‘Cursing’ as an adjunct to analgesia – I swear

When a patient uses swear words during a painful procedure, it can be a little unsettling for a healthcare professional. However, it is becoming increasingly clear that vulgarities are not just a crude response to pain, but serve a purpose on some instinctive level.

It’s generally accepted that research into the analgesic effects of swearing began around 2009, when Stephens et al used the ‘cold pressor task’, which is designed to induce mild-to-moderate pain by getting somebody to submerge their hand or arm in cold water for as long as they can tolerate it. But in recent years, this fringe area of research has gained traction, with new studies starting to emerge more regularly.

Generally, it has been found that swearing not only increases heart rate, but it points to a distinct connection between speech and its influence on autonomic control centres. In various studies, swearing results in a concomitant increase in heart rate, and decrease in perceived pain. A separate study to the 2009 research (references on request as always) showed that 73 per cent of participants who swore were able to keep their hand or arm in ice water for longer – on average, a full 31 seconds.

But of course, sometimes research just opens up new questions and one of these is: Does it matter what swear word you use to express discomfort, or does it even need to be a swear word at all? If a person just blurts-out some random word, does that have the same effect?

A study published in 2020 looked at this question. Titled ‘Swearing as a response to pain: Assessing hypoalgesic effects of novel swear words’, the study looked at the differences when the conventional ‘f**k’ was used in response to pain, compared to the aforementioned ‘novel’ swear words – ‘fouch’, and ‘twizpipe’, or a totally neutral word. “For conventional swearing (‘f**k’), confirmatory analyses found a 32 per cent increase in pain threshold and a 33 per cent increase in pain tolerance, accompanied by increased rat- ings for emotion, humour, and distraction, relative to the neutral word condition,” wrote the authors. “The new swear words, ‘fouch’ and ‘twizpipe’, were rated as more emotion- al and humorous than the neutral word, but did not affect pain threshold or tolerance.”

In addition, changes in heart rate or pain perception were absent with the novel swear words, and “our data replicate previous findings that repeating a swear word at a steady pace and volume benefits pain tolerance, extending this finding to pain threshold”, they added. So, clearly, it’s not just whether you swear or not that counts; it’s also the way you do it.

But what if a patient uses vulgar hand gestures instead of swearing out loud, or in combination – does that work? This is exactly what researchers looked at in 2022, when they assessed the effectiveness or otherwise of sticking the middle finger up during a painful experience. “Participants submerged their non-dominant hand in the cold pressor as they repeated ‘f**k’ or ‘flat’, or repeatedly extended their middle finger or their index finger with their dominant hand,” wrote the authors.

Further, it was revealed that “pain tolerance increased by engaging in a taboo act and this effect was similar regardless of whether the participant said ‘f**k’ or produced the middle finger. While both taboo acts (‘f**k’ and middle finger) increased pain tolerance, they did not impact pain threshold (onset of pain).”

Now, brand new research takes the hypothesis a step further. A study from late last year, published in American Psychologist, postulates that swearing can also improve performance in tough physical tasks. The key seems to be in shifting people to a more disinhibited mental state – swearing releases people from the usual social constraints and this seems to improve endurance and pain perception. In this study, a total of 192 participants were involved and were asked to perform chair push-ups while using either a swear word, or a neutral word. In short, those who used industrial language were able to support their own body weight for significantly longer than those who didn’t.

“These findings help explain why swearing is so commonplace,” said Dr Richard Stephens (PhD), Keele Uni- versity, UK.

“Swearing is literally a calorie-neutral, drug-free, low-cost, readily available tool at our disposal for when we need a boost in performance.”

The team now plans to study how swearing influences public speaking and romantic approach behaviours, “two situations where people tend to hesitate or second-guess themselves,” said the researchers.

Only a tiny minority of our vocabulary is made up of swear words and of course context and cultural factors are important. But the analgesic effects of swearing have opened up an intriguing dimension in the still mysterious mind-body connection.