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.


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.


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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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.

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 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.


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