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Coping with Injury
Emotional and Motivational Brain Connections Predict Chronic Pain

Pain

Pain is the most frequent reason people seek medical help and take medications. You should consult your family physician if you develop any new pain problem, if you have an ongoing pain problem which has not yet been medically investigated, or if you experience any change in the quality or intensity of the pain.

Most people with a pain problem think only about medical consultation and medications.We do not usually look inward to use our own resources to cope better and promote healing nor do we typically think about consulting with a psychologist. There is a lot of research evidence that psychological pain management treatments help people cope and feel better. When people learn psychological coping strategies, they feel empowered so that they can take more control of their pain, whatever the cause. Psychological treatments complement medical and other physical treatments. Different types of treatments taken together often help more than employing only one modality.

Acute vs. Chronic Pain

We are all familiar with acute pain. The pain of a sprained ankle may be severe but over time, it fades and eventually disappears. Chronic pain, on the other hand, is a pain that persists. It may be due to a diagnosed illness such as arthritis or cancer. It may follow an injury or it may arise without any definable cause.

Chronic pain can be:

  • Periodic – pain that is intermittent, such as migraine headaches or arthritic flare-ups
  • Intractable and benign – pain that is present most of the time although the intensity might vary, and which is not associated with cancer
  • Progressive – pain that is associated with malignancies or some other progressive disease

Sub-types of Pain

  • Somatic Pain – this is pain believed to originate from the skin or deeper soft tissues including muscles and ligaments; for example, are soft-tissue injuries after a car accident resulting in back or neck pain
  • Visceral Pain – this is pain believed to originate in internal areas of the body that are in a cavity, for example, cancer-related pain or pain due to a fracture
  • Neuropathic Pain – this is pain believed to originate from damaged or irritated nerves, for example, diabetic-related leg pain or sciatica due to a herniated disc

Psychological treatment can help people with any type of pain.

All Pain is Real

Every sensation, every thought, every feeling, and every experience we have occurs because of neurological and chemical activity in our brains. Every reaction we have to those experiences changes the activity in our brains. This means that there is a complicated interplay between the brain and the rest of our bodies. Everything going on in the brain affects the rest of the body and everything going on in the rest of the body affects the brain. The mind-body connection is a complex two-way street. Any pain we experience reflects an interaction of activity in the brain and activity in the rest of the body. One cannot be separated from the other.

It used to be thought that pain could be categorized as physical “organic” or psychological “functional.” This implies a mind-body split that reflects a misunderstanding of the mind-body interaction that underlies all of our experiences.

Our medical tests are very sophisticated but far from comprehensive. We cannot measure everything that occurs in the human body. There are many people with significant pain problems whose medical tests come up with negative results. Negative medical tests does not indicate that the pain isn’t real. What it does indicate are the limitations of the tests. When the tests are negative, it means that the tests are not precise enough to detect the causes of the person’s pain. Negative medical tests do not mean that the pain is “all in the head” or not real. It does not mean that the pain is “purely psychological” as none of our experiences are purely psychological.

Negative medical tests can rule out serious illness or damage that might be causing the pain because serious illness or damage often does show up on medical tests. As a result, it is important to consult with your family physician to investigate any new pain problem, or any change in an existing pain problem to rule out illness or damage.

Psychological Treatment Can Help

The fact that psychological factors are always involved in our experiences means that we can change our experiences by altering our thoughts, emotions, and behaviour. For example, imagine that you stub your toe while you are on the way to the dentist for a root canal procedure. Now, imagine that you stub your toe in exactly the same way, but this time you are on your way to collect your lottery winnings. The injury is the same in both cases. However, your experience of pain will likely be dramatically different.

In the first case, you would likely feel anxious and upset about having to go to the dentist for the root canal. You might be anticipating pain. When you stub your toe, you might feel angry and think, “Why does this have to happen now?” or perhaps you think self-critical thoughts such as “Why wasn’t I more careful? How could I be so clumsy?” In the second case, you would likely be feeling happy and anticipate the joy of receiving your winnings. You might be thinking happy thoughts about what you are planning to do with your winnings. When you stub your toe, you might feel irritated but you might think, “Oh well. This isn’t important. I’m going to pick up my winnings!” Your thoughts about the lottery ticket would likely distract you from the pain of your stubbed toe, resulting in a less intense experience of pain. This is not an imaginary difference in pain perception. It is a real difference caused by different emotions and thoughts occurring at the time.

In the same way, altering your thoughts, emotions, and behaviours can make a dramatic difference in the quality and intensity of the pain you experience, no matter what the underlying cause.

Types of Psychological Treatments for Pain Management

People are all different. The goal of psychological treatment is to find the strategies and approaches that are most effective for you, as a unique individual. Many people with pain problems benefit from a combination of psychological treatment techniques. These include:

  • Cognitive-Behavioural Interventions – help people identify and change negative self-statements, thoughts and interpretations about their pain
  • Relaxation Procedures – help people learn to calm themselves physically and emotionally especially when the pain becomes challenging to manage
  • Hypnosis – helps people alter their habitual often self-destructive thoughts and reactions to their pain, relax more emotionally and physically, and focus their attention elsewhere so that the pain fades more into the background of awareness-or choose different images or sensations as a focus to decrease the intensity and quality of the pain
  • Psychodynamic Interventions – help people become more aware of their emotional reactions and thoughts about themselves, their health and others; help people achieve insight into their learning history concerning pain and illness and move toward better self-care
  • Mindfulness Meditation Interventions – help people focus more on the here and now and establish a more gentle and compassionate way of viewing themselves and their pain problem

Many people with chronic pain unknowingly adopt self-destructive habits in response to their pain, which aggravate the problem. These habits may include becoming focused a lot of the time on the pain and on their body; worrying a lot and appraising the pain as extremely threatening and as catastrophic; avoiding activity and interactions with others due to the anticipation of pain; experiencing depressive thoughts and feelings about themselves and their pain; feeling angry  about their pain and with themselves; sleeping poorly; eating more or less than usual; abusing medications and other drugs; and withdrawing from others. Self-destructive responses often reduce the effectiveness of other forms of treatment. This is the reason psychological treatment often becomes a priority.

Other Treatments

Most people with pain problems benefit from a multidisciplinary approach which involves medical treatment, including medications, psychological treatment, and rehabilitative treatments including physiotherapy, occupational therapy, and kinesiological or other exercise-related interventions.

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DISCLAIMER

The information provided on this blog is for informational and educational purposes only. It is not professional advice or treatment and does not imply the establishment of a psychologist-patient relationship.

This blog does not replace your consultation with your physician or other medical specialists. It is recommended that you seek the opinion of your physician for any health problem that you experience. You should not delay in seeking medical help or disregard medical advice because of something you have read on this blog.

Although I have aimed to provide correct and current information, I cannot guarantee that the content is entirely accurate, complete, or current. This blog contains links to third-party websites for educational purposes only. I do not necessarily agree with or endorse the content of these links. Any information that you send to or receive from the blog is not secure due to the fact that the confidentiality of information sent via the internet cannot be guaranteed. If you are experiencing a mental health or other health-related emergency, you should call 911 or go to the emergency department of your nearest hospital.