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By Robert Edwards, Ph.D.
Pain is a universal and intensely private experience. While nearly all of us have felt (or will feel) acute pain at various points in our lives, the experience of chronic pain can be diffi- cult to describe and to communicate. What is clear is that pain, by its very definition, is not a purely sensory experience. Rather, pain (especially chronic pain) has prominent emotional aspects. As pain becomes prolonged and persistent, our ability to cope with it begins to wane. Many sufferers of chronic pain, whether headache pain, low back pain, arthritis pain, post-surgical pain, etc. come to feel helpless, lonely, anxious, depressed, frustrated, and even angry. In part because pain is invisible, and because others may not be able to understand its severity and impact, it is quite common for individuals living with chronic pain to wonder “Is it all in my head?” There is an old term (rarely used by pain specialists or pain researchers these days) called “Psychogenic Pain”, referring to a situation in which the experience of pain is assumed to be initiated or maintained predominantly by psychological factors. However, the old dichotomy between psychogenic and organic pain has generally been abandoned because the experience of pain always involves physiologi- cal and psychological aspects, and these processes may reciprocally influence one another. For example, psychological stress of any kind can result in increased muscle tension, which can directly cause physical discomfort if prolonged. Moreover, simply the experience of living with chronic pain can produce a broad array of negative psychosocial consequences. Let’s look at some of the devastating effects of chronic pain.
Over 50% of patients with chronic pain report clinically significant levels of depression. Symptoms of depression overlap to some degree with responses to pain, and include (in addition to feeling sad) low energy, sleep disruption, feelings of irritability and guilt, loss of interest or pleasure in life activities, etc. The presence of depression is associated with greater disability and worse long-term outcomes in individuals with chronic pain, and it is important that depression be treated as soon as possible. While many people suffering from chronic pain understandably feel that “if the pain was better managed I wouldn’t feel so down”, the reality is that treating pain and depression concurrently produces better out- comes (in terms of pain relief, increases in physical activity, etc.) than just treating the pain and waiting for the depressive symptoms to resolve on their own.
In the same way that depression and pain are reciprocally related, anxiety is very common in the context of pain. Patients with chronic pain often find themselves worrying to a greater degree about their health and other life stressors (finances, etc.). Moreover, specific pain-related anxious thoughts, such as catastrophizing (e.g., ruminating about the negative impact of pain, worrying about whether the pain will get worse, etc.) are associated with long-term increases in pain and disability. At the physiological level, anxiety and catastrophizing are associated with increases in muscle tension, alterations in stress hormones, and even activation of brain regions involved in processing pain, suggesting that cognitive and emotional factors can directly influence the perception of a painful stimulus (Campbell and Edwards 2009).
Numerous studies have now shown that chronic pain is strongly related to both suicidal ideation and completed suicide. Our own survey of over 1,000 patients with chronic pain suggested that approximately 1/3 had recent suicidal thoughts (Edwards, Smith et al. 2006), and that it wasn’t the severity of the pain that was associated with greater risk for suicidal thinking, it was the presence of depression and high levels of catastrophizing about pain.
Source: Pain. COM