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The Lone Wolf or the Support Group Enthusiast?



The 2024 Global Year will examine what is known about sex and gender differences in pain perception and modulation and address sex-and gender-related disparities in both the research and treatment of pain.

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What type of person are you?? When tough times come around – whether it is stress at work, a painful injury, or forced participation in Secret Santa – what do you do? Some people, those lone wolf types, find relief in being alone, taking some time to regroup, and dealing with the problem themselves. Others, aka the support group enthusiasts, prefer to find an empathetic friend with whom to talk the problem through, discuss a million options, and come out refreshed and re-invigorated. This is often referred to in research as ‘attachment style’. There are two main hypothesized attachment styles: ‘avoidant’ (lone wolf) and ‘anxious’ (support group enthusiast).

Chiara Sambo and colleagues recently published an intriguing study that investigated whether observation of a person in pain could affect that person’s pain levels. Specifically, they were interested to see if the presence of an empathic observer affected a person’s self-reported pain (VAS) in response to noxious thermal stimuli. They modified two things: 1) social presence (participant either got noxious stimuli alone or with an observer present) and 2) perceived empathy (when observers were present they were thought of as having either high-empathy versus low-empathy for the participant). Importantly, Sambo et al were also interested in whether differences in a person’s attachment style would modulate the effects of social presence and perceived empathy on pain.

Interestingly, (and contrary to their predictions), they found that the presence of an observer and their high ‘perceived’ empathy were not associated with lower pain ratings. However, this was elucidated when they investigated further. They found that the effect of perceived empathy and social presence on pain ratings was predicted by the participants’ attachment styles. Higher scores on attachment anxiety significantly predicted lower pain ratings in the presence of a ‘high-empathic’ observer compared to a ‘low-empathic’ observer (eg, if you are a support group enthusiast you have lower pain when a person who can really understand what you are going through is present). In contrast, higher scores on attachment avoidance significantly predicted lower pain ratings when participant experienced pain alone than when they experienced pain in the presence of an observer (eg, if you are a lone wolf, you experience less pain when no one else is there watching).

A fascinating result and a good thing to consider when treating patients – identifying a patient’s attachment style may help guide our interaction. In fact, I’d be curious to see if attachment style predicted patient care-seeking…do we, as clinicians, even see the lone wolves?

Tasha Stanton

Tasha is a Canadian living in Australia, who consistently disappoints people at conferences when she speaks and doesn’t have a hint of a ‘Strayan accent. She was originally trained as a Physiotherapist at the University of Alberta, Canada and then apparently couldn’t get enough of school so she completed a Master’s degree studying spinal biomechanics. She then decided that she liked beaches more than 4 feet of snow and moved to Australia to complete her PhD at The George Institute for Global Health. Luckily she is able to use the advanced skills attained during her PhD to expertly wash Prof Chris Maher’s car.


Sambo CF, Howard M, Kopelman M, Williams S, & Fotopoulou A (2010). Knowing you care: effects of perceived empathy and attachment style on pain perception. Pain, 151 (3), 687-93 PMID: 20869808

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