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Sticks and Stones – The Psychology

How the brain works

The following article explores the effect words can have on a person and the how it can impact pain levels.

Sticks and Stones – Previous article exploring the subject

Psychology Today
E. Paul Zehr Ph.D. Black Belt Brain

Sticks and Stones Break Your Bones but Words Hurt Your Brain

There’s overlap in how the brain processes physical and emotional pain.

Posted October 7, 2023
Reviewed by Gary Drevitch


  • Pain processing is about detecting imminent damage.
  • Words associated with physical pain can change the perception and brain processing of pain.
  • Brain imaging shows that semantic pain partly shares the neural substrates of nociceptive pain.

When I was a kid my mom used to tell me “sticks and stones can break your bones but words will never hurt you.” She was riffing on a phrase from GF Northall in 1894 but she was also trying to tell me to ignore other kids in school who might say unkind things. She was trying to encourage resilience and mostly succeeded, but words seem to “hurt” also, even when no bones are broken.

Sticks and stones

Do words hurt?
Researchers Eleonora Borelli and her colleagues in Modena, Italy were interested in similarities in the brain’s processing of pain from physical injury and that from words. They extended prior work showing that processing “semantic pain” (e.g. words associated with physical pain) can change the perception and brain processing of pain. They also wanted to relate this to social pain, that “of social exclusion, rejection or loss of significant others.”

In a cohort of 34 women, the researchers studied brain activity using fMRI in two different sessions. The “semantic” session involved “positive words, negative pain-unrelated words, physical pain-related words, and social pain-related words”. The “nociceptive” session related to bodily somatic pain involved mechanical activation of the skin that could be “painful” or non-painful. Subjectively each person rated how unpleasant each condition was.

Words hurt

When examining regional changes in brain activity, words in the semantic session associated with social pain led to increased activity in many of the same areas found for physical pain. The researchers conclude that their results confirm that “semantic pain partly shares the neural substrates of nociceptive pain.”

There is a point to pain
This doesn’t mean that the neural processing of physical pain due to mechanical injury is exactly the same as that from words, but it does suggest that there is overlap and sharing. This results in related effects in how we feel.

This suggests something additional about pain processing. A fascinating thing about physical pain is that it’s a brain-level interpretation of impending tissue damage detected by “nociceptors” relaying in the spinal cord. The point of nociceptive responses is to warn you that something damaging is about to happen or will happen if we keep doing what we are doing. If you accidentally put your hand too close to something very hot, nociceptors in your skin will activate to generate a reflex to pull your limb away before you get burned. The key here is that the receptors help out before injury to prevent damage. This means that many events that are detected are avoided and don’t lead to ongoing damage.

Changing the threshold for pain
I think how we react to pain from words can be related to bodily reactions to pain from mechanical inputs. Many of the things we hear and see that might be insulting or hurtful don’t always have to be experienced at the level of “damage.” That is, we can ignore and be resilient to some things by changing our threshold of reaction in the same way bodily reactions to non-damaging impacts are handled by the nervous system.

When framing the potential effects of words on how we feel this way, we gain some agency over how they can affect us long term. It doesn’t mean to ignore everything and certainly not more serious injuries. I am suggesting we do have the capacity to ignore some things, though, and treat them a bit like our brain treats the little bumps and bangs our bodies experience every day. Not everything that can be reacted to has to lead to lasting damage.

The most important takeaway for me is that this is another example of research clearly demonstrating the fallacy of separating the brain from the body. Humans, like all animals, are integrated, holistic beings. We can easily see a broken bone and infer the real extreme pain that the person must be experiencing. It’s critical to realize that the injuries and pain that a person might have from social experiences are also real.

That old expression, often used to put down feelings, is apt but for a different reason. It really is “all in your head,” but so is the entire universe. All of our experiences, regardless of point of origin, are in our heads. That’s the point of being conscious. It doesn’t matter whether our brains get information from our skin, our ears, our eyes, or our thoughts; hurtful intentions can cause pain. While my mom wasn’t completely correct in using that old saying, her intentions were always helpful and did help manage hurt.

Research Article as a PDF

Words hurt: common and distinct neural substrates underlying nociceptive and semantic pain


Borelli E, Benuzzi F, Ballotta D, Bandieri E, Luppi M, Cacciari C, Porro CA and Lui F (2023). Words hurt: common and distinct neural substrates underlying nociceptive and semantic pain. Front. Neurosci. 17:1234286. doi: 10.3389/fnins.2023.1234286

About the Author
E. Paul Zehr Ph.D., is a sensorimotor neuroscientist and a martial artist of Okinawan, Japanese, and Chinese traditions. His books include Becoming Batman, Inventing Iron Man, Project Superhero, and Chasing Captain America.


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Should You Stop Talking About Your Pain?

Should You Stop Talking About Your Pain?

Getting pain under control starts by talking about it differently—and less.

Posted April 9, 2021 Reviewed by Devon Frye


  • The language we use in both words and thoughts plays a key role in how the brain processes information and produces pain.
  • We often mistake symptoms that occur when the brain senses a threat—including pain—for a disease or disorder.
  • Healthcare providers unknowingly can increase a person’s concern about their health and well-being by using alarmist or hopeless language.
  • Reducing the sense of threat in the brain—and thus the pain itself—can start by simply changing how people talk about pain.

We love to share our struggles with others, get support, and feel understood. That is a good thing, right?

It depends. Talking about pain keeps pain at the center of our attention, which in turn keeps our brain in threat mode. When the brain senses a threat, increased pain may be the result. Luckily, this downward cycle toward pain can easily be stopped.

Why Pain Education Matters

A central part of pain rehabilitation is providing education to pain patients and their families. Chronic pain not only impacts the individual who is hurting, but it also impacts family, friends, and coworkers as well.

Most people share common misunderstandings about chronic pain—they picture that an injury, mechanical problem, or disorder has taken over a person’s life and is producing unmanageable pain. This misconception leads to a great deal of “pain talk.”

Chronic pain sufferers often talk about their pain levels, latest injections, doctor visits, and surgeries. Friends and family ask about sleep problems, medications, treatments, and therapies. Everyone feels bad that so little can be done to manage pain and worries about the wellbeing of the pain sufferer. This is understandable but not helpful.

What “Pain Talk” Does to the Brain

Pain neuroscience education begins by helping people understand the role of language in how the brain processes information and produces pain. As our brain monitors our peripheral nervous system, it is collecting evidence for danger and evidence of safety. The brain weighs available evidence to determine if there is truly a threat that requires it to produce a protective response.

The brain’s protective response might be pain, but it could be any number of rsponses. Common ways the brain says, “Something is wrong,” might be a tremor, non-epileptic seizure, stomachache, headache, dizziness, hives, nausea, blurred vision, muscle tightness, heart palpitation, chest pain, or a muscle twitch.

We often mistake symptoms that occur when the brain senses a threat for a disease or disorder. Chronic pain is often the result of an overactive nervous system that is constantly sensing a threat and producing pain even though pain would provide no help or protection. Chronic pain is thus not necessarily a disease or disorder that can be treated directly with medical intervention.

Healthcare providers unknowingly can increase a person’s concern about their health and well-being by the language that they use when talking with patients. Here are some common medical statements our brain would use as evidence for danger:

  • Your MRI is abnormal.
  • This is the worst case I have ever seen.
  • I am surprised you can still walk.
  • Strong medication hardly seems to touch your pain.
  • You have degenerative disc disease.
  • Your mother had the same problem. It runs in your family.
  • You are going to eventually need more surgery.
  • You need to start using a cane or walker to get around.

These statements are viewed by the brain as evidence for danger. When people have chronic pain, their brain lacks a good collection of credible evidence for safety. They have few reasons to believe that they should not be in pain, few reasons to believe that movement doesn’t cause harm, and few reasons to believe they can learn to manage their pain effectively.

How to Change the Conversation Around Pain

Reducing the sense of threat in the brain can start by simply changing how people talk about pain. The goal of changing how we talk about pain is to get our attention off pain and on to the direction we want to be moving with our life despite pain.

James Hudson, M.D., a chronic pain specialist, provides new chronic pain patients with two simple instructions written out on his prescription pad. He wants pain patients to change how they talk and how they think about pain.

The first prescription is simple: “Stop talking about pain.” People ask pain sufferers about pain all the time, but the pain patient needs to learn to redirect questions to focus on other aspects of life. They might say, “Thanks for asking. I’d rather not talk about pain anymore. I’d be happy to tell you what I have planned for this week.”

The second prescription is similar: “Stop exaggerating about your pain to others or even when talking to yourself.” We often use extreme language when referring to pain, such as, “This pain is killing me,” or “My pain is at a level 12 out of 10 right now.” This type of language only reinforces the idea that there is an extreme threat; when the brain senses there is a threat, it will often protect you by producing more pain.

When patients bring these two instructions home, it takes a while to retrain friends, family, and coworkers. Friends and family are often anxious and worried, which is why they ask about pain. But if the topic of conversation changes, the results are often dramatic. After years of starting conversations focused on their pain, pain patients begin to talk about things that are meaningful, hopeful, and enjoyable. They focus on what they can do, not what they can’t do.

As minor as these changes may seem, the language we use every day affects how the brain views and produces pain. You can start today by telling your friends and family that you appreciate their concern, but it’s time to start a new conversation, one that is focused on growth, hope, and a better future.

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