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      El cuerpo duele, y el dolor social… ¿duele también? Translated title: The body hurts, and what about social pain? Does it hurts too?

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          Resumen

          En este trabajo se habla del concepto de dolor social relacionándolo con el dolor físico, y se hace una revisión profunda sobre su fisiología, vías comunes y diferenciales de procesamiento con el dolor físico, e interacciones entre ambos.

          El dolor social se define como una experiencia emocional desagradable desencadenada al percibirse el individuo como excluido o rechazado por parte de personas o grupos con los que desea relacionarse, lo que produce los mismos sentimientos de sufrimiento que el dolor físico. Se procesa en las mismas áreas cerebrales que el dolor físico en su dimensión afectiva. Puede revivirse mentalmente, aunque la situación conflictiva interpersonal haya terminado hace tiempo. Ambos tipos de dolor son fuentes de estrés. La confluencia en el sujeto de ambos complica y suma más presión a la que ejercen ambos estresores por separado. Esto debe ser tenido en cuenta a la hora de abordar a pacientes con dolor crónico.

          Translated abstract

          This paper studies the concept of «social pain» and its relationship with physical pain. An in-depth review of its physiology has been carried out, including similarities and differences in processing with relation to physical pain, as well as the interactions between both processes.

          Social pain is defined as an unpleasant emotional experience which is triggered when the individual feels excluded or rejected by people or social groups with whom they wish have a relationship. This perceived situation produces the same feelings of suffering as that of physical pain. This kind of pain is processed in the same brain areas as physical pain in its affective dimension. It may be revived mentally, even though the interpersonal conflictive situation may have ended long ago. Both types of pain are sources of stress. The confluence of both situations in the same individual adds complications and more pressure to that which is already exerted separately by both stressing factors. This circumstance must be taken into account when dealing with patients with chronic pain.

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          Most cited references19

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          Why does social exclusion hurt? The relationship between social and physical pain.

          The authors forward the hypothesis that social exclusion is experienced as painful because reactions to rejection are mediated by aspects of the physical pain system. The authors begin by presenting the theory that overlap between social and physical pain was an evolutionary development to aid social animals in responding to threats to inclusion. The authors then review evidence showing that humans demonstrate convergence between the 2 types of pain in thought, emotion, and behavior, and demonstrate, primarily through nonhuman animal research, that social and physical pain share common physiological mechanisms. Finally, the authors explore the implications of social pain theory for rejection-elicited aggression and physical pain disorders.
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            Attachment figures activate a safety signal-related neural region and reduce pain experience.

            Although it has long been hypothesized that attachment figures provide individuals with a sense of safety and security, the neural mechanisms underlying attachment-induced safety have not been explored. Here, we investigated whether an attachment figure acts as a safety signal by exploring whether viewing an attachment figure during a threatening experience (physical pain) led to increased activity in a neural region associated with safety signaling, the ventromedial prefrontal cortex (VMPFC), and corresponding reductions in pain. Female participants in long-term romantic relationships were scanned as they received painful stimuli while viewing pictures of their partner and control images (stranger, object). Consistent with the idea that the attachment figure may signal safety, results revealed that viewing partner pictures while receiving painful stimulation led to reductions in self-reported pain ratings, reductions in pain-related neural activity (dorsal anterior cingulate cortex, anterior insula), and increased activity in the VMPFC. Moreover, greater VMPFC activity in response to partner pictures was associated with longer relationship lengths and greater perceived partner support, further highlighting a role for the VMPFC in responding to the safety value of the partner. Last, greater VMPFC activity while viewing partner pictures was associated with reduced pain ratings and reduced pain-related neural activity. An implication of these findings is that, in the same way that stimuli that historically have threatened survival (e.g., snakes, spiders) are considered to be prepared fear stimuli, attachment figures, who have historically benefited survival, may serve as prepared safety stimuli, reducing threat- or distress-related responding in their presence.
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              Acetaminophen reduces social pain: behavioral and neural evidence.

              Pain, whether caused by physical injury or social rejection, is an inevitable part of life. These two types of pain-physical and social-may rely on some of the same behavioral and neural mechanisms that register pain-related affect. To the extent that these pain processes overlap, acetaminophen, a physical pain suppressant that acts through central (rather than peripheral) neural mechanisms, may also reduce behavioral and neural responses to social rejection. In two experiments, participants took acetaminophen or placebo daily for 3 weeks. Doses of acetaminophen reduced reports of social pain on a daily basis (Experiment 1). We used functional magnetic resonance imaging to measure participants' brain activity (Experiment 2), and found that acetaminophen reduced neural responses to social rejection in brain regions previously associated with distress caused by social pain and the affective component of physical pain (dorsal anterior cingulate cortex, anterior insula). Thus, acetaminophen reduces behavioral and neural responses associated with the pain of social rejection, demonstrating substantial overlap between social and physical pain.
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                Author and article information

                Contributors
                Journal
                Aten Primaria
                Aten Primaria
                Atencion Primaria
                Elsevier
                0212-6567
                1578-1275
                28 December 2019
                April 2020
                28 December 2019
                : 52
                : 4
                : 267-272
                Affiliations
                [a ]Departamento de Enfermería y Fisioterapia, Universidad de Alcalá, Alcalá de Henares, Madrid, España
                [b ]Centro de Salud Nuestra Señora del Pilar, Alcalá de Henares, Madrid, España
                [c ]Centro de Salud Miguel de Cervantes, Alcalá de Henares, Madrid, España
                [d ]Centro de Salud Los Cármenes, Madrid, España
                [e ]Centro de Salud Juan de Austria, Alcalá de Henares, Madrid, España
                [f ]Clínica de Fisioterapia ALFIX, Alovera, Guadalajara, España
                Author notes
                [* ]Autor para correspondencia. yolanda.perez@ 123456uah.es
                Article
                S0212-6567(19)30426-3
                10.1016/j.aprim.2019.10.003
                7118561
                31892425
                9d67564f-4512-42d9-8662-5642c2d486c0
                © 2019 Published by Elsevier España, S.L.U.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 7 July 2019
                : 29 October 2019
                Categories
                Artículo especial

                dolor crónico,percepción del dolor,salud mental,dolor social,chronic pain,pain perception,mental health,social pain

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