotions. And I am a person who is highly sensitive to having my feelings hurt. I have lived with such a degree of "emotional" pain all my life. It makes me wonder, what purpose does emotional pain serve in our evolution? Why should we even have the capacity to feel emotional pain and why does it hurt so bad?

Is it some element from caveman days where the trait of compassion or empathy or sensitivity to whether other people liked us or not, was so significant to our survival, that the pain had to be serious enough to really get our attention? Of course, people who can't feel compassion or empathy are sociopaths. But why oh why does it have to hurt so bad, be so all-encompassing, and last so long? A hurtful episode suffered 40 years ago, when remembered, hurts just as much today. What is the good of that?

I would definitely separate emotional pain from physical pain. You recover from physical pain. I'm not sure if you ever do recover from emotional pain. Maybe something does change in our brains - maybe my brain was defective in the first place. Thanks for sharing your research. I would love to see more information and answers on this topic.

Serendip Visitor's picture

Holding On To Pain

It is quite fascinating how we tend to allow our minds to focus on thoughts that will sometimes literally inhibit us from making any kind of choices what-so-ever. I believe so strongly in the power of our thoughts. What ever we tell ourselves is truly "so". If we are not liking the path we are on, change the "story", let go of the thoughts that are causing the pain and refocus on ONLY what we want, feeling into it at every moment. This re-training of the brain, is where the "work" comes in. And I mean WORK. We have to be so very consious of our thoughts at every moment. It's amazing when I become so aware of my feeling, as I am thinking and consiously cvhange the thought - like a wand I feel better - mentally and physically. The wizard IS inside each one of us.


Steven Clark's picture

Mental Pain caused by Physical Pain

Most of the literature I've read on the web has to do with how mental pain contributes to physical pain. I have not seen anything on how Chronic intense physical pain can contribute to mental illness. I have a very much loved friend who has been in increasing chronic pain for the last 25 years. Lately I wonder if the pain is contributing to a fall into mental illness. I can find nothing about this.

Anonymous's picture


When even the slightest misalignment occurs in the body's Chakras, pain can last indefinitely, as well as slowing down or stopping the healing process. Certain herbs have been proven to aid the healing process, and also relieve pain to different extents. Using both together properly can have far more benefits than just dealing with the issue at hand. The Third Eye Chakra is responsible for the Endocrine System and Nervous System. If it is thrown out of alignment, it affects the entire body, which affects all other Chakras. There are Chakra Tuning programs on the market right now using sound waves to tune and align the body's Chakras properly, by using the frequencies that the Chakras resonate to in a healthy place of alignment. I tried pain meds for my back injury, and only metaphysical methods made the pain go away, without making me sick, or increasing the pain. Metaphysical methods have no side effects or chances of not working, if done the right way. Tuning them improperly can throw them further out.

Anonymous's picture

Chronic physical pain has to

Chronic physical pain has to affect the sufferer psychologically. How could it not? You cannot get rid of it no matter what you do. I have multiple sclerosis and suffer from chronic pain, which is more or less intense depending on the day. People with MS often have chronic pain, and also suffer from depression. Therefore there is a correlation, but, as with so many medical conditions, actual causation has not been proved. Hope this helps/

harihot's picture

Physical & emotional pain

Books I would recommend are those by John Sarno including The Divided Mind , Scott Brady 's Pain Free in 6 Weeks and Candice Perts Molecules of Emotion.

Belinda N's picture


Such a beautifully written paper, I am ecstatic that I had stumbled upon this. Currently I am writing my Junior research paper, and my topic happens to be pain. Reading your paper has provided a lot of insight for me. Thank you so much for writing it in such terms that a simpleton like me can find meaning. :] And I certainly agree with the others, you have written this paper in a fashion that keeps the reader interested, instead of a factual online textbook. That, or maybe it's the fact that us readers are interested enough in the topic that we may read on because of the topic. I actually think that it's a bit of both. Anyhow, I kudos you for such an amazing paper. :D

Sandi's picture

Releasing Emotional Pain Providers

I am working on providing a location as well as a Holistic Business to assist those who may need a person just to talk to. Not Psychologial Therapeutic, "fix-me", type. No offense to those wonderful folks, But, to assist those that want to vent, talk, express emotions & basically cry.

At this time I provide Physical Therapy as well as Massage. My clientele that I have come to see me, are those that really need someone to just talk,listen,hold & have a shoulder to cry on.

Does anyone have any ideas or suggestions on how & what needs to be done in order to assit those in need besides Volunteering? I have done that as well.

kattella's picture

People hesitate to admit emotional pain.

Even though we can start to understand the effects of pain on emotional and physical responses(too often not both) in our bodies, I think it is important that we all start stressing the similarities. We wonder today why Cancer is so common yet, people are still reacting to emotional pain (smoking, drinking, food, etc.)that results in physical suffering. If we could just take this to an awareness where mental illness and setbacks are not shamed in our society we are then another step closer to healing and cures of these life threatening illnesses that face us.

Anonymous's picture

This interests me for many

This interests me for many reasons, but mainly two.

The first reason is that I have multiple sclerosis, which entails all kinds of strange, what I call "fake pains" - for instance, it feels like my feet are burning, but they're not. *Knowing* that my feet are not *really* burning (as in, standing in a fire) enables me to keep the fake pain under control, albeit still bothersome.

The second reason is that i am a professional anthropologist. It is both work and a calling for me. Having been working for so many years, I have quit my job because I have MS and because I have enough savings to support myself for the duration. In my work I have focused on, among other things, cultural refractions of emotion. How the "same" emotion is expressed in different cultural environments, and is it really the "same"? And does the meaning of an emotion in a particular cultural environment alter the experience of the emotion, and thereby the emotion itself? To what extent does emotional pain transform into physical pain and vice-versa.

Just so many questions.

It seems to me that emotional and physical pain can be distinguished at the extremes, but in the middle, the line between them is blurry. For instance, if I stub my toe, that is indisputably physical pain. But when the man I love walks out on me, that is indisputably emotional pain. But there are times the line is blurred, as when you are both depressed and ill, and you do not know whether the illness brought on the depression, or conceivably the other way round or are they the same thing?

Serendip Visitor's picture

Thank you

Great work! I wholeheartedly agree that the disparity between the medical literature and the common layman is an obstacle we must overcome! I appreciate the hard work you've put into this article; it was very interesting!

Anonymous's picture


hey joseph! im really interested in this too! ive been wondering about this for ages, and at the moment it is really bugging me! i really want to find out more about emotionally caused physical pain, and if there isnt enough research done about it, i want to do the research. thanks for writing this article in such simple terms

Anonymous's picture

heartbreak pain

I am very intrigued with the emotional pain that is best described as a heartache. I've had my heart broken several times and what I've noticed is that it is unbearably painful the first few weeks (more-so the first 3 days)- to the point that I know something physical must be happening in my brain. I am currently researching what science has to say about it. I know the pain I feel is beyond "normal" and can't be controlled just by wanting it to go away. However, I have also found that by working my own 12 steps that I wrote, "recovering from a heartbreak", that the pain will ease quite a bit after about 4 weeks. If I do nothing at all, it last much longer.
On the other hand, the first 3 days there are no steps or tools that can make the pain easier. It's there every waking second and it is unbearable. There are physical symptoms during the first 3 days too. The physical feeling of pure and total emptiness inside you.

Anonymous's picture

Please please, could you tell

Please please, could you tell me where to read your
12 steps "recovering from a heartbreak"? What are the 12 steps, is it the same as Al Anon? Please I need to try this.
Thank you for helping me and all of us.

Serendip Visitor's picture

Couldn't find it anywhere, but this will definitely help ...

Funny as all get out, even if you are still in the puking-your-guts-out stage (my current locale): 12 Steps to Heal Heartbreak,

Just found out that my 2-1/2 year live-in boyfriend, with whom an entire future had been planned and a biz started to fund it, never loved me to begin with and is now in love with another woman to whom he is lying through his teeth when it comes to our relationship. Don't blame her, not her fault.

Oh, I could have my friends and family set her straight, but screw it, that would only hurt her and I gotta move on. Heaven bless Joseph Santini for his article. Finally, someone who makes sense, is not pedantic, is free of platitudes and condescention, and does not write with a patronizing tone.

One article assured me that my ex is hurting, too. 1 - who cares, and 2. are you kidding me? He's acting like a teenage boy with his first love.

Dylan's picture

just to say you ve done a

just to say you ve done a good job there
sort of helped a bit

Jacqueline Sue Celia's picture

Pain and Depression

I really enjoyed reading this. I guess I never "thought" about separating the types of pain that I have dealt with in my own life. Nothing in the world hurts worse that losing a loved one, yet there is no obvious wound that one could put a bandaid on. There is no pain like dealing with child-hood abuse, that haunts you even at the age of 44. It creeps up on you, out of your deepest memories, and when you least expect it, arises to the surface like it happened yesterday. Can't see that on the outside either. You said that depression was a toxic situation built up over time beginning as early as childhood. I do not suffer from depression but agree with what you said. I have become a master at turning those feelings into positive action in order to cope with my own emotions. I am a better parent because of what I went through and more in tune with my own children's emotions and feelings. Sure, I have had physical pain as well. When my oldest daughter asked me if childbirth hurts I simply say, "yes, but it is a pain you quickly forget"!

Anonymous's picture

I'm working on a

I'm working on a concept-analysis of "emotional pain" and would like to find studies done on the topic and any tool that has been developed that measures emotional pain.please respond with any resources.