Love, Heartbreak and Pain

“We need to talk.” Blood pulses inside your head. “It’s been a good run, but I don’t think things are working out between us, anymore.” While mourning the miserable break up, you sit in your room, download a dating app, and your intestines tingle with butterflies as you swipe right. 

When love leads to heartbreak, then why do we open ourselves to a new relationship as a cure for our heartache? Does love increase or reduce pain? 

In the occasions when love does not lead to a lifelong commitment, it often leads to pain. 93% of students in an American college reported feeling spurned by someone they passionately loved. Researchers have even linked the sensations of heartbreak to the symptoms of withdrawal experienced by drug addicts. Conversely, feelings of enamorament have led people to report decreased symptoms of pain and depression. Then, what explains our proclivity towards infatuation? Might the poison also act as the remedy? 

Why don’t you gut punch me, instead? 

While romantics often associate love with emotional pain, the pain of losing a loved one can show up physically. A behavioural imaging study showed that physical and emotional pain activate the same neurological pathways. 

In a 2012 study from the University of Los Angeles department of psychology, Dr. Naomi Eisenberger scanned the brains of 40 participants who reported feeling ‘intensely rejected’ after breaking up with their romantic partners. Eisenberger conducted the scan under two different conditions: First, she scanned the participants while they observed photographs of their friends and exes. Then, Eisenberger repeated the scan while applying painful thermal stimuli to the participants forearms. 

After observing the participants react to both physical and emotional stimuli, Eisenberger concluded that physical and emotional pain activated three different brain regions: The dorsal anterior cingulate cortex which mediates conflict with senses and sadness, the thalamus which processes behavioural and cognitive sensory input, and the secondary somatosensory cortex which regulates sensory recognition and memory. 

Source: Bernard J Baars Blog (Bernard J Baars, 2019) 

Physical and emotional pain activate the dorsal anterior cingulate cortex, the thalamus, and the secondary somatosensory cortex. 

If physical and emotional pain activates the same affective and somatosensory brain regions, then that explains why love can act as pain regulator. In a follow up study, Eisenberger decided to further gauge the correlation between these different types of pain, by exploring if Tylenol –a common analgesic drug– could also reduce social pain. 

An experimental group took daily doses of Tylenol, while a control group took a placebo drug for three consecutive weeks. Both groups self-reported hurt feelings each evening. Eisenberger also conducted an fMRI imaging scan. In this experiment, Eisenberger concluded that Tylenol reduces hurt feelings, considering that “Tylenol, a physical painkiller, appears to double as a social painkiller.” 

If Tylenol can reduce symptoms of emotional pain, then an amorous split may develop symptoms of physical pain. Couples feel chest aches when experiencing heartbreak because of a rupture of the neurological pathways that connected thoughts of their partners. Eisenberger supports this idea, arguing that people experiencing a forced separation from their beloved can endure symptoms of withdrawal similar to those undergone by drug addicts, since the chemicals secreted during the formation of romantic attachments, such as oxytocin and dopamine, have addictive and exhilarating properties. 

According to Fisher, Xu, and Brown, “like many addictions, romantic rejection can also jeopardize one’s health, because abandonment rage stresses the heart, raises blood pressure and suppresses the immune system.” The link between depression, heart attacks or strokes, abandonment rage, and hypertension gives biological foundation to the physical pain of heartbreak. Stress cardiomyopathy, also known as the broken heart disease, involves a sudden heart muscle failure due to a sudden emotional stress. 

Source: Cleveland Clinic (Cleveland Clinic, n.d.) 

The broken heart disease, or stress cardiomyopathy, involves forceful contractions and sudden heart failure as a result of emotional stress. 

Still, there is some truth to the adage that a new devil helps us forget an old flame. Love can act as a modulator for pain since emotional regulation can lead to a perceived reduction of pain intensity. In the words of Hsu and colleagues, social acceptance increases social motivation and reward, as “dopamine-rich reward areas are also responsible for cravings and addiction.” 

This might explain why people tend to seek validation from a new romantic prospect after their brain severs a dopamine pathway connected to a past romantic attachment. 

Kiss or slap me, but please inject me with dopamine 

When your psychologist recommended love as a cure for heartbreak, they probably referred to self-validation rather than asking an external source to confirm your self-perceived attractiveness. However, love can act as a propeller for emotional regulation and as a powerful coping mechanism. 

Tamam and Ahmad explain that emotional regulation involves an emotional situation that attracts attention and appraisal. This situation arouses a multisystem response involving moods and a reassessment of the self and others. While emotional regulation diminishes pain responses, “heightened awareness and the appraisal of pain can reduce, nullify the effect of or increase pain.” 

An experiment by Master and colleagues measured the pain perception of 25 women in long term relationships. The researchers observed their brain activity in relation to thermal stimuli, showing that either the physical presence of their partners, or their symbolic presence in the form of photographs, acted as love-induced analgesics. 

More than that, these stimuli activated reward brain regions, such as the nucleus accumbens, which mediates motivation, the caudate nucleus which regulates reward and pair bonding, and the prefrontal cortex which modulates social behaviour. These areas are all responsible for dopamine secretion, meditating the neurological pathways of pleasure and reward. 

Source: Wikipedia 

The nucleus accumbes, the caudate nucleus and the prefrontal cortex regulate dopamine secretion. 

More impressive still, the secretion of dopamine can regulate chronic pain. Dopamine acts as one type of monoaminergic pathway. Monoaminergic pathways refer to the routes that the neurotransmitters –chemicals involved in neural communication– use to connect when regulating mood processes. In patients with chronic conditions, “activating different types of receptors, the descending dopaminergic pathways can exert either facilitatory or inhibitory pain-modulating effects.” As many patients with chronic conditions can tell you, emotional pain manifests physically and vice versa. 

Love can cause pain. Love can cure pain. 

Sources

Baars, B. J. (2019). The Great “Cortico-thalamic” System: Bidirectional signaling in cortex. [Photograph]. Bernard J. Baars Blog. https://bernardbaars.com/2019/01/06/the-great-cortico-thalamic-system/ 

Cleveland Clinic. (n.d.). Takotsubo Cardiomyopathy. [Photograph]. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22022-takotsubo-cardiomyopathy#management-and-treatment 

Eisenberger, N. I. (2012). Broken Hearts and Broken Bones: A Neural Perspective on the Similarities Between Social and Physical Pain. Association for Psychological for Psychological Science 21(1). doi: https://doi.org/10.1177/0963721411429455 

Fisher et al. (2016). Intense, Passionate, Romantic Love: A Natural Addiction? How the Fields That Investigate Romance and Substance Abuse Can Inform Each Other. Frontiers in Pscyhology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861725/ 

Hsu et al. (2015). It still hurts: altered endogenous opioid activity in the brain during social rejection and acceptance in major depressive disorder. Molecular Psychiatry 20, 193-200. https://www.nature.com/articles/mp2014185 

Master et al. (2009). A Picture's Worth: Partner Photographs Reduce Experimentally Induced Pain. Association for Psychological for Psychological Science 20(11). doi: https://doi.org/10.1111/j.1467-9280.2009.02444.x 

Nameroff, C.B. & Goldschmidt-Clermont, P.J. (2012). Heartache and heartbreak—the link between depression and cardiovascular disease. Nature Reviews Cardiology 9, 526-539. https://www.nature.com/articles/nrcardio.2012.91 

Tamam, S. & Ahmad, A. H. (2017). Love as a Modulator of Pain. Malaysian Journal of Medical Sciences 24(3), 5-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545613/#!po=86.8421 

Wikipedia. (n.d.). Basal Ganglia. [Photograph]. Wikipedia the Free Encyclopedia. https://en.wikipedia.org/wiki/Basal_ganglia