Saturday, September 17, 2011

The Phenomenology of Pain During REM Sleep


Have you ever felt pain in dreams? I have. Once I dreamed I was lying on my stomach, getting a tattoo on my calf against my will. Because it was a particularly malevolent tattoo studio, I cried out in the dream. When I woke up, I felt no pain at all. It was false, a figment of the Pain Matrix. Another time a monkey bit me on the arm. Once again, the pain vanished upon awakening.

I think these examples of what I'll call "fake pain" are unusual. More common are instances when you get a calf cramp or have pins and needles in your arm while sleeping, and this real life pain gets incorporated into dreams about tattoos or monkey bites. But even these possibilities have been discounted as unlikely, because of limitations on which sensory modalities can be represented in dreams (Nielsen et al., 1993):
One possibility is that pain is beyond the representational capability of image formation processes -- that neither pain memories nor pain images are reproducible in the dreaming mode. A second possibility is that the sensory systems that might contribute to the representation of pain imagery are not functional during dreaming. This possibility is consistent with the finding that the high threshold polysynaptic afferent fibers that conduct pain sensations are actively inhibited during REM sleep in cats.
But plenty of people have reported feeling pain in dreams, so why construct hypotheses about why it's impossible? So skeptics Tore A. Nielsen and three fellow psychology graduate students, along with an undergrad art therapy student, conducted experiments on themselves in a 1993 paper. They inflated a blood pressure cuff above the knee of their colleagues 5 min into a bout of REM sleep1 [to produce ischemia of the leg muscles, i.e. pins and needles or paralysis].

Results indicated that pain sensations occurred in 13 out of 42 stimulation trials with usable dream reports (31%). In contrast, only one of the 21 non-stimulated control dreams contained a reference to pain (4.8%). Many of the dreams were realistic and took place in a sleep lab-like setting. Others were more fantastic; one was set at a rodeo, another at a dance party in a barn [the authors lived in Montreal]. Some were lucid2, like the "ugly shoe" dream:
I'm in a small store trying on a pair of ugly shoes. I started walking. Then I staggered forward because I was waking up and not fully conscious. You were laughing at me. I said "come on, its not funny, I'm trying to wake up!" This is the second or third time I've been trying to wake up.
Some of the participants were more likely to experience pain dreams than others. Subject B, who reported pain dreams on 70% of the stimulation trials, had knee surgery a few years prior and still felt numbness or tingling sensations on occasion. Most of the time, the pain sensations occurred in the appropriate leg for all participants. Interestingly, the "crampy pressure", "tingling", or "hurting a bit" sensations felt upon awakening were much less intense than those that occurred during the dream.

When interpreting these subjective reports, one has to consider an expectation or priming effect, since all the students were focused on dream research, with extensive experience in the sleep lab. However, this was not the case in a study of 28 hospitalized burn patients (Raymond et al., 2002). Obviously, the severity of suffering in burn patients is intense and chronic, unlike having temporary "pins and needles" in your leg. Over a period of 5 days, pain dreams comprised 30% of all reported dreams, which is quite comparable to the artificial BP cuff study. The patients who reported pain dreams (39%) had more nightmares, worse sleep quality, and more post-traumatic stress symptoms. The other 61% of the patients did not have any pain dreams. Why?

What sort of neurophysiological activity can account for painful sensations that are experienced during REM sleep? We'll find out in the next post.


Footnotes

1 It wasn't clear how they monitored for REM, since EEG methods were not described. However, the transcript of one dream suggested that EEG was in fact recorded:
Then I was trying to get comfortable on the bed. All the electrodes but one for the EEG had fallen off; the others were dangling free.
The dream transcript continues:
You said that this was too bad. I had tossed around in bed trying to get comfortable. It was really cold and hurt my backside. There was almost no mattress; I was on a board. I was saying to you that we had hit rock bottom in this bed.
The interesting part about this segment is that there was no BP cuff applied; out of 14 dreams this was the only one without external stimulation (kind of like my "fake pain" dreams).

2 The subject was aware they were dreaming and tried to control the action.


References

Nielsen TA, McGregor DL, Zadra A, Ilnicki D, & Ouellet L (1993). Pain in dreams. Sleep, 16 (5), 490-8 PMID: 7690981

Raymond I, Nielsen TA, Lavigne G, Choinière M. (2002). Incorporation of pain in dreams of hospitalized burn victims. Sleep 25:765-70.


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35 Comments:

At September 18, 2011 12:14 PM, Blogger Neuroskeptic said...

Interesting. I believe these studies, but in my dreams, physical pain is the one thing I never get. I get all of the emotions, I've been thirsty and (I think) hungry, etc. but never suffered pain.

 
At September 22, 2011 2:39 AM, Anonymous Matthew said...

Really interesting post, I hadn't thought about dreams as examples of non-physical pain.

I've done some experiments using hypnosis to induce an experience of pain in the absence of a physical stimulus and we found that it leads to similar activation of the pain matrix to 'real' pain. I also found a patient with PTSD who had flashbacks of pain during psychological treatment.

I'm not sure how unusual these 'fake pain' experiences are either. Osborn & Derbyshire (2010) found that 1/3 of participants in their study experienced an actual noxious somatic experience when they viewed images of unpleasant injuries.

 
At September 25, 2011 1:51 AM, Blogger The Neurocritic said...

Matthew - Thanks for the links to your very interesting work.

 
At December 20, 2012 4:42 AM, Blogger Ahmed Chowdhury said...

Very interesting .....
I often feel pain in dreams just this early morning i had a dream i was being stabbed in the hand repeatedly and i could clearly feel it , as usual though once i awoke the pain was gone .

 
At January 04, 2013 6:14 PM, Anonymous Anonymous said...

Really, this is interesting but sometimes I dream of being hurt in many different ways! I know that sounds kind of morbid! My problem is the pain I feel doesn't go away when I wake, I actually have to wait til I realize I was dreaming before the pain stops!

 
At January 21, 2013 8:37 PM, Anonymous Anonymous said...

Very real occurrence, regardless of what the "experts" say. For years I have suffered terrible (non-recurring) nightmares. I have experienced excruciating pain in my dreams, most recently (last night) in my right knee, which has never been injured in any way. The pain startled me awake, and upon waking, the pain instantly vanished. I was left searching my bed for anything that may have bitten me or caused such a senstation, nothing. No marks on my knee, just - nothing. I am proof such a condition exists, and to the skeptics, I can only hope one day you can experience the same level of distress this can cause, particularly when you can't wake up....

 
At March 29, 2013 7:13 AM, Blogger Steve Eidson said...

Just last night, I dreamt of an alien invasion situation. My daughter was with me, and a bunch of other people, who I didn't know. We were surrounded and couldn't go anywhere. It turned into a farming situation. People were rising into the air at random times. When it was, "my turn", I felt a sharp pain in my spine while ascending towards, what I imagine to be this alien space ship. I woke up, and the pain went away. There are no marks on my back.

 
At March 31, 2013 2:05 AM, Anonymous Anonymous said...

What about emotional pain? My fiance and i broke up. And every night i dream of immense sadness as well as physical pain. (Last night i was shot twice!) Then i wake up at exactly 7.34am and throw up! Is that beyond weird? This has been happening for the best part of a year.
Katie.

 
At May 12, 2013 10:50 PM, Anonymous Anonymous said...

What i remember of my dream was talking to a man with lots of tattoos down his neck and arms. Everything was just fine no unhappy emotions more of a pleasent feeling; then he put his hands on my neck not in a choking motion but more like a stabing with his fingers. I felt intence pain and felt parolized. Couldnt talk. Then some how i got him to move off me but not for long he then moved to my stomach where again i felt pain, parolized, but not just there it was back in my neck which along with the pain and parolization i felt like i couldnt breathe.. i didnt know i was dreaming but other than pain it didnt feel real either. I finally woke to minor aches that after 8-10 mins went away.. maybe not fully away but barely there now. I have no injuries to neck or stomach. I have felt before in other dreams pain that felt like pressure to curtin bady parts and even needles or bites.. dont remeber the dreams just the pain it had caused. Dont really want to sleep now cuz i dont want to feel that again..

 
At May 20, 2013 11:36 PM, Anonymous Anonymous said...

Last night I dreamed that a monkey bit me on my lower right leg just above my ankle. I can remember vividly the gruesome image and the reaction of others in my dream because it was a deep injury ,very painful and caused me to limp. I woke up in pain, grabbing my leg. Yes, I have several health issues and I'm no stranger to pain or sleep issues or odd dreams. However this extremely severe nerve pain is new and lasted all day. I find the brain, dreams and pain very interesting. Found this site while searching the web and thought I'd share.

 
At June 07, 2013 6:15 AM, Anonymous Anonymous said...

I had the craziest dream tonight! A boy ran in my direction with a big knife and stabbed me in the back through my spine. I felt the WORST pain of all my life! I could actually feel my flesh being dilacerating! it just lasted some seconds because I started to contorce myself and woke up. Right away the pain was gone... I was afraid of touching my back then thinking the dream may have been caused by a real wound, but there was nothing. crazy... I never felt it before. I dreamt with shots, wounds etc before, but I felt no pain... Today was REAL.

 
At June 21, 2013 7:07 AM, Anonymous Anonymous said...

Can anyone help me i dream the same dream a hundred times in a nite about trying to find my family in a city i dont know to take me to the hospital to have an op on my shoulders..i cant find them and my brain and the pain tells me if i dont find them soon il b in agaony and the pain in my shoulders gets worse...i wake up...feeling like ."thankgod thats over"...its driving me crazy as the pain is so real...ihave a certain same dream for months and then it will change to another annoying dream for 6 mnths...im going crazy

 
At August 21, 2013 7:44 PM, Anonymous Anonymous said...

Let me get this out of the way. I never really "dream" I never have happy, sad, emotional dreams. It's always nightmares. And most the time I feel the pain.

I have had pain dreams. And wake up in pain. I have been dealing with medical physical pain for quite a few years now. And random dreams where I get hurt like my back I wake up with my back hurting. My backs still been buggin me all day. This will be the 3rd night I've had back wounding dreams. And waken up in pain with my back.

The other night I had a dream where it was like Jurassic Park Era (this dream was fantasy obviously). Me and a few people who I didn't know went into this greenhouse. It was so vibrant with colors and flowers and greenery it was beautiful. But not until long. This huge. I mean HUGE spider like dinosaur spider came out. She was like a big spider from Harry Potter movies (Just to give ya'll an example) And she wrapped her web around my body. I couldn't move. And She used her lil pinchers by her mouth and started eating my back. Everyone just stood there watching as she feasted on my back. I was crying in the dream screaming in pain. I woke up with my entire back still hurting.

Last night I dreamed that a guy (now this dream was realistic) This guy I didn't see his face or anything. But he was chasing me and I was running. I had no idea what for. But I was trying to run so fast. He ended up throwing a knife or a hatchet of some sort. Into my spine. I fell down. My back hurting with excruciating pain. I woke up with my back still in pain.

Hopefully even though my back is still in pain. I don't have no more nightmares. Tired of feeling pain twice specially while I'm trying to rest. This last week has been pretty bad. I just want sleep :(


Found this site when I was looking up why I was dreaming of pain and waking up in pain. Just thought I'd share a few dreams. Hopefully happy dreaming everyone.

 
At October 08, 2013 3:33 PM, Blogger Gill Pinch said...

Last night I had another recurring dream where in it my boyfriend is squeezing me so tight round my waist that it is agony, hurts so much I want to scream or push him away but can,t utter a sound, feels like a kidney is being crushed, when I manage to wake the pain slowly subsides but I,m left crying and rubbing my side. These dreams only happen when I,m actually sleeping with my boyfriend, we,'ve discussed them and can only come up with that he might have his arm over my waist while sleeping. I don,t sleep as well with anyone else in my bed, but just hope these dreams don,t keep recurring as the fear inspired by the strength of the pain is pretty bad. Sweet dreams all!

 
At October 29, 2013 7:35 PM, Anonymous Anonymous said...

I had a dream last night so I researched it and found this website blog...
I had a dream that I had the most excruciating deep nerve pain in my lower spine. when I woke up I realized it was just a dream. It was a very long dream.

 
At December 28, 2013 10:54 AM, Anonymous Anonymous said...

I had a really weird graphic dream last night, my rib bones were puncturing my skin and pointing straight forward and it hurt like something I've never felt before never ever existed. I tried pushing my ribs back under my skin back in to place, and I did but one of my ribs wasn't sitting properly inside my chest I tried to push it down but it felt like it hit my lung and I couldn't breath. This went on for what felt like 10 minutes and then I woke up. I've never experience pain in my dream before last night. Is it likely that this will this happen more often now?

 
At March 16, 2014 5:45 PM, Anonymous Anonymous said...

I have been feeling pain in my dreams for as long as I can remember. Most of the time the dream scenario is one where pressure is applied continuously e.g. something is latched on to me with its teeth (dog, alligator, small child etc), an appendage is trapped between two objects or my whole body is being crushed, or objects/creatures are slowly driven into my body. I also once dreamed I was hanging from a cliff in the snow, and the pain in my hands from the cold was excruciating. In all scenarios the pain starts off bad but intensifies further until it gets so unbearable I wake up. It usually disappears upon waking, although once I dreamed someone was crushing my solar plexus with their fist and the pain was unbelievable and there was a lingering dull ache when I awoke. It's very rare these days that I'm in a situation where I actually feel pain but as a child I would often experience pains resulting from applies pressure - I'm the youngest of three boys :) - so I can't help but wonder if my brain is recreating these pains from memory. I also once dreamt about being shot, but the pain was not at all intense or very realistic for the scenario and I wonder if my brain struggled to simulate such a pain because it's something I've never experienced before. Pain in dreams is very real, although it does seem to be very rare.

 
At April 19, 2014 4:49 PM, Blogger Nataly Richardson said...

Just last night I had a dream where I got hit in the leg and got a deep gash and when I woke up my leg still hurt. My husband told me I was whimpering while asleep.

 
At April 20, 2014 1:48 PM, Anonymous Anonymous said...

I also experienced pain, I was stung by a bug in my left hand and the pain was horrendous,

 
At May 08, 2014 1:45 PM, Anonymous Anonymous said...

I have similar experiences. I just dreamt that I was shot by an FBI agent accidentally. The pain was horrible, in my left shoulder, right upper thigh, and lower right leg. I was unable to vocalize anything in my dream, but remember thinking, "You stupid idiot!". It's like I was screaming to the top of my lungs, but only whispers were coming out. I awoke feeling pain and in emotional distress. I had been crying, and the pain in my leg lasted for approximately 30 minutes, although not nearly as severe as it felt in my dream. My actual sleep position was in a reclined position. I have terrible nightmares similarly 2-3 times a week. 30 year-old female.

 
At May 19, 2014 11:43 PM, Anonymous Anonymous said...

I am the exact same way! !!

 
At May 20, 2014 7:38 AM, Anonymous Anonymous said...

The dreams are not real, but the pain certainly is. Had a dream recently where I was walking in a store and all my joints started to hurt and began to fall apart. I was in very real agony inside the dream. I was going around looking for medicine I could buy in the dream store to stop my pain. Of course it was gone when I woke up. My real joints are just fine.

I also have dreams of being killed in different ways. I feel the pain from those as well.

 
At May 28, 2014 3:10 PM, Anonymous Anonymous said...

You guys are thinking to much, your brain just creates the pain, the pain doesn't have to be there. For example, last night I just had a dream of call of duty in real life where you would respawn if you died, my friend had a big maybe half a meter sword but it was dull like an over sized letter opener. Basically I got stabbed by this sword 3 times missing all my vitals and making me think I just want this to be over because it was the most excruciating pain you could imagine. When I woke up I could still feel the pain in the exact spots I was stabbed. It went away after about 3-4 mins, it was like my mind hadn't fully waken up yet and realized those wounds weren't real. Anyways thought I'd share my experience.

 
At June 04, 2014 5:10 AM, Anonymous Anonymous said...

Uhm. You probably need to see a professional about that.

 
At June 12, 2014 1:46 PM, Blogger Victoria Childress said...

I had a dream about a week ago where my leg snapped in half. Of course in the dream the pain was excruciating. When i woke up i still felt the pain. Even though its been a week i still have pain in the exact part of my leg where it "snapped" and it hurts so bad tothe point that i want to cry when i walk. What does this mean?

 
At June 12, 2014 3:59 PM, Blogger The Neurocritic said...

Victoria - Have you seen a doctor yet?

 
At June 20, 2014 9:06 AM, Blogger Christian Fairall said...

Is there any reason for the absolutely unbearable and intense pain I've been getting lately? For example, just last night in my dream my back hurt SOOO bad that I could not move and I had to lay down because it hurt so bad so I was just laying there in suffering. Another time, I jumped off a high place in the dream and it felt like my joints were rubbing together really hard after that and, again I had to lay down. This is interesting because my dad has severe neck pain and whenever his neck starts hurting he has to go lay down in his bed for a while because he can't deal with it. Dreams are weird but the pain in my dreams is almost inhibiting my sleep because I'll wake up from it being so unbearable and it sucks because my REM sleep prior to these pains I've been experiencing were always so pleasant.

 
At June 23, 2014 8:20 PM, Blogger Elise McCurdy said...

6 - 23 -2014

My dream was just yesterday night. I had a dream I was falling from some great height. I then came to my end and SMASHED into a brick wall face down. When I woke I had a terrible pain in my head. There was a bruise already forming in the exact same spot I hit on the brick wall. Can anyone tell me how this happened?

 
At July 22, 2014 1:53 AM, Blogger Sven Golly said...

I don't see why it is so hard to believe that we can feel pain in dreams, whether caused by outside influences or by our brain activity. If we can't feel pain in dreams then should we be able to feel pleasure as well? How are pleasure centers of the brain allowed it function normally during dreams, to the extent of orgasm, and yet pain is not? This would seem to be a contradiction. Could our being able to feel during our dreams be a survival instinct? If most people during REM sleep are essentially paralyzed, would not being able to feel pain be an significant benefit if you were being attacked. I believe there is more of our ancestors survival skills in us than we know. Do those that feel pain in their dreams make better soldiers? I just had a dream about being bitten in the shoulder and woke up with a dull ache in the same location but no reason for the pain. I like to say "the mind is a terrible thing".

 
At August 14, 2014 2:45 AM, Anonymous Varalai said...

Ok just had a dream that I've never had before. I'm with my family at a lake home (never seen it before) my dad hands me an antique zippo lighter after he's lit a cigarette of which I can smell, was confused my mom let him smoke in the house. I set down my unopened can of Pepsi to look at the lighter, my sister tries to use it to light her cig but it spews the lighter fluid so she drops it on the carpet. We try putting it out but since the top is open it keeps re lighting so I reach down to try and close it. I pick it up because at first it doesn't feel as hot then a second later it intensifies burning my hand so I also drop it. When it falls this time the fire goes out so I use my shirt to pick it up and set the top straight to close it. I reach back for my can of pop because it's cool and I want to use it to cool my hand. As soon as I grab it I can feel it's cold and I tear up from the relief. The dream goes on for a bit and when I wake up nothing is wrong with my hand and there's no pain. No one smokes in the house either so idk where I was smelling cigarette smoke. I do recall drinking something berry flavored - cherry maybe? Was kinda freaked out as I've never experienced anything like this before when dreaming.

 
At August 15, 2014 3:11 PM, Anonymous Anonymous said...

I keep dreaming that I have been struck by lighting, I can feel the electricity burning through my body from my hands down to my feet. I wake feeling in pain and exhausting and pretty helpless. I have recently been tested for MS and sleep apnea with no diagnosis. I have been diagnosed with PMS for 2 weeks of amonth This reacurring dream happens a couple of times amonth...any ideas?

 
At August 16, 2014 10:20 PM, Anonymous Anonymous said...

I’ve experienced many vivid dreams. Last night I was dreaming of a dark damp landscape with many strangers. It was dark outside and I could only see outlines of others. They were fighting these black flying shadows but were being killed one by one. I decided to come up with a strategy to finally kill the shadows and knew I could but before I could get to the hill, I was struck in the back of my head and it felt like a sharp static feeling which continued 2 more times after I awoke from the dream. It was very strange.

 
At August 20, 2014 4:53 PM, Anonymous Anonymous said...

I once had a nightmare in which I felt horrible, consuming pain after having drunk poison in the dream. And when I jolted awake, my entire body was buzzing and I couldn't move. As if my whole body had been numb. It only lasted a minute or so, and then I had to deal with the panic as my heart raced. Can anyone explain that?

 
At September 05, 2014 5:42 AM, Blogger Mary W said...

So, fake pain huh? I'm not sure if I find this comforting or not! I've had such a hard time recently... I've started having nitemares almost everyday. When I take a nap, it's not likely I will when I go to sleep at night, I wake up at 4 am and get my husband ready, get our puppy situated, and usually around 7 am I take a nap until I have to get ready at 9 am. It never fails I always have a nitemare, and pain is always present. Not only is pain present but recently I spoke with my brother he said that a study was done and long story short try to remember something about your dream.. The example he gave me was about light, he said in most people's dreams they report that the lights do not work there isn't a light on, so everyday go past a light switch and flip it, if it turns on say this is real life, then in your dream if you're able to pass and flip a switch and it doesn't turn on you'll know it's a dream. Well, I never got the chance to do that. Ever since he told me that when I am in a dream somehow I just know now that it's a dream. I know I probably sound crazy but it's true :-/ so I'll have these nitemares and I'll be like closing my eyes and trying to open them really fast hoping it will send a message to my brain to do so, or shouting up at myself wake up wake up!!!!! I cry in my dreams and I wake up and I'm crying as well, so I thought if I Yelled or smacked myself or what I might do it in real life too and it would wake me up. It's terrible knowing you're in a dream and not being able to wake yourself up. I find mySelf hiding in my dreams and trying to just hide and wait it out until I wake up so nothing crazy or painful will happen. Wondering if they will ever end. I wake up with a huge gasp finally happy that I got out of it. However lately I've been feeling so much pain in them, it really hurts so bad I wake up crying, whatever is being done to me weather some random person stabbed me or a dentist walking down the road says "smile" then pulls out a drill and drills my tooth off (lol) I really feel it and it hurts! I don't know how I feel about it being "fake"... On top of the knowing I'm in a dream but I'm stuck, knowing the pain is fake too but still feels just as real? That kind of sucks? Reoccurring dreams I have are, world ending, I'm the last one left, or the world is fine but for some reason nobody can hear me, being taken by some kidnappers, having my child taken from me. All sorts of things. I find it really weird, my brother had nite terrors as a kid, he would be walking around talking it was scary but he's the only one who did that. My grandmother always had flying dreams and when she passed my dad started to have flying dreams, then my other brother brother started having flying dreams. Me? I've never had one, just theSe scary, painful, I know I'm in a dream but can't wake up nitemares. Sometimes my entire family will have bad dreams the same night. And it's not what we "ate" we don't even live together. Obviously im all worked up right now because I just woke up from having my teeth pulled out in a dream while I was trying to save the world and wake myself up at the same time, so forgive me if I sound a little flustered. I'm 22 years old, I'm sick of this! I don't want my kids to have this either, any advice? Please?

 
At October 09, 2014 12:58 AM, Anonymous Anonymous said...

Last night was probably one on the scaryist nights of my life I had a terrible nightmare and I was in so much pain. In my dream my chest had been stamped on multiple times and I was struggling to breath but that wasn't all before the nightmare woke me my arm was cut off in this nightmare and when I woke for 5-10 seconds I couldn't feel my arm exept from where it was cut in my dream and I couldn't breath after the 10 seconds had past I started feeling my arm again and there was no pain what so ever plus my breathing had gone back to normal I don't know what happened to me or why it happened but I just hope it doesn't happen again

 

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