title: Investigating the relationship of pain and negative emotions
Creators: name: Rosenek, Norma
Publisher: name: University of Reading
Year: 2022

description: Pain and emotional dysregulation are prevalent conditions in our society that 
impact daily functioning and quality of life. Often, these conditions occur comorbidly 
and exacerbate each other. Underlying neural and behavioural mechanisms 
involved in processing pain and emotion overlap, which formed the basis of an 
ongoing debate on the comparability and phenomenology of pain as a result of 
nociception opposed to social or emotional distress in the absence of nociceptive 
input. Pain modulated by negative emotion is increased, while positive emotions 
have been shown to facilitate pain reduction. Evidently, pain and emotion are 
strongly entwined, and the primary aim of this Ph.D. project was to further the 
understanding of the bidirectional modulatory influences of emotion and pain.
In an attempt to reduce ambiguity around the use of pain scales to express 
emotional distress, Chapter 2 presents findings of two studies on reported pain 
responses following social rejection in the absence of nociceptive stimulation. 
Although half of the participants reported pain despite the option of alternative 
distress scales, one individual described the experience as an injury. Findings 
suggest that pain and emotion appear to overlap particularly on a linguistic level but 
emphasise the need to distinguish between experiences, taking into consideration 
their respective phenomenology (“physical pain” vs. “emotional pain”) to avoid 
ambiguity around self-reported pan in clinical and experimental settings. One way 
that this could be done is by following up with individuals to determine whether self-reports were due to “physical” or “emotional” pain.
Chapters 3 and 4 discuss the effects of treatment approaches to reduce pain and 
negative emotions. In Chapter 3, a lab-based experiment used pain- and affect-focused cognitive reappraisal to reduce self-reported pain and distress and tested 
the effectiveness of cognitive intervention on secondary hyperalgesia (SH), a 
central pain process. Findings demonstrated that cognitive reappraisal successfully 
reduced pain and negative affect, as well as SH, regardless of its focus. These 
findings suggest that a psychological intervention focusing on either reappraising 
pain or emotion may be beneficial, specifically in comorbid clinical populations. 
Future research should further investigate the specificity of cognitive top-down 
modulation of central pain processes through reappraisal or general cognitive 
effort.
A clinically depressed population with comorbid chronic pain received 
antidepressant treatment, as described in Chapter 4. Individuals whose depression 
improved with treatment, reported reduced pain intensity and interference. These 
findings suggest that pharmacological treatment aimed to reduce affective 
symptoms can positively modulate co-occurring pain when mood improves.
Taken together, the findings confirm the bidirectional relationship of pain and 
negative affect and suggest that the modulation of emotions through cognitive and 
pharmacological intervention can reduce pain and its impairment on functioning. 
The work of this thesis contributes to the understanding of mechanisms underlying 
the overlap between pain and emotion and offers several suggestions for future 
mechanistic and clinical research to further investigate cognitive modulation of 
central pain processes and inform treatment of comorbid pain and affective 
pathologies.