Psychology and Chronic Pain

When people are referred to me, there is often a look of confusion on their face. Why would they need to see a psychologist? Some are understandably offended. And, unfortunately, there is still a stigma to seeing a “shrink.” Here is what I normally tell people:

As mentioned in the second post, we know that pain is really complex. I generally operate by the biopsychosocial model, where “humans are inherently biopsychosocial organisms in which the biological, psychological, and social dimensions are inextricably intertwined” (Melchert, 2007, p. 37). The biological component may include the injury, cancer, or location of the pain. 

The psychological component incorporates the pain, emotions, and thoughts. When people experience pain (especially chronic pain), they may suffer from frustration, anxiety, worthlessness, depression, anger, irritability, etc. For example, pain can cause people to worry about the future (job loss). Pain can cause people to feel worthless by not being able to work, bring in an income, or even follow-though on daily chores that otherwise felt so simple. Pain can lead to anger. I sometimes hear, “I didn’t cause this car accident. I didn’t cause this pain! Why me!?” Lives can be forever changed by pain, and the associated emotions make sense. They are completely valid. 

But, what we also know is that when people experience extreme emotions, it can often make their pain worse. For example, consider a time when you’ve been stuck in bad traffic. We can get frustrated, worried, irritated, & angry. As a result, our muscles become tense or our stomach is in knots. These physiological responses can increase pain levels. And, when we are in more pain, we can be even more stressed (causing a vicious cycle). Lastly, our thoughts can have an influence, too.

For example, catastrophizing is a thought process that has been associated with higher pain. “Catastrophizing is an irrational thought a lot of us have in believing that something is far worse than it actually is. Catastrophizing can generally can take two different forms: making a catastrophe out of a current situation, and imagining making a catastrophe out of a future situation” (psychcentral.com). For example, one may accidentally make a mistake at work. The thought process may look like, “I made a mistake at work! Oh no! Now that project is going to be behind. My coworkers are going to be so mad. This is going to impact our financial quarter and I won’t be able to get my raise.  My boss is going to hate me! I’m so stupid. I’m probably going to get fired! I’m going to lose my house and my wife will probably divorce me because I will be broke!”

I call this going down the rabbit hole or the downward spiral. These thoughts can lead to serious stress, increased anxiety, make us more tense, and thereby increase pain.

Here is a great article on this topic (disclaimer: I don’t agree with everything in this article):

https://www.vox.com/science-and-health/2018/5/17/17276452/chronic-pain-treatment-psychology-cbt-mindfulness-evidence

Lastly, there is the social component. How do people respond to your pain? Does your family understand it? Will they go with you to the ER? Do they believe in your pain? Are there other social stressors (relationship drama, financial problems, etc)? All of these can also increase stress, thereby increasing pain levels. (BTW – educating family and friends on chronic pain is immensely important.)

So, the idea behind the biopsychosocial theory is that pain can be influenced by medical treatment, our emotions & thoughts, and by our relationships. ALL of these factors should be considered when treating pain levels. A therapist or psychologist who understands pain can help individuals conceptualize contributing factors that may be increasing pain levels. In a future post, I will discuss different types of research-based psychological/therapeutic treatments that have been effective for treating individuals suffering with chronic pain. 

Hope this is helpful when considering how psychology is related to pain.

Till next time,

Yvonne