Touch and Pain

Learning Objectives

  • Explain the receptors that respond to touch
  • Explain the importance of pain and give examples of how expectations and context affect pain and touch experiences.

Touch, Thermoception, and Noiception

A number of receptors are distributed throughout the skin to respond to various touch-related stimuli (Figure 1). These receptors include Meissner’s corpuscles, Pacinian corpuscles, Merkel’s disks, and Ruffini corpuscles. Meissner’s corpuscles respond to pressure and lower frequency vibrations, and Pacinian corpuscles detect transient pressure and higher frequency vibrations. Merkel’s disks respond to light pressure, while Ruffini corpuscles detect stretch (Abraira & Ginty, 2013).

An illustration shows “skin surface” underneath which different receptors are identified: the “pacinian corpuscle,” “ruffini corpuscle,” “merkel’s disk,” and “meissner’s corpuscle.”

Figure 1. There are many types of sensory receptors located in the skin, each attuned to specific touch-related stimuli.

The skin can convey many sensations, such as the biting cold of a wind, the comfortable pressure of a hand holding yours, or the irritating itch from a woolen scarf. The different types of information activate specific receptors that convert the stimulation of the skin to electrical nerve impulses, a process called transduction. There are three main groups of receptors in our skin: mechanoreceptors, responding to mechanical stimuli, such as stroking, stretching, or vibration of the skin; thermoreceptors, responding to cold or hot temperatures; and chemoreceptors, responding to certain types of chemicals either applied externally or released within the skin (such as histamine from an inflammation). For an overview of the different receptor types and their properties, see Table 1. The experience of pain usually starts with activation of nociceptorsreceptors that fire specifically to potentially tissue-damaging stimuli. Most of the nociceptors are subtypes of either chemoreceptors or mechanoreceptors. When tissue is damaged or inflamed, certain chemical substances are released from the cells, and these substances activate the chemosensitive nociceptors. Mechanoreceptive nociceptors have a high threshold for activation—they respond to mechanical stimulation that is so intense it might damage the tissue. Sensory information collected from the receptors and free nerve endings travels up the spinal cord and is transmitted to regions of the medulla, thalamus, and ultimately to somatosensory cortex, which is located in the postcentral gyrus of the parietal lobe.

Table 1. Categories of low-threshold mechanoreceptors*
Identity of receptor Size of receptor* Type of skin where found Speed of adaptation* Adequate stimulus*
Merkel’s disks small, sharp borders glabrous* slow pressure
Meissner’s corpusles small, sharp borders glabrous rapid indentation
Ruffini corpuscles large, diffuse borders hairy + glabrous slow stretching
Pacinian corpuscles large, diffuse borders hairy + glabrous rapid vibration
*Terms:

Adequate stimulus-the type of stimulus that the receptor is specialized to receive and respond to.

Glabrous skin-the hairless skin found on our palms and the soles of our feet. This skin has a higher density of receptors of a more complex range, which reflects the fact that we use these areas of our body to actively explore our surroundings and to discriminate tactile properties of objects we’re interacting with.

Low-threshold mechanoreceptors-mechanoreceptors that respond to stimulus that is so light it doesn’t threaten to damage the tissue around it. high-threshold mechanoreceptors respond to stimulation of higher intensity, and are a type of nociceptor.

Receptive field-the space of skin or tissue in which stimulation will elicit a response in the receptor. Smaller receptive fields make the receptor more sensitive to details.

Speed adaptation-slowly adapting mechanoreceptors continue to fire action potentials during sustained stimulation. Rapidly adapting mechanoreceptors continue to fire action potentials in response to stimulus onset and offset (i.e. to stimuli changes), and help detect stimulus movement on the skin.

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Pain Perception

Life Without Pain?

Imagine a life free of pain. How would it be—calm, fearless, serene? Would you feel invulnerable, invincible? Getting rid of pain is a popular quest—a quick search for “pain-free life” on Google returns well over 4 million hits—including links to various bestselling self-help guides promising a pain-free life in only 7 steps, 6 weeks, or 3 minutes. Pain management is a billion-dollar market, and involves much more than just pharmaceuticals. Surely a life with no pain would be a better one?

Well, consider one of the “lucky few”: 12-year-old “Thomas” has never felt deep pain. Not even when a fracture made him walk around with one leg shorter than the other, so that the bones of his healthy leg were slowly crushed to destruction underneath the knee joint. For Thomas and other members of a large Swedish family, life without pain is a harsh reality because of a mutated gene that affects the growth of the nerves conducting deep pain. Most of those affected suffer from joint damage and frequent fractures to bones in their feet and hands; some end up in wheelchairs even before they reach puberty (Minde et al., 2004). It turns out pain—generally—serves us well.

Living without a sense of touch sounds less attractive than being free of pain—touch is a source of pleasure and essential to how we feel. Losing the sense of touch has severe implications—something patient G. L. experienced when an antibiotics treatment damaged the type of nerves that signal touch from her skin and the position of her joints and muscles. She reported feeling like she’d lost her physical self from her nose down, making her “disembodied”—like she no longer had any connection to the body attached to her head. If she didn’t look at her arms and legs they could just “wander off” without her knowing—initially she was unable to walk, and even after she relearned this skill she was so dependent on her visual attention that closing her eyes would cause her to land in a hopeless heap on the floor. Only light caresses like those from her children’s hands can make her feel she has a body, but even these sensations remain vague and elusive (Olausson et al., 2002; Sacks, 1985).

Pain is an unpleasant experience that involves both physical and psychological components. Feeling pain is quite adaptive because it makes us aware of an injury, and it motivates us to remove ourselves from the cause of that injury. In addition, pain also makes us less likely to suffer additional injury because we will be gentler with our injured body parts.

Generally speaking, pain can be considered to be neuropathic or inflammatory in nature. Pain that signals some type of tissue damage is known as inflammatory pain. In some situations, pain results from damage to neurons of either the peripheral or central nervous system. As a result, pain signals that are sent to the brain get exaggerated. This type of pain is known as neuropathic pain. Multiple treatment options for pain relief range from relaxation therapy to the use of analgesic medications to deep brain stimulation. The most effective treatment option for a given individual will depend on a number of considerations, including the severity and persistence of the pain and any medical/psychological conditions.

Some individuals are born without the ability to feel pain. This very rare genetic disorder is known as congenital insensitivity to pain (or congenital analgesia). While those with congenital analgesia can detect differences in temperature and pressure, they cannot experience pain. As a result, they often suffer significant injuries. Young children have serious mouth and tongue injuries because they have bitten themselves repeatedly. Not surprisingly, individuals suffering from this disorder have much shorter life expectancies due to their injuries and secondary infections of injured sites (U.S. National Library of Medicine, 2013).

Link to Learning

Watch this video of a girl who feels no pain to learn more about congenital insensitivity to pain.

Action Potentials in the Receptor Cells Travel as Nerve Impulses with Different Speeds

When you step on a pin, this activates a host of mechanoreceptors, many of which are nociceptors. You may have noticed that the sensation changes over time. First you feel a sharp stab that propels you to remove your foot, and only then you feel a wave of more aching pain. The sharp stab is signaled via fast-conducting A-fibers, which project to the somatosensory cortex. This part of the cortex is somatotopically organized—that is, the sensory signals are represented according to where in the body they stem from (see homunculus illustration, Figure 2). The unpleasant ache you feel after the sharp pin stab is a separate, simultaneous signal sent from the nociceptors in your foot via thin C-pain or Aδ-fibers to the insular cortex and other brain regions involved in processing of emotion and interoception (see Figure 3a for a schematic representation of this pathway). The experience of stepping on a pin is, in other words, composed by two separate signals: one discriminatory signal allowing us to localize the touch stimulus and distinguish whether it’s a blunt or a sharp stab; and one affective signal that lets us know that stepping on the pin is bad. It is common to divide pain into sensory–discriminatory and affective–motivational aspects (Auvray, Myin, & Spence, 2010). This distinction corresponds, at least partly, to how this information travels from the peripheral to the central nervous system and how it is processed in the brain (Price, 2000).

Homunculus and somatosensory map, showing the areas in the sensory cortex that respond with the greatest sensitivity to touch. Hands, faces, and genitals are particularly sensitive.

Figure 2. The Homunculus: Homunculus means “little man”, and here you see a scale model of the human body distorted to reflect the relative space that body parts occupy in the somatosensory cortex. As you can see, the lips, hands, feet and genitals send more somatosensory projections to the brain than do any other body parts. Figure 2b. Cortical mapping of the sensory homunculus: The body parts are represented in specific locations on the somatosensory cortex. Representations map out somatotopically, with the feet located medially and shoulders and arms laterally to the interhemispheric fissure. Facial structures are represented in a different location to the scalp and head; the face oriented «upside down» with the forehead pointing towards the shoulders.

Pain Is Necessary for Survival, but Our Brain Can Stop It if It Needs To

In April 2003, the climber Aron Ralston found himself at the floor of Blue John Canyon in Utah, forced to make an appalling choice: face a slow but certain death—or amputate his right arm. Five days earlier he fell down the canyon—since then he had been stuck with his right arm trapped between an 800-lb boulder and the steep sandstone wall. Weak from lack of food and water and close to giving up, it occurred to him like an epiphany that if he broke the two bones in his forearm he could manage to cut off the rest with his pocket knife. The thought of freeing himself and surviving made him so exited he spent the next 40 minutes completely engrossed in the task: first snapping his bones using his body as a lever, then sticking his fingers into the arm, pinching bundles of muscle fibers and severing them one by one, before cutting the blue arteries and the pale “noodle-like” nerves. The pain was unimportant. Only cutting through the thick white main nerve made him stop for a minute—the flood of pain, he describes, was like thrusting his entire arm “into a cauldron of magma.” Finally free, he rappelled down a cliff and walked another 7 miles until he was rescued by some hikers (Ralston, 2010).

How is it possible to do something so excruciatingly painful to yourself, as Aron Ralston did, and still manage to walk, talk, and think rationally afterwards? The answer lies within the brain, where signals from the body are interpreted. When we perceive somatosensory and nociceptive signals from the body, the experience is highly subjective and malleable by motivation, attention, emotion, and context.

Cross sections of the cortex, midbrain, medulla, and spinal cord and the pain processing pathways traveling through them.

Figure 3. Pain processing pathways. Left – Ascending pain pathways: An injury is signaled simultaneously via fast-conducting Aα or Aβ-fibres and slow-conducting C-pain or Aδ-fibres. The fast A-fibres signal pressure, stretching and other tissue movements to the somatosensory cortex via the dorsal column nuclei. The C-pain and Aδ-fibres sends pain information from nociceptors in the tissue or skin, and transmits these signals to second order neurons in the dorsal horn of the spinal cord. The second order neurons then cross over to the opposite side, where they form the ascending spinothalamic tract. This tract projects signals to nuclei in the medulla and midbrain on the way up to the thalamus (T). The thalamus relays the information to the somatosensory and insular cortex, as well as cortical regions mediating different aspects of the pain experience such as affective responses in the cingulate cortex. Right – Descending pain modulation pathways: Information from the environment and certain motivational states can activate this top–down pathway. Several areas in the limbic forebrain including the anterior cingulate and insular cortex, nuclei in the amygdala and the hypothalamus (H), project to the midbrain periaqueductal grey (PAG), which then modulates ascending pain transmission from the afferent pain system indirectly through the rostral ventromedial medulla (RVM) in the brainstem. This modulating system produces analgesia by the release of endogenous opioids, and uses ON- and OFF-cells to exert either inhibitory (green) or facilitatory (red) control of nociceptive signals at the spinal dorsal horn.

The Motivation–Decision Model and Descending Modulation of Pain

According to the motivation–decision model, the brain automatically and continuously evaluates the pros and cons of any situation—weighing impending threats and available rewards (Fields, 2004, 2006). Anything more important for survival than avoiding the pain activates the brain’s descending pain modulatory system—a top-down system involving several parts of the brain and brainstem, which inhibits nociceptive signaling so that the more important actions can be attended to.

In Aron’s extreme case, his actions were likely based on such an unconscious decision process—taking into account his homeostatic state (his hunger, thirst, the inflammation and decay of his crushed hand slowly affecting the rest of his body), the sensory input available (the sweet smell of his dissolving skin, the silence around him indicating his solitude), and his knowledge about the threats facing him (death, or excruciating pain that won’t kill him) versus the potential rewards (survival, seeing his family again). Aron’s story illustrates the evolutionary advantage to being able to shut off pain: The descending pain modulatory system allows us to go through with potentially life-saving actions.

However, when one has reached safety or obtained the reward, healing is more important. The very same descending system can then “crank up” nociception from the body to promote healing and motivate us to avoid potentially painful actions. To facilitate or inhibit nociceptive signals from the body, the descending pain modulatory system uses a set of ON- or OFF-cells in the brainstem, which regulates how much of the nociceptive signal reaches the brain. The descending system is dependent on opioid signaling, and analgesics like morphine relieve pain via this circuit (Petrovic, Kalso, Petersson, & Ingvar, 2002).

The Analgesic Power of Reward

Thinking about the good things, like his loved ones and the life ahead of him, was probably pivotal to Aron’s survival. The promise of a reward can be enough to relieve pain. Expecting pain relief (getting less pain is often the best possible outcome if you’re in pain, i.e., it is a reward) from a medical treatment contributes to the placebo effect—where pain relief is due at least partly to your brain’s descending modulation circuit, and such relief depends on the brain’s own opioid system (Eippert et al., 2009; Eippert, Finsterbusch, Bingel, & Buchel, 2009; Levine, Gordon, & Fields, 1978). Eating tasty food, listening to good music, or feeling pleasant touch on your skin also decreases pain in both animals and humans, presumably through the same mechanism in the brain (Leknes & Tracey, 2008).

In a now classic experiment, Dum and Herz (1984) either fed rats normal rat food or let them feast on highly rewarding chocolate-covered candy (rats love sweets) while standing on a metal plate until they learned exactly what to expect when placed there. When the plate was heated up to a noxious/painful level, the rats that expected candy endured the temperature for twice as long as the rats expecting normal chow. Moreover, this effect was completely abolished when the rats’ opioid (endorphin) system was blocked with a drug, indicating that the analgesic effect of reward anticipation was caused by endorphin release.

For Aron the climber, both the stress from knowing that death was impending and the anticipation of the reward it would be to survive probably flooded his brain with endorphins, contributing to the wave of excitement and euphoria he experienced while he carried out the amputation “like a five-year-old unleashed on his Christmas presents” (Ralston, 2010). This altered his experience of the pain from the extreme tissue damage he was causing and enabled him to focus on freeing himself. Our brain, it turns out, can modulate the perception of how unpleasant pain is, while still retaining the ability to experience the intensity of the sensation (Rainville, Duncan, Price, Carrier, & Bushnell, 1997; Rainville, Feine, Bushnell, & Duncan, 1992). Social rewards, like holding the hand of your boyfriend or girlfriend, have pain-reducing effects. Even looking at a picture of him/her can have similar effects—in fact, seeing a picture of a person we feel close to not only reduces subjective pain ratings, but also the activity in pain-related brain areas (Eisenberger et al., 2011). The most common things to do when wanting to help someone through a painful experience—being present and holding the person’s hand—thus seems to have a measurably positive effect.

The Power of the Mind

The context of pain and touch has a great impact on how we interpret it. Just imagine how different it would feel to Aron if someone amputated his hand against his will and for no discernible reason. Prolonged pain from injuries can be easier to bear if the incident causing them provides a positive context—like a war wound that testifies to a soldier’s courage and commitment—or phantom pain from a hand that was cut off to enable life to carry on.

The relative meaning of pain is illustrated by a recent experiment, where the same moderately painful heat was administered to participants in two different contexts—one control context where the alternative was a non-painful heat; and another where the alternative was an intensely painful heat. In the control context, where the moderate heat was the least preferable outcome, it was (unsurprisingly) rated as painful. In the other context it was the best possible outcome, and here the exact same moderately painful heat was actually rated as pleasant—because it meant the intensely painful heat had been avoided. This somewhat surprising change in perception—where pain becomes pleasant because it represents relief from something worse—highlights the importance of the meaning individuals ascribe to their pain, which can have decisive effects in pain treatment (Leknes et al., 2013). In the case of touch, knowing who or what is stroking your skin can make all the difference—try thinking about slugs the next time someone strokes your skin if you want an illustration of this point.

Pain and pleasure not only share modulatory systems—another common attribute is that we don’t need to be on the receiving end of it ourselves in order to experience it. How did you feel when you read about Aron cutting through his own tissue, or “Thomas” destroying his own bones unknowingly? Did you cringe? It’s quite likely that some of your brain areas processing affective aspects of pain were active even though the nociceptors in your skin and deep tissue were not firing. Pain can be experienced vicariously, as can itch, pleasurable touch, and other sensations. Tania Singer and her colleagues found in an fMRI study that some of the same brain areas that were active when participants felt pain on their own skin (anterior cingulate and insula) were also active when they were given a signal that a loved one was feeling the pain. Those who were most “empathetic” also showed the largest brain responses (Singer et al., 2004). A similar effect has been found for pleasurable touch: The posterior insula of participants watching videos of someone else’s arm being gently stroked shows the same activation as if they were receiving the touch themselves (Morrison, Bjornsdotter, & Olausson, 2011).

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Glossary

congenital insensitivity to pain (congenital analgesia): genetic disorder that results in the inability to experience pain
inflammatory pain: signal that some type of tissue damage has occurred
Meissner’s corpuscle: touch receptor that responds to pressure and lower frequency vibrations
Merkel’s disk: touch receptor that responds to light touch
neuropathic pain: pain from damage to neurons of either the peripheral or central nervous system
nociception: sensory signal indicating potential harm and maybe pain
Pacinian corpuscle: touch receptor that detects transient pressure and higher frequency vibrations
Ruffini corpuscle: touch receptor that detects stretch
vestibular sense: contributes to our ability to maintain balance and body posture