Pain, Fear, and Anxiety—A Study in their Interrelationships1

Pain, traditionally the most important reason causing the individual to seek medical assistance, has always been a central concern of medicine, just as fear and anxiety have been central concerns of dynamic psychology. The relationships of the phenomena of pain to those of fear and anxiety have been, however, but little explored. Inquiries into the psychological aspects and relationships of pain have been chiefly in the area of psychophysics (demarcation of thresholds, etc.) and the tracing of peripheral pathways and central connections on the neuroanatomical and neurophysiological level. Stone and Jenkins (1940) reviewed the psychophysical and neurophysiological literature to that date and summarized the contributions listed in 153 titles (covering, however, the two sensory modalities, pain and temperature). Hall (1953), surveying the literature since 1940, added 62 more titles on pain alone. In this, as well as another article (1954), Hall called attention to the importance of what he called "attitude factors" in the total pain experience. His list includes instructional set, verbal intellectual level, emotional stability or instability, as well as the effects of mental fatigue, nervous tension, distraction, suggestion, and hypnosis. He concludes (1953)