Detailed guides to painful problems, treatments & more

Euphoric tingle therapy: optimizing therapy for autonomous sensory meridian response

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Recently I blogged briefly about autonomous sensory meridian response (ASMR): weird showers of yummy tingles we sometimes get. They cascade over the head, neck, shoulders, and upper back, and are usually triggered by receiving attention and gentle, quiet, rhythmic stimuli — like getting a haircut.

I didn’t expect to touch on the topic again for years, if ever — but then I realized its potential relevance to healthcare and pain treatment, and especially massage therapy. ASMR might be a potent “active ingredient” of therapy.

Photo by Haroon Niaz on Unsplash.

ASMR has many triggers, and one of the most classic is receiving attention. So how much does it account for the value of going to see a healthcare professional, regardless of what else they do? What does it contribute to the surprisingly potent placebo/expectation effects that come from working with an attentive healthcare practitioner? Quite a bit, I suspect.

I have had ASMR in doctors’ offices and other kinds of healthcare appointments many times. Massage therapy is particularly chock-a-block with ASMR triggers:

  • attentiveness
  • quiet, repetitive actions
  • soft voices and whispers
  • interesting and gentle tactile stimulation (especially around the head)

Do we love massage partly because of ASMR? Probably. But the same things are going on to a lesser degree in many other kinds of healthcare.

ASMR as a potent non-specific effect of healthcare

Every time we have any kind of interaction with a healthcare professional, there are countless subtle impacts on our nervous systems. These are the non-specific effects of therapy, collectively notorious for being more potent than treatment itself. Expectations are raised or managed. Hopes are dashed or reinforced. Fears are inflamed or eased. We may feel defensive or collaborative, supported or undermined, amused or disgusted.

And we might “tingle” with some ASMR. Because therapeutic interactions are often similar to grooming, and therefore full of ASMR triggers.

The peculiar neurology of the ASMR exists at the intersection of sensation and psychology. It may be an ideal example of the power of the therapeutic interaction to affect us in complex ways that go beyond psychosocial effects.

Could ASMR be useful as a kind of pain treatment?

Yes. The brain can definitely blunt pain when it’s reassured and happy… and ASMR is about as good as it gets in the “making brains happy” department. It is not just a weird feeling — it has predictable effects on mood and physiology, and “may have therapeutic benefits for mental and physical health” (Poerio et al).

To the extent that ASMR is a potent non-specific effect of therapeutic interactions, it is at least somewhat therapeutic by definition. Anything that makes that interaction more reassuring can probably boost its power to relieve pain. And ASMR is semi-literally an “orgasmic” positive reinforcement. “Healthcare professionals should be aware of this emerging topic, and the potential for therapeutic applications should be investigated” (Reddy et al).

Wise therapists already optimize for positive therapeutic interactions, also known as “good bedside manner.” They might go further and make a point of optimizing treatment for ASMR specifically, as the apotheosis of good bedside manner — you know you’re really doing it right when you are triggering ASMR!

It’s an interesting exercise to imagine how that would be done. I explore that in a whole new article about ASMR. This post is an abridged excerpt, about one third the length of the article.

Autonomous Sensory Meridian Response — That nice, weird tingly head feeling (and its possible relevance to healthcare and treating pain, especially with massage). (2,100 words, 9-min read)