I'm going to switch gears a bit with this post, and discuss a new topic that I feel is important and interesting. I want to talk about how psychological factors can influence chronic pain. I would estimate that the majority of people would not see much of a connection. Most people assume that pain is simply due to some kind of injury to the body. And by extension, chronic pain is due to some injury that has not yet healed. This is partly true.
Usually, when someone with chronic pain is told that there are "psychological factors" affecting their pain, alarm bells go off. The immediate reaction tends to be:
- "You think I'm making this up?"
- "You think this is all in my head?"
- "You think I'm crazy?"
Unfortunately, these kinds of thoughts make chronic pain sufferers less likely to see a psychologist for help. It is not uncommon for a physiotherapist or a GP to recommend that their patients see a psychologist -- only to have their patient feel insulted!
It is for this reason that I wanted to provide a brief introduction to the role that psychology plays in chronic pain. I hope that those with chronic pain get to understand a little more about psychology and pain.
Let me start by answering the common questions written above:
Are you "crazy?" - No.
Is the pain "fake?" - Absolutely not.
Is the pain "all in your head?" - Absolutely yes! But pain is always in the head.
You see, pain is basically a combination of things. First, there is often some damage or injury to the body (ex: broken arm; dislocated disc; micro-tear in the shoulder). There are receptors in the body that detect these injuries and send the information to the brain through the spinal cord.
This "pain information" then gets processed in the brain. Technically speaking -- the pain is actually in your brain and not in the body -- but of course you "feel" it at the site of injury.
It is the interaction between pain information from the body and the way the brain processes this information that determines how severe the pain will be.
Given that the brain plays an important role in the pain experience, and everyone's brain is different, it is not surprising to learn that two people can have identical injuries, and yet have completely different pain experiences. This is where psychology comes into play.
There is a lot of research showing that negative emotions (ex: depression; anxiety; anger) and feelings of stress tend to be associated with more intense pain. In other words, if you are feeling very sad and stressed, your pain is probably going to be worse than if you were relaxed and happy.
Why? What's going on here?
Based on research findings, what seems to be happening is this -- negative emotions and stress influence the amount of pain information received from the spinal cord. Pain researchers believe there are "gates" in the spinal cord that can be opened and closed depending on various factors. One of the factors that determines how much information reaches the brain is emotion. When you are depressed, more pain information is allowed through the "gate" and the person experiences more pain.
The really unfortunate thing is that increases in pain create negative emotions and stress -- so people with chronic pain end up in a vicious cycle. It's not surprising that up to 50% of people with chronic pain end up suffering from problems with depression.
Emotions and stress are not the only psychological factors that affect pain levels. Here are some other interesting facts that show a pain-psychology connection:
1) Suppressing feelings of anger can worsen pain
2) A number of research studies show that the way you think about your pain can seriously affect pain severity
3) Personality factors can affect pain in indirect ways
4) People who are more sensitive to rejection have lower pain thresholds
I hope this blog helps people understand a little more about how pain works. Especially chronic pain sufferers.
If your physician, physiotherapist, massage therapist or any other professional you are working with recommends you see a psychologist - please don't be insulted! They are simply trying to improve your care. In fact, The International Association for the Study of Pain recommends that mental health professionals be included in the treatment of pain. It's a treatment option that deserves some consideration.
Dr. Roger Covin
Montreal Psychologist
www.drcovin.ca
Usually, when someone with chronic pain is told that there are "psychological factors" affecting their pain, alarm bells go off. The immediate reaction tends to be:
- "You think I'm making this up?"
- "You think this is all in my head?"
- "You think I'm crazy?"
Unfortunately, these kinds of thoughts make chronic pain sufferers less likely to see a psychologist for help. It is not uncommon for a physiotherapist or a GP to recommend that their patients see a psychologist -- only to have their patient feel insulted!
It is for this reason that I wanted to provide a brief introduction to the role that psychology plays in chronic pain. I hope that those with chronic pain get to understand a little more about psychology and pain.
Let me start by answering the common questions written above:
Are you "crazy?" - No.
Is the pain "fake?" - Absolutely not.
Is the pain "all in your head?" - Absolutely yes! But pain is always in the head.
You see, pain is basically a combination of things. First, there is often some damage or injury to the body (ex: broken arm; dislocated disc; micro-tear in the shoulder). There are receptors in the body that detect these injuries and send the information to the brain through the spinal cord.
This "pain information" then gets processed in the brain. Technically speaking -- the pain is actually in your brain and not in the body -- but of course you "feel" it at the site of injury.
It is the interaction between pain information from the body and the way the brain processes this information that determines how severe the pain will be.
Given that the brain plays an important role in the pain experience, and everyone's brain is different, it is not surprising to learn that two people can have identical injuries, and yet have completely different pain experiences. This is where psychology comes into play.
There is a lot of research showing that negative emotions (ex: depression; anxiety; anger) and feelings of stress tend to be associated with more intense pain. In other words, if you are feeling very sad and stressed, your pain is probably going to be worse than if you were relaxed and happy.
Why? What's going on here?
Based on research findings, what seems to be happening is this -- negative emotions and stress influence the amount of pain information received from the spinal cord. Pain researchers believe there are "gates" in the spinal cord that can be opened and closed depending on various factors. One of the factors that determines how much information reaches the brain is emotion. When you are depressed, more pain information is allowed through the "gate" and the person experiences more pain.
The really unfortunate thing is that increases in pain create negative emotions and stress -- so people with chronic pain end up in a vicious cycle. It's not surprising that up to 50% of people with chronic pain end up suffering from problems with depression.
Emotions and stress are not the only psychological factors that affect pain levels. Here are some other interesting facts that show a pain-psychology connection:
1) Suppressing feelings of anger can worsen pain
2) A number of research studies show that the way you think about your pain can seriously affect pain severity
3) Personality factors can affect pain in indirect ways
4) People who are more sensitive to rejection have lower pain thresholds
I hope this blog helps people understand a little more about how pain works. Especially chronic pain sufferers.
If your physician, physiotherapist, massage therapist or any other professional you are working with recommends you see a psychologist - please don't be insulted! They are simply trying to improve your care. In fact, The International Association for the Study of Pain recommends that mental health professionals be included in the treatment of pain. It's a treatment option that deserves some consideration.
Dr. Roger Covin
Montreal Psychologist
www.drcovin.ca
2 comments:
I also learned the other day that many studies have shown that, believe it or not, there is NO RELATIONSHIP between the severity of an injury and the pain felt in the brain.
For example - we can all agree that a paper cut hurts ALOT, even though it's such a tiny injury. Add to that reports from people who've had arms, legs, fingers, etc. cut off, and say that it didn't hurt as much as they would've expected.
Pain, and the brain, are funny things :)
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