CHRONIC PAIN- Determinants of Pain Behavior. The psychological factors associated with our feeling of pain. Reviewed by Gary Drevitch

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KEY POINTS-

  • Pain involves more than just unpleasant physical sensations.
  • Painfulness is determined by a variety of circumstances, some of which can be controlled.
  • We experience pain to a great extent as who we are, in terms of biology, psychology, personality and culture.

Pain is not only damage to the body, but it is also a kind of mental episode (Ambron, 2022). The experience of pain is shaped by subjective considerations, such as past experience, attention, anxiety, and present circumstances. And this has major implications for how we manage chronic pain (Warraich, 2022).

 

1. Attention. Pain entirely absorbs our attention and thought processes. The primary purpose of pain is to make us aware of an injury because it signifies a threat that might endanger our lives. So, painfulness can be diminished by diverting our attention to another sensation, such as music or attending to an image of a beautiful sunset. This is why dentists often play music in their offices.

 

2. Context matters. Pain is sensitive to context. The meaning of the situation can influence the intensity of pain. The same injury can have different effects on different people or even on the same person at different times. For a construction worker who falls from a high roof and suffers a major injury, the experience of pain may bring deep anxiety about whether she or he will ever again work and lead a normal life. In contrast, the positive emotional consequences of a new mother's labor pain may offset, to some degree, its unpleasantness.

 

3. Culture. The cultural background has a powerful effect on the pain perception threshold. Thus, pain can be seen as a learned behavior. It is widely accepted that children are affected by the attitudes of their parents toward pain. Some parents worry a lot about ordinary cuts and bruises, while others tend to show little sympathy toward even fairly serious injuries.

 

4. Placebo effect. The placebo effect is the case in which pain is relieved when patients believe that the treatment will succeed, even when the treatment has no therapeutic value. A placebo can be a fake pill or even a ritual that has no direct therapeutic effect. The placebo may also decrease anxiety because it makes the patient believe that something is being done to relieve the pain.

 

5. Emotional pain. Chronic pain can have psychological origins, even in the absence of physical pain. Pain can be caused by grief, or stress without any physical cause. The distress can arise from rejection by a loved one, exclusion from a social set, or even an inability to find employment. Severe grief will cause the release of stress hormones that can result in aches and pain in the body. Physical pain and psychological pain share at least some underlying neurological mechanisms. Evidence indicates that the same brain centers that process bodily pain are also activated with emotional pain. It is no wonder that administering pain medication such as Tylenol to psychologically upset patients helps alleviate their pain.

 

6. Psychosomatic disorders. In some cases, illness originates not in the body but in the mind (O'Sullivan, 2021). It is widely known that the brain can directly cause chronic pain in the body (soma) in the absence of any external pathology. The conversion of stress or psychological problems into physical symptoms is one of nature’s basic mechanisms in mobilizing the body to cope with mental stress. For example, the aches experienced by those who are grieving can be considered a type of psychosomatic pain. And it is common for those affected to turn to medical doctors, not to psychiatrists, to provide a diagnosis.

In sum, the quality and intensity of pain are influenced by our unique past history, the meaning we give to the pain-producing situation, and our state of mind at the moment. The psychological influence of pain helps all of us gain a better appreciation of pain in those around us. We cannot assume that another person’s pain is unimportant even if the injury looks ordinary or would not be painful to us.

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