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Psychology & Pain

by Dr. Sanyogita Nadkarni

Pain is not only a perceptual problem but also an emotional one. We know of another's pain only when the person in pain speaks of it or emits behavior consistent with injury or personal discomfort. The effect of chronic pain on a person is a cascade of psychological problems.

What happens in chronic pain ?

Pain prevents good sleep causes fatigue, impairs attention to demands of daily life and fosters inactivity. Poor sleep and inactivity in turn lead to general myalgia, malaise and negative mood state.

Most people with chronic pain have difficulty meeting physical, emotional and cognitive demands of daily life and many become partly or wholly disabled. Months or years of chronic pain force habit patterns and adjustments in life-style and self-image that lead the person to redefine him or herself.

Importance of psychological factors in arthritis / chronic pain :

Chronic pains by definition defy conventional explanation. It is often seen that chronic pain cases have very little identifiable or treatable causes. Removing the cause of pain does not necessarily result in patient's recovery and return to productive living. The secondary myalgia, poor sleep, fatigue, discouragement and social problems continue to perpetuate the cycle of misery and disability long after the original injury has healed. The real challenge is therefore not just pain relief but rehabilitation, a psychological more so than mere physical.

Impedance to the understanding of psychological factors :

Although most of us can understand that psychology plays an important part in pain, it is also true that many would not readily acknowledge this. We have been pre-conditioned to the concept of mind-body divide and we would rather keep "mind" separate from "body". Unfortunately this has an adverse effect. As we know "Healthy mind - Healthy body" which means an emotionally stable, healthy mind leads to healthy body. It is natural that although a problem may be entirely physical, it will affect the mind, as seen before. The affected mind may in turn function differently producing other symptoms or simply interfering with symptom relief. Studies have shown that negative mood state and somatic (bodily) hyper vigilance are intrinsic parts of pain. Moreover, brain alters bodily states during emotional arousal. Simply put, the brain cannot readily differentiate between "mind pain" and "body pain". This becomes important as pain limits function and targeting the psychological factors appropriately can result in great deal in pain relief.

Contribution of environment to pain :

It is often said that "The wearer knows where the shoe pinches", indicating that pain is a subjective and private experience. This is not entirely true. It can be considered a set of behaviors of the person operating in his / her environment. Behavior patterns including expression of distress develop as a function in individual's environment and such patterns change in response to change in person's environment. This way, surrounding factors including other peoples' response to pain, social support and opportunity for participation in social events all modify the person's perception of pain.

Patient's perspective :

As a patient, you may have several questions. Some of the commonly asked questions and their answers are given below :

"It's not all in the mind, is it ?"

No. as said before, physical pain may be the main reason. But the effects of this pain are many fold and affect our mind. Mind or psychological factors could be secondary but are nevertheless important in continuing the pain. Remember "Healthy mind - Healthy body".

"Doctor, am I crazy ?"

No ! Pain is not a symptom of craziness. It has created bad psychological effects on your otherwise healthy mind. Moreover, having psychological problems does not at all mean that you are crazy.

"Can psychological factors be treated - like physical pain ?"

Like pain, psychological factors can be modified with the right treatment.

This does require your motivation to change certain patterns which you may have got accustomed to, especially due to pain.

There are many types of counseling / therapies on offer and you psychiatrist / counselor would be the best person to choose one that is right for you.

In my experience, cognitive therapy is very useful.

"What is cognitive therapy ?"

Cognitive therapy, a research based therapy, works on the principle of thought - emotion - behavior cycle, how our behaviors reinforce our thoughts that in turn perpetuate the cycle.

The aim is to successfully break the cycle with guided approach.

"Will I be given pills / tablets ?"

Only in exceptional cases. Talking therapies are of great help and only a few people will require treatment for, say, depression that is serious. Treatment will be for a certain length of time and is not addictive.