We all know that pain is a normal and instinctive sense, when tissue is damaged. It is necessary for our survival. If pain went unrecognized it would end in death; therefore, pain is a protective mechanism.

 

Under normal conditions, i.e., acute pain (short-term), it is a signal that alerts to real or potential damage, yet pain is also part perception. Thanks to the PET scan it has been learned that the anterior cingulate cortex is a prominent pain control center. In a 1997 study subjects were hypnotized subsequent to their hands being placed in ice water, a painful experience. The PET scan indicated that the hypnotized subject’s anterior cingulate cortex was less active. The subjects in this study reported that they felt the cold but “it was not too unpleasant”. Hypnosis changed the emotional response to pain and therefore the pain intensity.

 

The perception of pain is psychologically increased or decreased through one’s mood, attitudes, beliefs and thoughts. A very interesting study completed in 2010 by B. Doganic found that subject’s expectation of pain significantly affected their response to painful stimuli. When there was little expectation of pain, over an 8 week period, the pain decreased or remained the same. In other words, what you expect to happen will happen.

If you feel that your pain will be worse today, there is a very good chance it will. There are countless studies that demonstrate that anger, suppressed anger, stress and depression increase pain intensity. In a recent study in 2010 conducted by a C.E. Kennedy, it was learned that ruminating or negative expectations about one’s physical condition (worrying about getting worse) increased pain anxiety and therefore pain intensity. While pain is not in a patient’s imagination it definitely can be increased or decreased by their mood, thoughts and behavior.

While few make up their pain in their imagination, one can be fairly sure that when pain intensifies, the increase can be accounted for through one’s thoughts, behavior and mood. In other words, when thoughts, behavior and mood are not regulated properly pain will increase. This brings up the necessity for all chronic pain patients to begin to pay attention to their mood, thinking and behavior. This means becoming aware of themselves and we pain patients do not pay attention to ourselves until we hurt. Until there was a pain condition most of us used our body as a tool, pushing it this way and that to accomplish a goal without thought of consequences. Prior to pain we had the privilege to ignore the consequences to our own body. Now pain has changed that. Now it is not the external goal or obstacles that we must first deal but our own body. We don’t give ourselves the time to pay attention to our thoughts, feelings or behavior until we become profoundly depressed or physically or emotionally hurt.

 

One of the main goals of a psychologically based pain management program is to teach pain patients how to consider their own needs along with the needs of others. This doesn’t mean putting themselves first but it means learning to consider their needs along with the needs of others. Like most life changes, it involves a process of trial and error. One begins by stopping and paying attention when mood, thoughts or pain begin to change. When reflecting on changes, consider your thoughts and feelings that came before the pain increased. Consider whether those changes in your body may have been influenced by prior events, feelings or behavior. I encourage all pain patients to write those thoughts and feelings down and maintain a journal. The reason for journaling is that paying ourselves is a new experience and doesn’t come naturally. By keeping the notes, you can look back and begin to see the themes that seem to affect your pain level.

 

Let me know about changes of mood, thought or behavior that may or may not affect your life and your level of pain.

Let me know if these suggestions were helpful.

Gene Hawkins, Ph.D.