Pain psychology

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Pain psychology is the study of psychological and behavioral processes in chronic pain. Pain psychology involves the implementation of treatments for chronic pain. Pain psychology can also be regarded as a branch of medical psychology, as many conditions associated with chronic pain have significant medical outcomes. Untreated pain or ineffective treatment of pain can result in symptoms of anxiety and depression, thus it is vital that appropriate pain management occur in a timely fashion following symptom onset. [1]

Contents

Mental health-related difficulties can arise as a result of pain, or can pre-exist and worsen during the course of chronic pain, thus causing one to seek out or be referred by the patient’s healthcare provider for pain-relief treatment. Pain psychology aims to treat the person in pain rather than strictly the pain itself. A pain psychologist’s job is to work with the mental health issues that can be feeding into the physical pain that the patient is experiencing, and help them manage and reduce the effect it has on their lives. [2]

Introduction

Pain is one of the most common sensations for which individuals seek medical attention. [3] Pain is an uncomfortable physical sensation that may manifest with different presentations. This sensation is a complex experience that involves both physical and psychological components. The perception and experience of pain can be influenced by a variety of bio-psychosocial factors, including genetics, emotions, cognitions, and social context. [4] Coping with intense forms of pain can lead to psychological feelings like depression, anxiety, and stress. [5] Research has demonstrated that psychological factors can significantly impact our experience of pain as well. Emotional state plays a critical role—negative emotions like fear and anxiety tend to intensify pain, while positive emotions can alleviate it. Moreover, more complex emotional experiences, such as empathy, which involve both emotional and cognitive components, can also influence how pain is felt and processed. [6] Additionally, cognitive functions such as attention and memory can either increase or decrease pain. Pain perception can diminish cognitive abilities, particularly in areas like working memory. Factors such as sleep deprivation can exacerbate pain, lowering pain thresholds and making it more difficult to manage. People with chronic pain may also overestimate their cognitive and emotional impairments, which further affects their daily functioning. [7]

Pain and Cognitive Function

Pain perception is significantly influenced by cognitive and emotional factors. Brain imaging studies have revealed that attention primarily modulates pain-related activity in the insula and primary somatosensory cortex (S1), while emotional states predominantly affect the anterior cingulate cortex (ACC). The direction of attention has been shown to alter pain intensity, with focus on pain increasing perceived intensity and distraction reducing it. In contrast, emotional states, particularly negative ones, primarily influence pain's unpleasantness without necessarily changing its perceived intensity. These findings have led to increased interest in mind-body techniques for pain management, including cognitive behavioral therapy, meditation, and relaxation procedures, which typically incorporate both attentional and emotional components. The effectiveness of these approaches is supported by evidence showing activation of distinct neural pathways: attention-related pain modulation involves a cortical network including the superior parietal cortex, while emotional modulation engages a pathway through the ACC to the periaqueductal gray matter (PAG) and brainstem. [8]

Pain—whether physical or emotional—acts as a distraction, hindering the ability to focus, retain information, and perform daily tasks. Brain regions like the dorsolateral prefrontal cortex and orbitofrontal cortex, which are involved in pain perception and coping, are often altered in those with chronic pain. These changes are especially pronounced in the Default Mode Network, which plays a key role in working memory and emotional regulation, further impacting pain management and mental health. [9]

Cognitive reserve, which refers to individual differences in cognitive abilities and mental flexibility, plays a critical role in how people cope with chronic pain. Those with higher cognitive reserve are better able to manage pain and direct their attention, leading to less cognitive and emotional distress. Cognitive reserve can be built and maintained through activities that promote mental engagement, such as physical exercise, social interaction, stress management, a balanced diet, and cognitive training. These strategies not only help chronic pain sufferers cope better with pain, but they also enhance cognitive performance and mental resilience, even in times of stress or distraction. Importantly, these interventions offer benefits not just for those with chronic pain, but for anyone seeking to improve cognitive functioning and reduce the impact of pain. [9]

Initial Medical Intervention

Individuals experiencing chronic pain typically contact a physician first. A physician is able to provide a prescription to medications to treat chronic pain. The medications commonly prescribed are acetaminophen, topical creams/sprays (applied to the skin) that contain pain relievers, opioids (narcotics), sedatives to help with insomnia, and medical marijuana. These medications are temporary pain relievers, some being highly addictive; therefore, it is common for a physician to recommend lifestyle changes along with a pain psychologist or therapist for further treatment. [10]

While individuals experiencing chronic pain typically contact a physician first, a pain psychologist will help address the mental effects that chronic pain causes. According to the American Psychological Association (APA) [11] , when a chronic pain patient goes in for treatment from a pain psychologist, they are asked various questions about their mental and physical health, their concerns about the pain they are experiencing, and a questionnaire may follow to keep track of any other information that may be needed to take note of. Once this initial process is done, a treatment plan is made specifically to meet the needs of the patient.

Therapeutic Approaches to Pain Management

Pain treatments include a host of therapeutic techniques and methods such as active listening, medication, reflection, empathy, as well as behavioral techniques like guided imagery or meditation. A common treatment for pain is psychotherapy, also known as talk therapy. [11] It has helped reduce patients’ pain, increased the contentment of their lives, and lowered the pain medication intake. An example of this presents itself in a study that was conducted on a group of workers in 1998 with chronic pain issues. Once they went through psychotherapy treatment, it resulted in decreased levels of depression and other conflicts, along with better control of their lives. [12] What is learned from the therapy sessions can become useful tools for patients to use for future conflicts with chronic pain due to injury and/or a surgical procedure.

Pain psychologists offer various mental therapies that include cognitive-behavioral therapy (CBT) [13] , acceptance and commitment therapy, mindfulness training, meditation, and relaxation therapies. To look at the therapies offered by a pain psychologist more in-depth here are some of the treatments associated with CBT:

  1. Biofeedback and relaxation training (e.g., diaphragmatic breathing, progressive muscle relaxation, autogenic training, self-hypnosis, guided visual imagery) to reduce muscle tension and promote the body’s calming response
  2. General stress management techniques (e.g., time management, problem-solving skills, assertive communication)
  3. Health promotion (e.g., nutrition and exercise, sleep hygiene)
  4. Anger management skills training
  5. Increasing understanding of personality style and its contribution to the pain experience
  6. Activity pacing and reducing fear of pain and/or activity avoidance
  7. Increasing acceptance of the chronic nature of pain condition
  8. Reinforcement (i.e., “operant”) techniques to increase adaptive behaviors and decrease maladaptive pain behaviors
  9. Cognitive approaches to manage clinical depression and anxiety disorders
  10. Cognitive approaches to foster thoughts, emotions, and actions that are adaptive for managing a life with pain

The longevity of seeking pain psychotherapy varies from patient to patient. Some who are experiencing severe psychological issues alongside their medical issues may need to stay in therapy for a little bit longer. It is up to the patient and the psychologist to discuss how extensive the treatment needs to be.

Prevention

Chronic pain is a public health problem that is difficult and costly to treat. [14] This pain can be induced from nerve damage, injury, and even repeated strain. There are very few findings on prevention of chronic pain. Treatment in acute pain can prevent chronic pain from developing. Many prevention studies suggest oral medications between 1 hour and 1 day prior to surgery. [15] Other studies suggests that pain can be managed through a diet of anti-inflammatory foods. [16] There is an increasing focus on mind-body approaches for pain management, with many chronic pain patients turning to techniques like cognitive behavioral therapy, yoga, meditation, hypnosis, and relaxation exercises to alleviate their discomfort. While these methods are multifaceted, they typically involve both cognitive elements, such as attention control, and emotional components. Research is steadily confirming that these therapies can be effective in reducing both acute pain and the development of chronic pain. [8]

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

<span class="mw-page-title-main">Pain management</span> Interdisciplinary approach for easing pain

Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.

<span class="mw-page-title-main">Anger management</span> Therapy for anger prevention and control

Anger management is a psycho-therapeutic program for anger prevention and control. It has been described as deploying anger successfully. Anger is frequently a result of frustration, or of feeling blocked or thwarted from something the subject feels is important. Anger can also be a defensive response to underlying fear or feelings of vulnerability or powerlessness. Anger management programs consider anger to be a motivation caused by an identifiable reason which can be logically analyzed and addressed.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Clinical psychology is an integration of human science, behavioral science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.

Health psychology is the study of psychological and behavioral processes in health, illness, and healthcare. The discipline is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness. Psychological factors can affect health directly. For example, chronically occurring environmental stressors affecting the hypothalamic–pituitary–adrenal axis, cumulatively, can harm health. Behavioral factors can also affect a person's health. For example, certain behaviors can, over time, harm or enhance health. Health psychologists take a biopsychosocial approach. In other words, health psychologists understand health to be the product not only of biological processes but also of psychological, behavioral, and social processes.

Child psychopathology refers to the scientific study of mental disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and autism spectrum disorder are examples of psychopathology that are typically first diagnosed during childhood. Mental health providers who work with children and adolescents are informed by research in developmental psychology, clinical child psychology, and family systems. Lists of child and adult mental disorders can be found in the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), published by the World Health Organization (WHO) and in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association (APA). In addition, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood is used in assessing mental health and developmental disorders in children up to age five.

Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used interchangeably, but incorrectly, with health psychology. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health.

Creative visualization is the cognitive process of purposefully generating visual mental imagery, with eyes open or closed, simulating or recreating visual perception, in order to maintain, inspect, and transform those images, consequently modifying their associated emotions or feelings, with intent to experience a subsequent beneficial physiological, psychological, or social effect, such as expediting the healing of wounds to the body, minimizing physical pain, alleviating psychological pain including anxiety, sadness, and low mood, improving self-esteem or self-confidence, and enhancing the capacity to cope when interacting with others.

<span class="mw-page-title-main">Psychological intervention</span>

In applied psychology, interventions are actions performed to bring about change in people. A wide range of intervention strategies exist and they are directed towards various types of issues. Most generally, it means any activities used to modify behavior, emotional state, or feelings. Psychological interventions have many different applications and the most common use is for the treatment of mental disorders, most commonly using psychotherapy. The ultimate goal behind these interventions is not only to alleviate symptoms but also to target the root cause of mental disorders.

<span class="mw-page-title-main">Effects of meditation</span> Surveys & evaluates various meditative practices & evidence of neurophysiological benefits

The psychological and physiological effects of meditation have been studied. In recent years, studies of meditation have increasingly involved the use of modern instruments, such as functional magnetic resonance imaging and electroencephalography, which are able to observe brain physiology and neural activity in living subjects, either during the act of meditation itself or before and after meditation. Correlations can thus be established between meditative practices and brain structure or function.

Chronic headache, or chronic daily headache (CDH), is classified as experiencing fifteen or more days with a headache per month. It is estimated that chronic headaches affect "4% to 5% of the general population". Chronic headaches consist of different sub-groups, primarily categorized as chronic tension-type headaches and chronic migraine headaches. The treatments for chronic headache are vast and varied. Medicinal and non-medicinal methods exist to help patients cope with chronic headache, because chronic headaches cannot be cured. Whether pharmacological or not, treatment plans are often created on an individual basis. Multiple sources recommend multimodal treatment, which is a combination of medicinal and non-medicinal remedies. Some treatments are controversial and are still being tested for effectiveness. Suggested treatments for chronic headaches include medication, physical therapy, acupuncture, relaxation training, and biofeedback. In addition, dietary alteration and behavioral therapy or psychological therapy are other possible treatments for chronic headaches.

Guided imagery is a mind-body intervention by which a trained practitioner or teacher helps a participant or patient to evoke and generate mental images that simulate or recreate the sensory perception of sights, sounds, tastes, smells, movements, and images associated with touch, such as texture, temperature, and pressure, as well as imaginative or mental content that the participant or patient experiences as defying conventional sensory categories, and that may precipitate strong emotions or feelings in the absence of the stimuli to which correlating sensory receptors are receptive.

Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques.

Cognitive behavioral therapy for insomnia (CBT-I) is a therapy technique for treating insomnia without medications. CBT-I aims to improve sleep habits and behaviors by identifying and changing thoughts and behaviors that prevent a person from sleeping well.

The primary care behavioral health (PCBH) consultation model is a psychological approach to population-based clinical health care that is simultaneously co-located, collaborative, and integrated within the primary care clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in primary care.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Audio therapy is the clinical use of recorded sound, music, or spoken words, or a combination thereof, recorded on a physical medium such as a compact disc (CD), or a digital file, including those formatted as MP3, which patients or participants play on a suitable device, and to which they listen with intent to experience a subsequent beneficial physiological, psychological, or social effect.

<span class="mw-page-title-main">Childhood chronic pain</span> Medical condition

Childhood chronic pain affects at least 5% of the population under the age of 18, according to conservative epidemiological studies. Rates of pediatric chronic pain have also increased in the past 20 years. While chronic pain conditions vary significantly in severity, they often affect children's mental health, academic performance, activities of daily living, social participation, and general quality of life. The outcomes of childhood chronic pain are affected by a number of factors, including demographic factors, genetics, access to rehabilitation services, and school and family support.

References

  1. ↑ Morley, S (28 May 2008). "Psychology of pain". British Journal of Anaesthesia. 101 (1): 25–31. doi:10.1093/bja/aen123. PMID   18511440 – via Oxford Academic.
  2. ↑ Darnell, Beth; Carr, Daniel; Schatman, Michael (August 2017). "Pain Psychology and the Biopsychosocial Model of Pain Treatment: Ethical Imperatives and Social Responsibility". American Academy of Pain Medicine. 18 (8): 1413–1415 – via Oxford Academic.
  3. ↑ "Pain". medlineplus.gov. Retrieved 4 December 2024.
  4. ↑ Gatchel, Robert J.; Peng, Yuan Bo; Peters, Madelon L.; Fuchs, Perry N.; Turk, Dennis C. (2007). "The biopsychosocial approach to chronic pain: scientific advances and future directions". Psychological Bulletin. 133 (4): 581–624. doi:10.1037/0033-2909.133.4.581. ISSN   0033-2909. PMID   17592957 – via American Psychological Association.
  5. ↑ Gorczyca, Rafał; Filip, Rafał; Walczak, Ewa (2013). "Psychological aspects of pain". Annals of Agricultural and Environmental Medicine: AAEM. Spec no. 1: 23–27. ISSN   1898-2263. PMID   25000837.
  6. ↑ Bushnell, M. Catherine; Čeko, Marta; Low, Lucie A. (30 May 2013). "Cognitive and emotional control of pain and its disruption in chronic pain". Nature Reviews Neuroscience. 14 (7): 502–511. doi:10.1038/nrn3516. ISSN   1471-0048. PMC   4465351 . PMID   23719569.
  7. ↑ Delgado-Gallén, Selma; Soler, M. Dolors; Albu, Sergiu; Pachón-García, Catherine; Alviárez-Schulze, Vanessa; Solana-Sánchez, Javier; Bartrés-Faz, David; Tormos, Josep M.; Pascual-Leone, Alvaro; Cattaneo, Gabriele (25 October 2021). "Cognitive Reserve as a Protective Factor of Mental Health in Middle-Aged Adults Affected by Chronic Pain". Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.752623 . ISSN   1664-1078. PMID   34759872.
  8. 1 2 Bushnell, M. Catherine; Čeko, Marta; Low, Lucie A. (30 May 2013). "Cognitive and emotional control of pain and its disruption in chronic pain". Nature Reviews Neuroscience. 14 (7): 502–511. doi:10.1038/nrn3516. ISSN   1471-0048. PMC   4465351 . PMID   23719569.
  9. 1 2 Delgado-Gallén, Selma; Soler, M. Dolors; Albu, Sergiu; Pachón-García, Catherine; Alviárez-Schulze, Vanessa; Solana-Sánchez, Javier; Bartrés-Faz, David; Tormos, Josep M.; Pascual-Leone, Alvaro; Cattaneo, Gabriele (25 October 2021). "Cognitive Reserve as a Protective Factor of Mental Health in Middle-Aged Adults Affected by Chronic Pain". Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.752623 . ISSN   1664-1078. PMID   34759872.
  10. ↑ "Chronic Pain - Diagnosis & Treatment | Made for This Moment". Made For This Moment | Anesthesia, Pain Management & Surgery. Retrieved 4 December 2024.
  11. 1 2 Bruns, Daniel; Kerns, Robert D. (2013). "Managing chronic pain: How psychologists can help with pain management". www.apa.org. Retrieved 4 December 2024.
  12. ↑ Cole, Jimmie D. (1998). "Psychotherapy with the chronic pain patient using coping skills development: Outcome study". Journal of Occupational Health Psychology. 3 (3): 217–226. doi:10.1037/1076-8998.3.3.217. ISSN   1939-1307. PMID   9684213.
  13. ↑ Eccleston, C (July 2001). "Role of psychology in pain management". British Journal of Anaesthesia. PMID   11460803.
  14. ↑ Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education (26 October 2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, D.C.: National Academies Press. doi:10.17226/13172. ISBN   978-0-309-25627-8. PMID   22553896.{{cite book}}: CS1 maint: multiple names: authors list (link)
  15. ↑ Gewandter, Jennifer S (2015 Jul). "Research design considerations for chronic pain prevention clinical trials: IMMPACT recommendations". Pain. 156 (7): 1184–1197. doi:10.1097/j.pain.0000000000000191. PMC   5769693 . PMID   25887465.{{cite journal}}: Check date values in: |date= (help)
  16. ↑ "Anti-Inflammatory Diet: What To Eat (and Avoid)". Cleveland Clinic. Retrieved 4 December 2024.
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