Does Humour Increase Pain Tolerance Directly?

In this essay I will discuss the relationship between pain tolerance and humour. According to Woodrow, Friedman, Sieglaub, and Collen (1972), Pain tolerance can be defined as the level at which an individual can withstand pain. I will look into whether humour has a direct influence on pain tolerance, or whether in studies on the relationship between humour and pain tolerance, there are other factors affecting pain tolerance.

Elmali and Akpinar (2017) looked into the effects of humorous videos on pain levels after surgery in patients. Pain intensity was measured before and after watching funny or unfunny videos after surgery. The aim of the experiment was to see if watching a video stimulus affected pain tolerance. In the study there were three groups where the participants were randomised, each with thirty participants and were named groups A, B, and C. Group A watched funny videos, Group B watched unfunny videos, while Group C did not watch any videos. These participants were in the control condition. The Visual Analogue Scale (VAS) (Cline, Herman, Shaw, and Morton, 1992) was used to measure and assess pain in this experiment. Three tests were used in each condition. The first VAS test was performed before watching the video, immediately after watching the video, and thirty minutes after watching the video. In the control group, their pain tolerance was measured twenty minutes after they were first measured as this was the length of the video other groups were watching, and then thirty minutes after the second test.

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No statistically significant difference between the groups pain levels before the videos was found. The second and third measurements were found to be statistically significant. Pain levels among Group C had increased by the third measurement. This shows that the videos Groups A and B watched decreased their pain levels. The third measurement from Groups A and B show that pain increases or becomes more of a focus once the video has ended. To conclude, humour found in funny or unpleasant videos have a positive effect on pain tolerance as it seems as though they help to reduce pain, although only temporary.

A strength of this study is that they used multiple groups in different conditions to see the outcomes of the individual videos. This allows the experimenters to be sure that the different videos are having an effect on individuals when compared to a control group. However, the experimenters cannot eliminate individual differences and so this may become a confounding variable to this research. The experimenters could have used a matched pairs design in this research to eliminate individual differences as much as possible, such as matching participants with the same pain levels. This would ensure that the experiment was more valid. As this study involves participants reporting their own pain levels, care should be taken to remove experimenter bias or social desirability bias. These would affect the answers of the participants, without intending to, and so results may not be reliable.

A literature review by Pérez-Aranda et al (2018) looked at the link between humour and pain. Forty-one studies were reviewed in total and separated into three categories; chronic pain, experimental pain, and pain in children.

In the experimental section they found support for the theory that funny distractions, such as watching humorous videos, increases pain tolerance. However, most studies also found that unfunny distractions also give the same effect on pain tolerance. In the chronic condition they found that humour has been found to be a way of coping with the pain and emotional strain that comes with a chronic illness. Humour and main symptoms of chronic illnesses such as anxiety, have been found to have a significant correlation. As for pain in children, there were similar findings to the other two conditions. Having clowns on a children’s ward promoted emotional wellbeing but it is not clear cut whether the relationship between humour and pain reduction in children is significant. This studies’ findings suggest that it is the distraction that comes with humour that helps with their pain, rather than the humour itself.

Weisenberg, Tepper, and Schwarzwald’s 1995 study looked into using humour as a cognitive technique to increase an individual’s pain tolerance. Distraction has been found to increase pain tolerance, and newer research has shown that humour and laugher may also have an effect on dealing with pain and stress. This study aimed to see whether it was distraction or humour that helps with pain tolerance specifically. In this study there were four groups of twenty participants. Each group watched either a funny film, a repulsive film, a neutral film, or were not shown a film at all. A cold pressor pain stimulation (Mitchell, MacDonald, and Brodie, 2004) was used to measure pain in this study.

The groups that watched the humorous or repulsive films showed a significant increase in their pain tolerance when compared to other groups. However, the group who watched the repulsive film actually had the largest increase in pain tolerance, as opposed to humour. This study also therefore suggests that it may be a distraction rather than humour that increases pain tolerance.

As with the aforementioned study by Elmali and Akpinar, this experimental design allows them to see that their video stimuli are having an effect on the participants, but would be more reliable if a matched pairs design was used to allow for individual differences, which is quite important in a study looking at something as subjective and individual as pain perception. As this study relies on participant feedback, care should have been taken to eliminate experimenter bias or social desirability toward answers as much as possible.

A study into pain perception in children by Stuber et al (2009) carried out cold pressor trials on children before watching a funny video, after watching a funny video, and whilst watching the funny video. The children were asked to rate how funny they found the videos as well as how painful the cold pressor test was, meaning they also had an idea of the subjectivity of the child’s humour.

As found in previous experiments, funny videos were found to increase pain tolerance for a moderate volume of pain. A significant difference was found between the baseline (before watching the video) and while watching the video, but there was not a significant difference found between baseline and after watching the video. This implies that humour does help with pain tolerance as there was a difference found while the children were watching the videos, but may only be a temporary effect as there was no significant difference after the children had finished watching the video. Again, this may be because it is distraction that helps to deal with pain, rather than humour.

As this study dealt with children, it may not be as valid as other studies due to the vulnerability of children. They generally tend to be more affected by experimenter effects and so extra care should be taken in the review of this study, appreciating that the children’s ratings may not be truthful.

To conclude, the overall findings of these studies suggest that while humour does have an effect on pain tolerance, it seems to be temporary or based on distraction rather than humour itself. All studies showed that pain tolerance increased when watching a funny video, but this was also the case with unfunny videos. As these were compared with neutral or control groups it shows that distraction instead of humour may increase pain tolerance. However, a reduction in pain and an increase in pain tolerance could be seen different variables, and so this should be applied to future research to allow for the differences. Though there is evidence that indicated humour does have a positive effect on pain tolerance, it cannot be said that humour alone has a direct effect on pain tolerance.

References

1. Cline M E.; Herman, J; Shaw, E R.; Morton, R D (1992). Standardisation of the visual analogue scale. Nursing Research. 41(6), 378-379.
2. Pérez‐Aranda, A; Hofmann, J; Feliu‐Soler, A; Ramírez‐Maestre, C; Andrés‐Rodríguez, L; Ruch, W; Luciano, JV (2018). Laughing away the pain: A narrative review of humour, sense of humour and pain. European Journal of Pain. https://doi.org/10.1002/ejp.1309
3. Mitchell, L A; MacDonald, R A R; Brodie, E E. (2004). Temperature and the cold pressor test. The Journal of Pain. https://doi.org/10.1016/j.jpain.2004.03.004
4. Stuber, M; Hilber, SD; Mintzer, LL; Castaneda, M; Glover, D & Zeltzer, L. (2009) Laughter, Humor and Pain Perception in Children: A Pilot Study. Evidence-Based Complementary and Alternative Medicine. 6(2) 271-276. https://doi.org/10.1093/ecam/nem097
5. Weisenberg, M; Tepper, I; Schwarzwald, J. (1995). Humour as a cognitive technique for increasing pain tolerance. PAIN. 63(2) 207-212. https://doi.org/10.1016/0304-3959(95)00046-U
6. Woodrow, K M; Friedman, G D; Siegelaub, A B; Collen, M F. (1972). Pain tolerance: Differences according to age, sex and race. Psychosomatic Medicine. 34(6) 552.