How to Control Your Sense of Pain & Pleasure
This episode with Dr. Andrew Huberman explores the science of pain and pleasure, their origins in the mind and body, and methods to control their intensity. It covers behavioral tools like hypnosis and pressure, neuroplasticity, and compounds like Acetyl-L-Carnitine, linking them to dopamine, serotonin, and oxytocin.
Deep Dive Analysis
22 Topic Outline
Introduction to Pain and Pleasure Sensation
Dopamine's Role in Motivation and Anticipation
How Skin Sensors and the Brain Process Touch
Magnification of Body Parts in the Brain's Somatosensory Map
Two-Point Discrimination and Dermatomes
Psychological and Biological Factors Influencing Pain Perception
Understanding Cold and Heat Sensation for Better Tolerance
Disconnect Between Injury and Pain Perception
The Power of Vision in Modulating Pain (Phantom Limb)
Whole Body Pain Syndromes and Psychosomatic Phenomena
Pharmacological and Supplement Approaches for Pain Relief
Scientific Mechanisms of Acupuncture for Pain Relief
Hypnosis and Self-Hypnosis for Pain Management
Pressure-Based Pain Relief and Gate Theory
Genetic Basis of Higher Pain Threshold in Redheads
The Link Between Love, Dopamine, and Pain Modulation
Neurochemical Basis of Pleasure and Reproduction
Contextual Control of Pleasure and the Pleasure-Pain Balance
Strategies for Sustaining Pleasure and Motivation Over Time
Immediate, Non-Goal-Directed Pleasure and Endogenous Opioids
The Role of Touch Direction and Arousal in Pleasure and Pain Sensitivity
Synthesis and Conceptualization of Pain and Pleasure
7 Key Concepts
Dopamine
Dopamine is a neuromodulator primarily associated with motivation and anticipation of reward, not the pleasure of receiving the reward itself. It fuels our drive to pursue goals and is released when we expect a reward, dropping back to baseline once the reward is achieved.
Homunculus
The homunculus is a distorted map of our entire body surface that exists in the somatosensory cortex of our brain. Areas of the body with a higher density of sensory receptors, such as the lips, face, fingertips, feet, and genitals, are disproportionately magnified in this brain map, allowing for higher resolution touch sensation in those regions.
Dermatome
A dermatome refers to the specific area of the skin that is mainly supplied by a single spinal nerve. Neurons in the dorsal root ganglia send out many branches to innervate a particular territory of the body, and events impacting these nerves can cause sensations or patterns with sharp boundaries on the skin.
Phantom Limb Phenomenon
This is the experience where individuals who have had a limb or digit amputated still feel as if it is present, often accompanied by extreme pain. It occurs because the brain's somatosensory map (homunculus) for that limb remains, and areas adjacent to it can invade its representation, leading to persistent sensations.
Syndrome (Medical Definition)
In medicine, the term 'syndrome' indicates a constellation of symptoms that point in a particular direction about what could be occurring, but does not necessarily reveal a true underlying disease or a full understanding of the condition. It often signifies that the medical establishment does not yet fully understand the underlying cause.
Gate Theory of Pain
Developed by Melzac and Wall, this theory explains how non-painful input can close the 'gates' to painful input, preventing pain sensation from traveling to the central nervous system. When we rub an injured area, it activates larger A-fibers which inhibit the smaller C-fibers carrying pain information, providing relief.
Periaqueductal Gray (PAG)
The PAG is a brainstem structure associated with both pain and pleasure, particularly in deploying endogenous opioids. It is activated by certain experiences, like sexual activity or childbirth, to increase pain thresholds and induce a feeling of bliss.
10 Questions Answered
Dopamine is primarily the molecule of motivation and anticipation, driving us to pursue goals and engage in effort, rather than being the molecule of pleasure itself.
If warned about a painful stimulus between 20 and 40 seconds in advance, our subjective experience of pain is reduced. However, warnings given just two seconds before or two minutes before can actually make the pain worse due to insufficient preparation time or increased anxiety, respectively.
Cold receptors in the skin respond to relative drops in temperature, not absolute temperature. By getting into cold water all at once, you bypass the gradual relative changes that would otherwise trigger more cold signals to the brain, making the experience feel less uncomfortable.
Yes, our visual perception and interpretation of an injury can profoundly impact the experience of pain, sometimes even overriding the actual physical damage. An example is a construction worker who felt excruciating pain from a nail through his boot, only for the pain to vanish instantly when he saw the nail had passed between his toes without piercing his foot.
Research suggests that electroacupuncture, particularly when applied to the legs, activates a neural circuit that goes to the brainstem (DMV) and then to the adrenal glands, causing the release of anti-inflammatory catecholamines. This anti-inflammatory effect can reduce pain symptoms and potentially accelerate wound healing.
Self-hypnosis modulates activity in the prefrontal cortex and insula, brain areas involved in executive function and interpreting context. This allows individuals to change how they interpret sensations, making painful experiences feel less painful or even not painful at all, effectively rewiring neural circuits for pain relief.
Redheads possess a specific MC1R gene that leads to the production of more endogenous opioids (like beta-endorphin) from a precursor molecule called POMC. These naturally produced opioids help buffer or reduce their perception of pain, resulting in a higher average pain threshold.
Studies show that individuals in new, highly infatuated relationships, characterized by high levels of dopamine, can sustain higher levels of pain. This is because dopamine, associated with motivation and resilience, can modulate brainstem neurons that communicate with organs like the spleen, deploying immune cells to combat inflammation and pain.
Dopamine is more closely associated with the anticipation, motivation, and pursuit of pleasure, while serotonin is more related to the immediate, in-the-moment experience of pleasure and well-being. They often work together, but have distinct primary roles in the pleasure system.
By implementing an intermittent reward schedule, where rewards are not delivered every time, one can keep the dopamine system tuned up. This prevents habituation to constant rewards, preserving the ability to experience excitement and motivation for future efforts.
18 Actionable Insights
1. Use Intermittent Reward Schedules
To maintain high motivation and energy, occasionally and randomly remove expected rewards for your efforts. This keeps the dopamine system tuned for anticipation and sustained pursuit of goals, rather than habituation to constant reward.
2. Practice Self-Hypnosis for Pain
Utilize self-hypnosis for 10-15 minutes a few times a week, or even 1 minute daily, to reinterpret painful events and achieve significant relief from chronic pain. The free Reverie.com app offers guided self-hypnosis scripts for this purpose.
3. Enter Cold Water Quickly
When engaging in cold water exposure (e.g., ice bath, cold shower), enter quickly and submerge up to your neck, including shoulders, and potentially your face. This minimizes the relative temperature drops sensed by cold receptors, making the experience less uncomfortable.
4. Optimal Pain Anticipation Timing
If a painful stimulus is anticipated, aim for a warning period of 20-40 seconds in advance to reduce the subjective experience of pain. This allows for mental preparation without the heightened anxiety caused by warnings that are too short or too long.
5. Apply Pressure for Pain Relief
To alleviate pain from an injury (provided it doesn’t worsen the wound), rub the affected area or apply pressure above or below the site. This activates A-fibers that release GABA, a neurotransmitter that inhibits C-fibers carrying pain signals, thus providing relief.
6. Manage Pleasure for Motivation
To sustain pleasure and motivation long-term, avoid over-rewarding yourself or others for every accomplishment. Occasionally and randomly remove expected rewards to keep the dopamine system properly tuned and prevent a decrease in the ability to experience future pleasure.
7. Understand Arousal and Sensitivity
Recognize that heightened states of arousal increase both your ability to experience pleasure and your tolerance/threshold for pain. This principle applies particularly to highly sensitive body areas like the lips, face, feet, and genitals.
8. Build Pain Threshold Safely
Increase your pain threshold safely through practices like ice baths, ensuring no tissue damage occurs. Leverage top-down modulation by consciously telling yourself the experience is beneficial or a chosen challenge, or by distracting yourself.
9. Leverage Obsessive Love for Pain
To buffer against pain, leverage the dopamine-rich state of obsessive love or infatuation by thinking about your partner. This mental state can modulate pain perception through brain stem interactions with the immune system, increasing resilience.
10. Enter Heat Gradually
When exposing yourself to heat, such as in a sauna, move into it gradually. Heat receptors respond to absolute temperature changes, and a slow transition allows your body to acclimate more safely and comfortably.
11. Visual Context Impacts Pain
Be aware that what you see and how you interpret an injury or event profoundly influences your subjective experience of pain. Your visual perception can dramatically alter the intensity of pain felt.
12. Mirror Box for Phantom Pain
For phantom limb pain, consider using a mirror box to create the visual illusion of the missing limb. Moving the intact limb to a relaxed position can reduce phantom pain by leveraging the visual system’s influence on perception.
13. Acupuncture for Leg/Foot Pain
Consider low-intensity electroacupuncture applied to the legs and feet for pain relief and potential wound healing. This specific stimulation can activate anti-inflammatory neural circuits.
14. Acetyl L-Carnitine for Nerves
Consider oral acetyl L-carnitine supplementation (1-4 grams/day) for chronic whole-body pain or certain acute pain conditions. Evidence suggests it can reduce pain symptoms and improve peripheral nerve health.
15. Agmatine and SAMe for Pain
Explore Agmatine and SAMe (or its precursor 5-MTHF) as non-prescription options for various types of pain, such as osteoarthritis or injury-related pain. Note that SAMe may take up to a month to show its pain-relieving effects.
16. 5-MTHF to Increase SAMe
Instead of direct SAMe supplementation, consider taking 5-methyltetrahydrofolate (5-MTHF) to increase endogenous SAMe levels. This molecule is a precursor necessary for the body to produce SAMe.
17. Low-Dose Naltrexone for Fibromyalgia
If experiencing fibromyalgia or chronic whole-body pain, consult a doctor about low-dose naltrexone. This prescription drug has shown success in treating certain forms of fibromyalgia by blocking TOL4 receptors on glia.
18. Pet Animals With the Grain
When petting animals, stroke their fur in the direction it naturally lies, as this is typically perceived as more pleasurable. This is due to specific neural pathways that respond to the direction of touch.
5 Key Quotes
Dopamine is a molecule of motivation and anticipation.
Andrew Huberman
pain is not an event in the skin, pain is a subjective emotional experience.
Andrew Huberman
anytime you hear or see the word syndrome, that means that the medical establishment does not understand what's going on.
Andrew Huberman
everything is neural whether or not it's pain in your body because you have a gaping wound and you're hemorrhaging out of that wound or whether or not it's pain for which you cannot explain it on the basis of any kind of injury, it's all neural.
Andrew Huberman
the currency of the brain and body has not changed in hundreds of thousands of years, it's always been dopamine, serotonin, glutamate, GABA, testosterone, estrogen.
Andrew Huberman
11 Protocols
Maximizing Motivation (with Dopamine & Pleasure)
Andrew Huberman- Understand that dopamine is released in anticipation of a reward, fueling motivation for work.
- Do not deliver the reward on an expected schedule; instead, make rewards intermittent or almost random.
- Occasionally, after working towards a goal, remove the expected reward entirely, even if the work was successful.
- This intermittent reward schedule will double or triple the amount of dopamine released and the motivation to continue working hard over time.
Getting Into Cold Water
Andrew Huberman- Ensure the cold water exposure is safe and does not pose risks like heart attack.
- Get into the cold water quickly, rather than slowly easing in.
- Submerge your body up to your neck, including your shoulders, for greater comfort.
- If safe and desired, put your face under the water to activate the dive reflex, further easing cold tolerance.
Gradually Acclimating to Heat
Andrew Huberman- Understand that heat receptors respond to absolute changes in temperature, and the body tolerates increases in temperature less safely than drops.
- Move into hot environments, such as a sauna, gradually.
- Find a threshold that is safe and comfortable, or at least within the realm of safety, to avoid hyperthermia and neuron damage.
Plasticity of Pain: Key Role of Vision (Mirror Box Therapy)
Andrew Huberman (referencing VS Ramachandran)- For phantom limb pain, use a mirror box: place the intact hand or limb into one side of the box.
- Due to the mirror configuration, it will appear as though there are two symmetric limbs inside the box.
- Look at the reflected intact limb and move it around.
- As the intact limb moves to a more relaxed position, the patient will perceive the phantom limb relaxing, reducing pain.
Acetyl-L-Carnitine for Pain and Nerve Health
Andrew Huberman- Consider Acetyl-L-Carnitine supplementation, which is available over-the-counter in the US (prescription in Europe).
- Take dosages between 1 to 4 grams per day.
- Consult a doctor to determine if this approach is suitable for your specific condition, especially for chronic whole body pain or diabetic neuropathy.
Agmatine, SAMe, and 5-MTHF for Pain Relief
Andrew Huberman- Consider Agmatine or S-adenosyl-L-methionine (SAMe) supplementation for various forms of pain, such as from osteoarthritis or injury.
- Be aware that SAMe may take up to a month to show pain-relieving effects.
- Alternatively, consider 5-methyltetrahydrofolate (5-MTHF) as a precursor to SAMe, which some companies now offer as a more bioavailable option.
- Always pay attention to specific dosage regimens and treatment durations described in scientific studies for these compounds.
Hypnosis (reveri.com)
Andrew Huberman (referencing Dr. David Spiegel)- Access the zero-cost Reveri app (reveri.com) on Apple or Android phones.
- Choose from a variety of self-hypnosis scripts, many of which are clinically shown to relieve certain patterns of chronic pain.
- Listen to the self-hypnosis scripts, typically for 10-15 minutes a few times a week, or use shorter one-minute sessions to reinforce the effects.
Pressure-Based Pain Relief
Andrew Huberman- When experiencing pain or injury, and provided it won't worsen the damage, rub the source of pain or provide pressure nearby.
- Alternatively, apply pressure above or below the location of the injury.
- This activates A-fibers (larger neurons) that release GABA, which inhibits C-fibers (thinner neurons) carrying pain information, thereby providing relief.
PEA, L-Phenylalanine (Precursor to Tyrosine)
Andrew Huberman- Consider PEA (phenyl ethylamine) supplementation to heighten the perception of pleasure, though its effects are short-lived (around 20 minutes).
- Alternatively, consider L-Phenylalanine, an amino acid precursor to tyrosine, which is upstream of dopamine production.
- Understand that these compounds aim to subtly increase the 'tide' of dopamine and serotonin, making it easier for experiences to evoke pleasure, rather than creating massive artificial peaks.
Controlling Pleasure, Dopamine & Motivation Over Time
Andrew Huberman- Engage in an intermittent reward schedule to keep your dopamine system tuned up and maintain motivation.
- Every once in a while, at random, remove the reward for an accomplishment, even if expected.
- When others are excited about your achievements, try to adjust down your own excitement a little to preserve the ability to experience excitement in various contexts.
- Avoid immediately layering on more dopamine release (e.g., buying something with a monetary reward) to maintain the ability to exert future effort.
Immediate, Non-Goal-Directed Pleasure (PAG)
Andrew Huberman- Engage in experiences that evoke immediate, visceral pleasure, which can activate the Periaqueductal Gray (PAG) area of the brain.
- Understand that PAG activation deploys endogenous opioids, leading to a 'blissed out' feeling and increased pain threshold.
- Examples include sexual activity and the natural processes during childbirth.