The neuronal pathways linking kindness to pain reduction

Note: This is written by Trishul Kapoor, MD¹, Amy Falzone, DNP and Sara Davin, PsyD, MPH¹ at Cleveland Clinic.

According to the National Institutes of Health, approximately 51.6 million adults in the U.S. live with chronic pain, defined as pain lasting longer than three months. About 21 million Americans experience high-impact pain, characterized by pain that affects day-to-day functioning and can lead to additional stress and emotional suffering. 

Pain is a complex and subjective experience influenced by biological, psychological and social factors. Recent advances in neuroscience have uncovered fascinating insights into how positive social behaviors — particularly kindness — can reduce the pain perception. This article delves into the neuronal pathways that mediate this effect, highlighting the interplay between emotional processing, reward systems and pain modulation in the brain. It also reviews clinical strategies that promote positive emotional states.

The neuroscience of pain perception

Pain perception begins with the activation of nociceptors, sensory neurons that detect harmful stimuli. These signals travel through the spinal cord to the brain, where they are processed by a network known as the pain matrix, which includes regions such as the thalamus, somatosensory cortex, insula and anterior cingulate cortex (ACC). However, pain is not simply a direct response to noxious input; it is profoundly shaped by cognitive and emotional processes that can amplify or dampen the experience.

Kindness and compassion as modulators of pain

Kindness — whether expressed, received or even directed toward oneself — triggers positive emotional states. These emotions are closely tied to the brain’s reward and social bonding systems, which in turn interact directly with pain pathways. Positive emotions and actions towards others can serve to interrupt pain pathways and move the focus of attention away from negative internal states. 

Compassion, closely tied to kindness, is defined as a connection to the suffering of others and a desire to alleviate it. Emerging work in the areas of self-compassion demonstrates that compassion is part of the neurobiological systems related to soothing and affect regulation, including the release of chemicals such as oxytocin and endorphins. These findings similarly support the pain-relieving properties of giving and receiving compassion. 

Key neuronal pathways involved in kindness-induced analgesia

Kindness modulates pain by engaging specific anatomical structures that overlap with both emotional processing and pain regulation circuits: 

• Mesolimbic reward system: Acts of kindness activate the mesolimbic pathway, particularly the ventral tegmental area and nucleus accumbens. This system is responsible for processing pleasurable and rewarding experiences. The resulting dopamine release in these areas not only creates feelings of well-being but also exerts analgesic effects by signaling safety and value; dampening threat-related neural activity. 

• Anterior cingulate cortex and medial orbitofrontal cortex: The ACC is involved in the affective component of pain — both the unpleasantness and emotional aspects of pain — and the regulation of social emotions. It integrates input from pain pathways and reward circuits, allowing positive social interactions to modulate pain signals. For example, empathy and compassion — core components of kindness — activate the ACC and are associated with reduced pain perception. Neuroimaging studies have shown that compassion training increases activity in the medial orbitofrontal cortex — a key reward region — and the ACC.

• Insula: The insula processes both physical pain and emotional states such as empathy and social connection. Its involvement in interoception, or the sense of the body’s internal state, allows positive feelings from kindness to directly influence how pain is experienced by the body.

• Prefrontal cortex: This is essential for cognitive control and reappraisal. It helps reframe painful experiences in light of positive social interactions, thereby reducing the perceived intensity of pain. Mindfulness and compassion-based practices, which recruit the prefrontal cortex, have been shown to diminish pain responses.

• Descending pain modulation pathways: This is the most critical anatomical link. The brain stem contains descending pathways, such as those involving the periaqueductal gray, that can inhibit incoming pain signals at the spinal cord level through endogenous opioid release, or natural painkillers. For example, activation of the reward system by kindness feeds into the periaqueductal gray, which subsequently signals the rostral ventromedial medulla to suppress pain transmission before it reaches conscious awareness.

Clinical implications 

Understanding the neuronal pathways linking kindness to pain reduction opens new avenues for non-pharmacological interventions in pain management. On a simple level, incorporating kindness-based practices — such as volunteering, social support groups and compassion training — may augment traditional treatments. 

Additionally, a wide range of psychotherapeutic techniques have been shown to be effective in assisting individuals reduce pain and associated suffering from the experience of chronic pain. While cognitive behavioral therapies are considered the most widely utilized, other therapies have emerged in recent years that incorporate skill building to enhance the “soothing systems” that may decrease pain. Compassion-based approaches in particular focus on helping individuals develop a sense of internal safeness and to build an ability to be compassionate towards oneself, including their experience of pain. It is thought that such a stance of compassion can also serve to decrease unhelpful coping behaviors — such as pushing oneself beyond one’s limits despite pain — and to serve as a buffer against pain enhancing emotional states such as depression and anger.  

Evidence for compassion- and kindness-based therapies

Research suggests that techniques used to help individuals increase positive emotional states and thought patterns can lead to lower pain intensity. Additionally, specific techniques to enhance self-directed compassion have been shown to not only decrease pain but also support other important pain related outcomes such as pain interference, pain-related self-efficacy, acceptance and pain related fear or catastrophizing. In summary, engaging in, receiving, or even witnessing acts of kindness and compassion can decrease the intensity, and unpleasantness, of pain experienced, suggesting a powerful neurobiological link between prosocial behavior and pain mitigation through social analgesia, or pain reduction.

Conclusions and future directions 

The reduction of pain through kindness is supported by a complex network of neuronal pathways involving the brain’s reward, emotional and pain modulation systems. By activating these circuits, positive social behaviors can profoundly influence how pain is perceived and experienced. Embracing kindness and fostering self-directed compassion, therefore, is not only a moral choice but a neurobiological strategy for enhancing well-being and alleviating suffering.

Future research will focus on targeting specific neuronal circuits to harness the brain’s innate capacity for self-analgesia. While the research to date suggests promise, longer term studies are needed to understand the impact of kindness and compassion on pain and the brain and its ability to change the nervous system in a sustained manner.

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