Psychological Factors that can Impact Pain: Depression and Anxiety
As we have discussed before, persons with chronic pain can become very frustrated when their doctors or health care providers recommend that they seek psychological treatment, for what that patient knows is a physical problem. However, pain is not just a physical problem.
The chicken and the egg phenomenon with respect to pain and depression and anxiety can provide another tool for people who are hurting to better cope with their pain. Many doctors may argue that pain can be produced by psychological issues such as depression and anxiety - in other words, the pain is created by the depressed or anxious state. We do know that when a person is depressed or anxious, they will focus more on negative experiences, which includes pain. Again, if you focus on uncomfortable sensations, those can become perceived as painful.
However, research is also very clear that pain can produce depression and anxiety, as well as being a product of anxiety and depression. Research has shown that particularly people who are in pain who do not receive the resources they need to deal with that pain are quite prone to developing psychological disorders, including depression and anxiety. As we said above, those negative emotional states can also lead to perceived increases in pain.
Honestly, all of the research on chronic pain has shown that the best way to deal with severe chronic pain is to use a variety of strategies - this is often called interdisciplinary pain management, and can include psychological treatment, physical and occupational therapy treatment, and some modes of alternative medicine in addition to primary allopathic medical therapies. What this means if you are hurting is that a psychologist or a psychiatrist can help you in developing tools and coping strategies that can assist in improving your abilities to deal with your pain. Most importantly, as we have discussed previously, shifting your attention away from your pain can also reduce how much pain you actually feel -so the more active you can become, the better you may feel.
While medications can be very helpful in treating acute depression and anxiety, most research indicates that the best way to deal with these psychological issues involves dealing with the thoughts and thought patterns that may have preceded those psychological states. One of my professors in clinical psychology described this very well - when you cut your hand, you do not ponder how you did it, or why you did it. You put pressure on the wound, and put the bandaid on first. THEN you explore how you actually got injured, in an effort to try to reduce the likelihood that you will have this kind of injury again. Medications can be an excellent means of dealing with acute issues of depression and anxiety, but long term, they are not as effective as using medications in conjunction with talk therapies.
The same is true for depression and anxiety that is associated with chronic pain. It is simply logical that a person would become sad and somewhat fearful if they have pain that is so severe that they cannot do many things that they want to do. But psychological techniques can be used to help you cope with your pain, as well as dealing with the psychological issues that may result from that pain. Long term recovery from depression and anxiety usually requires both therapies, not just medications.
One of the best therapeutic techniques for dealing with depression, anxiety, and pain involves a technique called cognitive behavioral therapy. CBT is a process whereby distorted cognitions (untrue or exaggerated thoughts) are identified, challenging evidence is searched for to challenge those irrational thoughts, and new patterns of thought are taught to assist in alleviating the psychological distress generated by those distorted thoughts. A classic example of a distorted thought is catastrophizing. When we were children, most of our parents taught us that when we have pain, something is wrong. However, as adults, most people recognize that there are ranges of pain, some mild, some severe. But some people can over-read to pain, based on distorted thinking. A person who has a severe stomachache may do one too many Google searches and conclude that they have stomach cancer. Obviously, this is an exaggerated example, but consider the following - you are a person with chronic low back pain. Your imaging tests have shown problems in your back, but surgery is not an option for you. If every time you try to increase your activity levels, you stop if you have even the smallest amount of pain, you can see how this can quickly devolve. Your body will become deconditioned, as you lose the muscle tone and cardiovascular condition you might have had before, and this can seriously increase your pain. This can create a vicious cycle.
In other posts, we have discussed how pain can exist in the complete absence of tissue damage, and that there are ways to increase your activity even if you have severe pain. Again, research has shown that increasing activity levels also increases the body’s opiates, endorphins, which can also improve pain. Finally, increasing activity can improve your self-efficacy, or how much you believe you can do what you want to do, and that can make a tremendous difference in coping with pain.
But back to the distorted thoughts - if you believe that every time you have any pain, that something bad is happening in your body and you need to stop what you are doing to prevent further injury, you can be very much shooting yourself in the foot. Any physical therapist will tell you that working through the pain intelligently, respecting that pain is an early warning system, NOT an indication in all cases that damage has occurred, you can increase your activity levels.
Also, you do not necessarily have to seek professional assistance to deal with your depression and anxiety that may result from your pain. Techniques like mindfulness and meditation can also improve your psychological state as well as your mood, and there are a tremendous number of self-help resources on psychological coping strategies for pain and even CBT (yes, there is a CBT for dummies) that you can use on your own to cope with the psychological issues that might be making your pain worse.
More importantly, studies on methods to improve depression and anxiety also show that increasing your levels of physical activity, as well as increasing your participation in activities that you find joyful or pleasurable, can really significantly impact your depression and anxiety.
In short, while you might not like to consider psychological issues like depression and anxiety as part of your experience with pain, it is important to respect that treating those problems actively, either by engaging in techniques like meditation or mindfulness or seeking professional help, can really improve your ability to deal with your pain, and honestly, may even reduce the amount of pain that you are actively experiencing.
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