Pain, including chronic pain, is a sensation. But this should not discount the effect emotion can have on the development and intensity of chronic pain, as well as its potential alleviation. Before anything is misunderstood, it’s important to clarify that certain pains cannot (and should not) be ‘thought away’, and while certain applications of psychiatry can greatly help specific patients – especially those struggling with pain exacerbated by mental health issues – one shouldn’t bank on treatments based on emotions to treat what is ultimately a sensation.
The issue with discussing chronic pain is that every case is different, so it is difficult to address the efficacy of any given treatment or compare it to other treatments based on a general overview of what chronic pain can be, rather than a specific case of what it truly is. However, rather than understanding chronic pain as solely a sensation or some form of emotion, it’s important to understand how a person’s emotions can affect pain, how pain can truly just ‘be in the head’, and how treatments for chronic pain need to address a patient’s full physical and mental health to effectively alleviate pain and bring relief.
How the Brain Interprets and Responds to Pain
Pain begins and ends in the nervous system, where receptors throughout the body send signals to the brain in reaction to stimuli that is considered painful. Pain is a warning system above everything else, meant to both teach us that something is dangerous, and to incentivize us to stay away from certain things. We learn from pain, ideally, and live to tell the tale after a painful experience.
But not all pain is beneficial in the sense that it makes us ‘stronger’, in one way or another. There are many forms of pain that leave behind a lingering effect that is anything but good. Severe or extreme forms of pain can scar the mind, and cause trauma. From losing a leg in an explosion to waking up during major surgery, many forms of extreme pain can cause serious psychological damage and leave lasting scars, both physically and mentally.
Chronic pain develops as a result of these extreme injuries, among other things. Chronic pain can also be part of an inherited disease or syndrome, many of which cannot be cured; or it may occur after a minor injury develops into something much more terrible due to a failed healing process. When an injury or disease requires surgery, especially in areas of the body dense in nerves, complications may lead to scarring and other issues that cause chronic pain. And finally, some cases of chronic pain have no apparent or obvious cause, making it very difficult to find a useful treatment.
In all cases, chronic pain is the constant presence of pain, a sensation caused by the brain communicating with the body and identifying a certain threat or problem. Anything from nerve damage to a sharp object lodged in our thigh can trigger these signals, and in the case of chronic pain, they trigger incessantly for at least 12 weeks. Chronic pain can be sharp or dull; strong or minor; and differs wildly depending on an individual’s experiences and perceptions of pain. As we experience more pain throughout our lives, we begin to numb to it. Other people are born with factors that lead them to develop a higher pain tolerance. In any case, pain is a highly individual experience, making it difficult to measure.
Pain and the Mind-Body Connection
Complicating matters further is the fact that we react very emotionally to pain, for obvious reasons. Pain is more than a ping letting us know we’re in danger. Nociceptors in the body trigger the pain mechanism that includes the release of adrenaline into the bloodstream and triggers temporary numbing agents in the form of endorphins to allow us to escape a painful situation. Many people experience a surge in energy in a life-threatening situation because we have an inbuilt response measure to things that are dangerous – a fight-or-flight response.
Aside from the more immediate endocrinologic response to pain, we also develop an emotional response to it. This can often amplify pain, but it can also subdue it. A lot of pain up to a certain point can be “toughened out” through a stubborn attitude, or it can be addressed through mindfulness (dissociating from the pain). Even more effective is the use of joy and euphoria to numb certain pains. But negative emotions, particularly emotions of fear, sadness, and anger, can amplify pain and make it worse and much harder to deal with. While the exact mechanisms behind psychological responses and pain are not understood, it may be that negative emotions cause to focus more on the pain, rather than allowing us to either distance ourselves from it or dissociate from it.
The Pain-Depression Connection
Emotions and feelings related to depression greatly exacerbates chronic pain, which presents itself as a big problem when chronic pain has also shown to increase a person’s likelihood of developing depression, ostensibly due to the pain itself, as well as the disabling effects of living with chronic pain and being unable to do much of anything. It’s an unfortunate cycle, as one feeds the other – and the only way to break it is to treat both concurrently.
One of the reasons why patients with chronic pain find relief in the use of antidepressants is because some of the pain may be intensified by emotions often experienced during prolonged periods of intense pain, especially in someone who has been put out of action physically for weeks or months at a time.
Being disabled by pain is not in any way glamorous – some struggle with feelings of shame or anger, frustrated by their immobility or their reliance on outside help to function normally. On top of the irritability, there can be bouts of hopelessness caused by pain that simply does not let up. And to make matters worse, research shows us that all these thoughts and feelings only serve to make the pain even more intense.
Treating Chronic Pain in a Post-Opioid World
Thankfully, there are ways to address chronic pain both physically and mentally, without the use of opioid medication. While not every case of chronic pain can be successfully alleviated without opioids, the use of non-invasive as well as surgical interventions, alternative treatment options with non-opioid analgesics and medications such as ketamine, and the use of both psychiatric treatment and psychiatric medication can greatly reduce a person’s chronic pain, in conjunction with patient-centric approaches to matters such as exercise, better eating, sleep management, and stress management.