“I have a high pain tolerance” may be one of the most common phrases used to describe a pain experience. I am guessing you have heard it numerous times and have developed an opinion about it. Among healthcare providers it may be perceived as an annoying declaration. A let it go in one ear and out the other kind of saying. The last time you heard it and how did you respond? Smile on the inside, get frustrated saying to yourself “not again”, roll your eyes, nod intently, or talk about it with your co-workers over lunch?
I have heard this phrase several times recently and for some reason it spiked my curiosity. Why is it used frequently and by so many during healthcare visits? Is there is a deeper meaning within these words? Here are three possible explanations for why someone might say, “I have a high pain tolerance”.
A Coping Strategy
Coping strategies are cognitive and behavioral approaches that can aide in dealing with, and overcoming, stressful events (here). Effective coping strategies differ from person to person and are best reflected in the individual functional abilities within a persistent pain population. While one person may be relegated to immobility and depression, another may demonstrate high levels of function at home, in the community, and at work despite the pain. I think this may be the number one reason the “high pain tolerance” phrase is used so often. These words may enhance cognitions and promote practical behaviors of an ideal self or hoped for reality that urge life forward in the midst of a struggle.
When I think of validation I imagine a boy who fell and scraped his knee. He runs to mom for a comforting kiss and thirty seconds later he is in the back yard playing again. He needed mom to know he was hurt and get her loving approval that it would all be ok. Viewing validation in regards to communicating pain is examined here. I think it is harder as an adult to find validation when something hurts. Patients seeking validation from a healthcare provider may use the “high pain tolerance phrase” as a way of communicating a perception that the pain is real, significant, and limiting; without necessarily asking for help or admitting that they need someone else’s help to get better. The above linked study introduces validation by noting “Marsha Linehan, a key validation theorist, suggests that validation is a process in which a listener communicates that a person’s thoughts and feelings are understandable and legitimate.” The article goes on to say, “Though validating thoughts and feelings does not mean that the person validating necessarily agrees with the speaker’s perspective. For example, when responding to someone who has chronic pain, validation may include conveying acceptance and understanding of pain-related thoughts and feelings without encouraging potentially maladaptive behaviors e.g. It must be frustrating to have so much pain, I wonder how you will be able to manage your activities.”
The paper concludes that validation may or may not be an effective form of therapy to improve function and treat pain. Though I expect that when someone claims a pain tolerance is high there is some degree of validation-seeking at play.
Sign of Positive Affect
Positive affect refers to a feeling state that may be characterized by pleasant moods or emotions that instill a sense of relaxation, contentment, or serenity (here). This one may be a little out there, but the more I thought about it the more it seemed to make sense. Saying to oneself “I have a high pain tolerance” may in fact instill a sense of positive affect about a current painful state. Verbalizing the perceived self as strong, stoic, persevering and resilient may be a method of shifting the internal state of wellbeing toward the positive. The above paper points out potential benefits of an induced positive affect may include lessening nociceptive sensitivity and modulating central pain networks. Say something enough times and it becomes a reality. Maybe saying “I have a high pain tolerance” induces the pain mediating effects of positive affect?
And the point is……..
Next time you hear these notorious words think again.
What is this person trying to convey and is it useful to help improve function? Can these words be used to leverage a better functional outcome by digging a bit deeper?
Never forget that all pain is real and every person’s pain is individually unique. The words used to describe a pain experience are noteworthy and often have an important meaning. Becoming a better clinician means continually looking for new ways to improve and interact with patients. I think I have ignored this phrase about a high pain tolerance for too long and am excited to examining this phrase more in the future.
I am interested in hearing from you. Why do you think the expression “I have a high pain tolerance” is used so often?