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Laughter Studies Confirm That Laughter Relieves Pain

Prepared for Julie Pugmire and Delan Jensen

Prepared by Katherine Kelsch BA
HLTH 1243

In an article that chronicles the events at a pain conference in Florence, Italy in 2013 Ian
Mason recounts the difficulty in getting pain relief to the individuals who need it the most
(Mason). In many countries there is no system put in place that educates the doctors regarding
appropriate or safe pain relief for their patients who have both acute and chronic pain. This is
unfortunate, because if there were such a system to educate caregivers, there is a relatively newly
recognized way to get them some pain relief. It is not a new drug, it is an activity that has been
around since the beginning of manit is laughter.
Among researchers there appears to be no question that it has been clinically proven that
laughter helps people in pain. Current research indicates that laughter has quantifiable positive
physiologic benefits. So far, these benefits have been small and not yet widely corroborated, but
in this era of preventative medicine, they indicate that research on laughter is not only timely and
useful but also potentially fiscally sound. This is because laughter is (usually) free, and often
without side effects (Louie). Other real questions left are to discover the modalities that are
used by the body to achieve this relief. In this paper we will explore the history of laughter,
some of the research that gives understanding as to how laughter can help mitigate pain, and how
this research can be implemented to help patients and their caregivers.
Researchers at the Kolmrden Wildlife Park in Sweden discovered that a short burst of
pulses followed by a whistle is the way that dolphins who are being attacked in a play fight show
that they are enjoying themselves. They laugh to keep real aggression at bay. It is believed that
through evolution, laughter changed from panting noises in primates during pain or social
interaction to the vocalized sounds that humans experience now. With the addition of language,
you can laugh not just to say, I get it, this is ok, but express a whole variety of feelings ranging

from superiority to fitting in within a social group to filling in gaps in conversation says Peter
McGraw, a psychologist at the University of Colorado (Cox).
Much of the research indicates that the findings regarding pain relief can only be related
to real or spontaneous laughter. Professor Willibald Ruch, Zurich University, says in a
Duchenne smile not only are the corners of the mouth pulled upward, but the eyes are also
involved with the typical small wrinkles at the outer corners (Mason). He said that acted out
smiles and laughter do not help people feel less pain. These statements are often made without
any explanation as to how these findings were made or whether the study even sought to
determine what types of smiles or laughs the responders exhibited. It is nevertheless true that
even laughter clubs that have sprung up throughout the world see the value of their pretended
laughter becoming spontaneous. The involuntary nature of Duchenne laughter is largely
responsible for the well-known contagion effect whereby we are stimulated to laugh just by
others laughingit is likely that the endorphin effect is limited to this form of laughter
(Dunbar). Determining whether there is a difference in the results between real and acted out
laughter is one of the important areas of laughter research requiring more attention.
According to Ian Mason A team of Swiss researchers reported that laughter and humor
can increase pain tolerance and improve quality of life (Mason). Believing that it is not possible
to accurately measure the endorphins released by the brain by measuring them in the blood,
many of these studies use increased pain threshold as a way to show an increase in these opiate
brain chemicals.


In one particular study a frozen vacuum wine cooler sleeve and a mercurial
sphygmomanometer normally used for blood pressure testing were tolerated for longer when the
subjects had laughed at a comedic video. Other subjects could tolerate leaning against a wall
with their legs at a right angle as if sitting in a chair for longer when exposed to live comedy
compared to the control groups (Dunbar).
There has also been some question as to whether there is any difference when people
laugh alone or in groups. There is a pattern of give and take in the social group when people are
laughing. The writers of one study about social laughter believe that it increases natural opiate
effects in the brain because of its synchronicity. They draw this correlation because a physical
exercise (rowing) was shown to have higher endorphin production than unsynchronized exercise.
In the study cited above there was a greater amount of laughing in groups rather than alone
In addition to increasing natural opiates in the brain, some studies are showing that a
decrease in stress hormones is helping in pain relief. Five experimental subjects viewed a 60
minute humor video and serial blood samples were taken. The mirthful laughter experience
appears to reduce serum levels of cortisol, dopac, epinephrine, and growth hormone. These
biochemical changes have implications for the reversal of the neuroendocrine and classical stress
hormone response (Berk).
Growth Hormone has been shown to be associated with joint symptoms such as pain and
swelling in Rheumatoid Arthritis patients. Some RA subjects were told a traditional Japanese
comical story called Rakugo that induces mirthful or merry laughter. After experiencing
mirthful laughter, the level of serum GH in the RA group significantly decreased, approaching


that in the control group (Ishigami). In another RA study, laughter from Rakugo was
unfortunately unable to have only positive results on the cytokines, proteins which behave in
pro- and anti-inflammatory ways. Patients whose RA is harder or easier to control had different
results in their serum. Mirthful laughter was said to affect the levels of serum pro- and antiinflammatory cytokines differentially, depending on the RA disease activity (Matsuzaki).
Despite these occasional results, there is enough evidence that for pain in general,
laughter is good. According to Thomas Benz (Reha Clinic Zurzach , Switzerland), targeted
humor interventions should be part of pain therapy (Mason). How can laughter be put in
practice? This question is asked and answered by the Laughter Prescription study. Providers
can ask, What has made you laugh recently? or How often do you laugh? Inquiring about
laughter opens the door to lightheartedness and also could lead to counseling on laughter and
sharing the latest research with the patient. This study even suggests that the provider give an
actual prescription for how often, how long and when the patient should laugh. An example
(F) Frequency: once a week
(I) Intensity: belly laughing
(T) Time: 30 minutes
(T) Type: your favorite sit-com (Louie).

The provider could also give information regarding laughter clubs in the area. In 1995
the practice of Laughter Yoga was begun in India. There are now over 6,000 clubs worldwide
where people go to enjoy the benefits of pain relief, stress reduction, and other advantages of
It is evident that laughter which was a way to protect oneself from aggression and help in
the bonding of a society has how been studied enough that there is clinical evidence to show it

benefits individuals in pain. Whether it is from the increased endorphins in the brain, the
reversal of stress hormones or the reduction of pro-inflammatory cytokines, or all of these states
together does not really matter to the patient who suffers less because of a bout of enjoyable
hearty laughter. What really remains now is the need for a mechanism to get this information to
people in general. Laughter Yoga has been able to reach many thousands of people with the
message that laughter is the best medicine. There are doctors like Dr. Patch Adams who use
humor and care for their patients to help them to heal. Other groups like Recovery International
are teaching their members that humor is their best friend. It is to be hoped that means such as
these can continue to be employed and invented to help the untold millions of suffering people
on the earth feel less pain from something as simple as a laugh.


Works Cited
Berk, LS et al. "Neuroendocrine and stress hormone changes during
mirthful laughter." Dec. 1989. 14 March 2016.
Cox, David. The Guardian. 17 November 2015. 4 February 2016.
<http://the guardian.com/science/blog/2015/nov/tickling-rats-giggling
Dunbar, R.I.M. et al. "Social laughter is correlated with an elevated pain
threshold." Proceedings of the Royal Society (2011): 1161-1167. 19 February
Ishigami, S. "Effects of mirthful laughter on growth hormone, IGF-1 and
substance P in patients with rheumatoid arthritis." Sep-Oct 2005. 14 March
2016. <http://www.ncbi.nlm.nih.gov/pubmed/16173241>.
Louie, Dexter, Karolina Brook and Elizabeth Frates. "The Laughter
Prescription: A Tool for Lifestyle Medicine." American Journal of Lifestyle
Medicine (2014). Jan. 2016.
Mason, Ian. "Laughing away pain." Medical News Today 15 Oct. 2013:
1-4. MediLexicon, Intl. 3 Mar. 2016.
Matsuzaki, T. "Mirthful laughter differentially affects serum pro- and
anti-inflammatory cytokine levels depending on the level of disease activity


in patients with rheumatoid arthritis." Feb 2006. 15 March 2016.