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Carrie came to see me for a flare-up in her neck pain. She had been doing relatively well recently, with the pain under control thanks to regular physical therapy. However, I was a bit concerned about this new neck pain flare-up, so I proceeded to investigate. I asked, "Did you do something that may have aggravated it, like twist the wrong way or overextend it?"
"No, it just came out of the blue," I examined her. There was evidence of some neck muscle tightness and spasms but no radiating arm pain--which was a good sign. Range of motion was a little limited by the pain. Then she said, "I feel like I was fine…until the night of the presidential election."
"Tell me more," I responded.
"I'm really upset that Hillary Clinton lost. I mean, she was a sure thing—or, so I thought. And, you know, I've idolized her for years. I'm just devastated. I feel like the country is taking a step backwards."
I could tell that Carrie was experiencing psychological pain; she was not only emotionally upset about the outcome of the presidential election, but she was experiencing physical pain as a result of her psychological distress. This is called somatization—taking a psychological feeling and experiencing a physical symptom as a result. In this case, the feeling was pain.
The pain of mental distress, or an “ache in the mind,” has been described as a "teeth gnashing, gut-wrenching anguish" that literally feels like pain in the body as per Dr. Joel Yager, a psychiatrist at the University of Colorado, who has studied psychological pain.
Carrie continued to fill in the details-- I could tell that the problem was not her neck, but her feelings of uncertainty after Clinton's loss. This distress...psychological pain...was the cause of her physical symptoms: neck pain and tension.
She continued by saying, "I'm worried about all the negative things happening...like an increase in sexist and racist language and aggressive behavior around the country. Over the last several years, I thought we were moving past some of the negative stuff in our nation's history."
I thought back to my psychiatry rotation in medical school. I replied, "Sometimes it's better to focus on what you can control...and not worry so much about the stuff out of your control. The last I heard, our country is called the United States of America...not the Divided States of America. You can't change the outcome of the election, just like you can't change the outcome of the NCAA basketball tournament when your favorite team loses (My alma mater, UNC, lost last year in the finals- and I remember how I felt after the game). But if you focus on what you can control in your life, I think you will feel better."
"So what should I do?"
"Take the high road. Get involved and lead by example in your community. Consider the positive things in your life and focus on those. Do things you enjoy that get your mind off things, like exercise, spending more time with friends and family, or doing activities you enjoy. But most of all, to overcome your pain, you have to accept the outcome of the election, or for that matter, any event that you can’t change.”
"Ok." I could see that her neck pain was starting to lift.
"If you're not better in 4 weeks, come back and see me."
As an interventional pain specialist, I commonly look for a physical source for pain. But I would be remiss if I totally ignored the complexity of pain, and shut out psychological reasons for pain as well. People have often dismissed psychological pain as "all in your head." But isn't all pain eventually interpreted in our brain? Functional MRI, used to measure blood flow to regions of the brain, shows that psychological pain and physical pain "light" up the same areas of our brains. So, one could argue, psychological pain is REAL pain. In the end, if mental anguish leading to pain can be addressed, then often both mind and body can be restored to a healthy balance.
Dr. Aneesh Singla is Medical Director of The Rockville Center of National Spine and Pain Centers in Rockville, MD. Dr. Singla is a sought-after media source to address public health issues and most recently the topic of pain management. He has published in medical literature within the field of Pain Medicine and currently focuses his practice on minimally invasive options for the treatment of chronic pain. He continues to serve on the physician faculty at Harvard Medical School with the title of Lecturer. For more information, visit www.WhyItHurtsBook.com or www.AneeshSinglaMD.com. Dr. Singla’s new book, Why It Hurts, will be available on February 15, 2017 on Amazon and at all fine booksellers.
