The Psychological Components of Pain

Posted on Friday, December the 28th at 6:48pm

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

To effectively manage a pain condition, especially for someone in recovery from an addictive disorder, it is very important to understand exactly what he or she is experiencing. When people are in pain they experience both physical and psychological symptoms. To understand the language of pain, we must learn to listen to how the pain echoes and reverberates between the physical, psychological, and social dimensions of the human condition. Pain is truly a total human experience that affects all aspects of human functioning.

The psychological symptoms include both cognitive (thinking changes) and emotional (uncomfortable feelings) that lead to suffering. Most people are not able to differentiate between the physical and psychological. All they know is "I hurt." For effective pain management people need to learn all they can about pain.

The easiest way to understand pain is to recognize that every time we feel pain our body is attempting to tell us that something is wrong. Pain sensations are critical to human survival. Without pain we would have no way of knowing that something was wrong with our body. So without pain we would be unable to take action to correct the problem or situation that is causing the pain. There are also two types of pain that need to be understood: acute and chronic.

It is also important to be aware of the differences between acute and chronic pain. Acute pain tells the body that something has gone wrong or that damage to the system has occurred. The source of the pain can usually be identified easily and typically does not last very long. An example of acute pain is when you touch a hot burner on the stove. Acute pain is mostly physical in nature, while chronic pain has a significant psychological component.

A chronic pain condition will linger long after the initial injury, sometimes for years. In many cases chronic pain no longer serves a useful purpose. To be considered a chronic pain condition the symptoms must last at least six months.

The treatment for acute pain conditions often depends primarily on medication and has a predictable healing process. When considering treatment for chronic pain, however, both medical and psychological interventions must be used. Chronic pain can be present because the body is not healing, or because physical damage is ongoing, arthritis, fibromyalgia, cancer, many traumatic injuries and some chronic illnesses. Additionally, chronic pain sometimes continues without a clear physical cause—the pain signal gets turned on and won’t turn off.

When medication does not eliminate the pain or address the lifestyle losses the person is experiencing, the result is usually irrational thinking and uncomfortable emotions—in other words, suffering. Some conditions—because they are terminal or because they are likely to result in significant disability—may also evoke amplified pain symptoms because of the psychological components of the illness or injury.

Another face of psychological pain is the anticipation of an expected pain level can influence the degree to which you experience pain. When your self-talk is saying, "this is horrible, awful, terrible," the brain tends to amplify the pain signal. When this occurs, your level of distress increases—you suffer, remaining a victim to your pain.

The anticipation of an expected pain level can also influence the degree to which pain is experienced in a positive manner. 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 lies the rationale for biofeedback and meditation as pain control methods. 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 on the body.

In addition, many people with chronic pain frequently become depressed. When their thinking is irrational or dysfunctional and they are mismanaging their feelings, they often have urges to indulge in self-defeating, impulsive or compulsive behaviors to cope with their depression. This in turn affects their relationships with others. Some people may become isolated and believe they can handle life without any help, or they may become increasingly dependent on others to take care of them. This caretaking by others may be enabling the person to continue ineffective behaviors and keep them in a victim role.

Psychological treatment for chronic pain needs to supplement medication treatment, not replace it. Emotional stress and negative thinking can actually increase the intensity of the pain, but the presence of psychological factors does not mean that the pain is imaginary. Psychological treatment goals are designed to help people learn how to understand, predict, and manage the pain cycle, how to use coping skills to minimize pain, and how to maximize active involvement in positive life experiences despite the presence of chronic pain.

Additionally, psychological treatment for chronic pain focuses on the emotional toll people experience living with pain on a daily basis. Important factors such as disability, financial stress, or loss of work are also a part of the pain picture, and psychological treatment is designed to address all relevant issues. The treatment for chronic pain does not include magical interventions; rather, it is a combination of proven psychological treatment approaches in addition to medication management and other non-chemical interventions that addresses all the issues people in chronic pain experience.