- The experience of pain involves both sensory and emotional components.
- Psychological factors, such as anxiety and depression, make people vulnerable to chronic pain.
- Positive psychological factors, such as hope, acceptance, and optimism, affect the adjustment to pain.
“One of the major reasons why pain becomes immortal in our bodies is how we feel in our minds.” —Haider Warraich
Pain is not a purely sensory experience reflecting underlying tissue damage (Melzack, 1996). Emotions, beliefs, and behaviors are vital parts of the human chronic pain experience. Negative emotions and limited emotional awareness contribute to greater pain and poorer adjustment (Lalkhen, 2021). Negative emotions stem from many sources including stressful life events, pain anxiety, attachment insecurity, and the experience of pain itself. The negative emotional aspect of pain can increase a person’s vulnerability to opioid addiction.
The followings are a list of psychological factors that influence pain perception. And they also contribute to pain relief and suffering (Allaz, 2015).
Suffering begets suffering. Our circumstances play a significant role. Unresolved acute stressors over the life course may be most relevant to persistent pain. Early stress in life can alter how the brain responds to stressors later in life and can sensitize us to trauma. For example, reports of childhood adversities (e.g., family conflict, sexual abuse, physical abuse) and adulthood conflict are higher in people with various pain conditions, including migraine headaches, irritable bowel syndrome, and fibromyalgia.
2. Poor mental health
Anxiety, depression, and anger are common in people with chronic pain. Anxiety and physical pain can amplify each other (Vadivelu, 2017). Distressed with chronic pain, a person may start to feel anxious that they have no control over their body. Their anxiety may increase their focus on the pain and intensify it. Problems with daily routines such as housework or gardening can trigger feelings of anxiety and fear, leading to avoidance behavior. The aim of therapy is to increase tolerance to trigger situations to reduce anxiety with each exposure.
3. Pain catastrophizing
Pain catastrophizing refers to the tendency to worry, exaggerate the seriousness of the pain sensations, and feel helpless about pain. Pain catastrophizing is associated with greater pain and maladjustment in acute pain, such as headaches and rheumatic diseases. People with trauma histories are more likely to catastrophize. Pain catastrophizing may communicate the patient’s need for support in dealing with both the pain and the emotional distress that goes with pain. Unfortunately, over the long term, catastrophizing may undermine patients’ support needs.
Vulnerability in interpersonal encounters and high sensitivity to rejection associated with an inability to create trusting bonds are hallmarks of the insecure attachment style. The difficulties in creating interpersonal relationships can in turn contribute to the difficult construction of a therapeutic alliance.
A substantial body of research demonstrates that being insecurely attached to parents is a risk factor for maladaptive outcomes (Lumley, 2011). For example, evidence shows that an insecure attachment style contributes to high pain intensity and disability, to feeling pain as a threat, and to a higher degree of pain-related distress. Insecure attachment is also correlated to high levels of depression, anxiety, and catastrophizing and to a tendency to express distress in a somatic way.
5. Emotional awareness
People vary in the degree that they verbally and non-verbally express their emotions. The difficulty with awareness and expression of emotions relates to the frequently observed somatic expression of mood disorders. That is, emotional problems can be expressed through bodily symptoms.
For example, evidence showed that anger inhibition predicted higher pain ratings at the end of the day, whereas anger expression predicted lower pain ratings, among women with fibromyalgia. Among people with low back pain, anger suppression led to increased pain behavior during a functional task. Many individuals manifest their anxieties and worries as physical symptoms such as abdominal pain. Somatization can be understood as a mode of communication of painful symptoms (grief or melancholy).
6. Positive psychological factors
Positive psychological factors, namely hope, pain acceptance, and optimism, affect the adjustment to persistent pain. Pain acceptance is defined as accepting what cannot be changed, getting involved in meaningful activities despite the pain, and decreasing ineffective struggles to eliminate pain. Acceptance requires that the individual continues the activities he/she values and maintains her personal goals despite the presence of pain. Evidence suggests that subjects with higher levels of pain acceptance experience substantially lower levels of pain, and distress.
In sum, psychological factors influence the perception of pain by affecting individual variations in sensitivity to pain. Reducing emotional hurt could be important for chronic pain patients.
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Allaz, A.-F., & Cedraschi, C. (2015). Emotional aspects of chronic pain. In G. Pickering & S. Gibson (Eds.), Pain, emotion and cognition: A complex nexus (pp. 21–34). Springer International Publishing/Springer Nature.
Lalkhen, Abdul-Ghaaliq (2021) An Anatomy of Pain: How the Body and the Mind Experience and Endure Physical Suffering, Scribner; 1st e.
Lumley, M.A., Cohen, J.L., Borszcz, G.S., Cano, A., Radcliffe, A., Porter, L., Schubiner, H., & Keefe, F.J. (2011). Pain and emotion: A biopsychosocial review of recent research. Journal of Clinical Psychology, 67, 1-27.
Melzack, R. & Wall, P. D. (1996). The Challenge of Pain, 2nd ed. New York: Basic Books.
Vadivelu, Nalini, et al. (2017). Pain and Psychology—A Reciprocal Relationship, The Ochsner Journal, 17(2): 173-180.
Warraich HJ. (2022). The Song of Our Scars: The Untold Story of Pain, New York: Basic Books.