Coping With Anticipatory Pain

Posted on Friday, December the 28th at 7:05pm

By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

When people live with chronic pain they hurt. Doing certain things can make them hurt worse. So they come to believe that these things will always cause them to hurt. In other words, they associate those things with pain. They believe that every time they do those things, they will have pain.

Because they believe that they are going to hurt, they can activate the physiological pain system just by thinking about doing something that they believe will cause them to hurt. This is called anticipatory pain. Patients anticipate that something will make them hurt, which in turn activates the physiological pain system. The patient starts hurting even before they begin doing whatever it is that they believe will cause them to hurt. All they have to do is to start thinking about doing that thing.

Once the physical pain system is activated, the anticipatory pain reaction can actually make the pain symptoms worse. Whenever they feel the pain, they interpret it in a way that makes it worse. They start thinking about the pain in a way that actually makes it worse. They tell themselves that the pain is “awful and terrible,” and that “I can't handle the pain.” They convince themselves that “it’s hopeless, I’ll always hurt, and there’s nothing I can do about it.”

This way of thinking causes people to develop emotional reactions that further intensify or amplify the pain response. The increased perception of pain causes them to keep changing their behavior in ways that create even more unnecessary limitations and more emotional discomfort. This can make the patient feel trapped in a progressive cycle of disability.

People’s expectations—what they believe it will be like when they experience pain—does affect their brain chemistry. The brain chemistry can either intensify or reduce the amount of physical pain that the individual experiences. What they think and how they manage their feelings in anticipation of feeling pain can make the pain either more severe or less severe. In other words, people usually get the level of pain and dysfunction that they expect—a self-fulfilling prophecy.

The anticipation of an expected pain level can influence the degree to which the patient experiences pain. When their self-talk is saying, “this is horrible, awful, terrible,” the brain tends to amplify the pain signals. When this occurs, the level of distress increases—people suffer, remaining a victim to their pain.

But patients can learn how to change their anticipatory response to pain. They can lower the amount of pain that they anticipate by changing what they believe will happen when they start to hurt. They can also change their thinking—the self-talk—and learn how to better manage their emotions. They can learn new ways of responding to old situations that cause or intensify pain. As they come to believe that they really can do things that will make their pain sensations bearable and manageable, the brain responds by influencing special neurons that reduce the intensity of the pain. The brain becomes less responsive to an incoming pain signal.

There are things patients can do that will make them habitually less responsive to incoming pain signals. In any event, both ascending (pain signals coming from the point of injury to the brain) and descending nerve pathways (signals from the brain to the point of injury) will influence or modify the effects of pain on the body.

Because of the two parts—pain and suffering—pain management must also have two components: physical and psychological. The way people sense or experience pain—its intensity and duration—will affect how well they are able to manage it.

As mentioned earlier, anticipation of an expected pain level (i.e., anticipatory pain) can influence the degree to which pain is experienced. In some cases, when the anticipatory level of pain expectation is lowered, the brain responds by influencing special neurons. This renders the brain less responsive to an incoming pain signal. Herein lays the rationale for including biofeedback, positive self-talk, meditation, and relaxation response training as part of the pain management treatment plan.