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IS IT ALL IN MY BRAIN? Overview of psychology of pain

Most people think of pain as resulting from physical injury or disease, but psychological factors play a huge role in pain perception. Pain is intimately tied to brain functions that govern behaviour and decision-making, including expectation, attention and learning. Pain makes one feel tired; it is mentally draining, making one more irritable, emotional and unable to remain positive. It is hardly surprising that things can rapidly spiral out of control. After all, if a person goes from being energetic, fun loving and happy, to being edgy, withdrawn and lethargic because of the pain, it is inevitable that very quickly family & social relationships begin to change. An employer or colleague, who sees a promising employee beginning to look tired, stressed and tearful, may quickly change their opinion about that person’s abilities to cope.

A Definition of Pain

Pain is not easy to define. In 1979, the International Association for the Study of Pain (IASP) published its first working definition of pain:

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

This definition emphasizes not just the sensory nature of pain and its relation to tissue injury, but also its unpleasant emotional component and the fact that it can be felt just the same without an obvious cause. The definition’s significance is exemplified by pain lasting beyond the point of tissue repair (spinal cord injuries) or appear without tissue damage (migraines) or be felt by stimuli that do not normally evoke pain, like lightly touching the skin (post herpetic neuralgia). So there is much more to pain than a simple sensory process.

Psychogenic pain

Psychogenic pain, also called psychalgia or somatoform pain is pain caused, increased, or prolonged by mental, emotional, or behavioral factors. Headache, back pain, and stomach pain are sometimes diagnosed as psychogenic. Sufferers are often stigmatized, because both medical professionals and the general public tend to think that pain from a psychological source is not “real”. However, specialists consider that it is no less actual or hurtful than pain from any other source.

“The term ‘psychogenic’ assumes that medical diagnosis is so perfect that all organic causes of pain can be detected; regrettably, we are far from such infallibility… All too often, the diagnosis of neurosis as the cause of pain hides our ignorance of many aspects of pain medicine.” Ronald Melzack, 1996.

Why visit a Psychologist for Pain?

One might wonder “why consult a psychologist if I have pain? Are you telling that the pain is all in my brain?” In one word, NO! Pain is seldom, if ever exclusively psychologically caused. However, the mind and the body are tied together in physiological & philosophical terms, and the mind can either be of incredible help in healing or can be an overwhelming obstacle. Consulting a psychologist certainly does NOT state that the pain is all in the person’s brain, as unfortunately some clients have been advised by physicians unable to establish the physical basis of the pain.

How can psychology help?

Psychology may reverse some of the impact of the pain giving people a greater sense of control, reducing anxiety, whilst improving memory, concentration and self-esteem. The aim is to help people work out how to live their life as normally and in the most satisfying way possible, despite the pain. The Psychologist will not tell how to live one’s life- after all you are the best expert on how to be yourself. Our role is to help one explore and discover what things in life are important and meaningful, and what factors past and present stand in the way of regaining control of his or her life.

What treatments does a psychologist provide?

Psychologists assess and treat individuals coping with chronic pain. Assessment often involves examination of coping skills and looking for the presence of depression, post-traumatic stress and other disorders that can occur in chronic pain and traumatic injuries. Psychologists employ treatment strategies such as muscle relaxation and cognitive-behavioural approach to help manage pain and improve functioning.

Chronic pain causes disruption of self-esteem, occupational & family roles. Stress reactions and pain cause the mind & body to become aroused and ready for action. Increased emotional and physical tension accompany this state which may become chronic, resulting in further increased pain, reduction of function and increased risk of anxiety & depression.

Chronic pain sufferers may find it difficult to focus on things other than their pain, and lose access to the satisfying things they previously enjoyed. Others may find it difficult to reduce their expectations and may overdo activities resulting in further injuries or a cycle of overwork and disability.

Relaxation Therapy along with Cognitive Behaviour Therapy is our first line of treatment, along with medical interventions. It is customized to one’s individual needs, and may include:

• Relaxation Training
• Cognitive Restructuring
• Stress Management
• Sleep Hygiene
• Activity Pacing
• Coping Strategies &
• Assertiveness Training

The psychological interventions that we provide at Atlas Pain Care are highly effective in reducing pain, disability and distress, with a positive impact on your quality of life.