In part 1 and 2 we described how the physical and psychological arenas of life influence pain and symptoms. In today's post we are going to give a general overview on the role that emotions and behaviour play when it comes to influencing pain.
In part 1 and 2 we described how the physical and psychological arenas of life influence pain and symptoms. In today's post we are going to give a general overview on the role that emotions and behaviour play when it comes to influencing pain.
Pain and the Emotional side of life
Emotions are another very important source of influence when it comes to pain. Pain itself almost always elicits an emotional response. In fact, I’d challenge you to think of a time when you were in pain that you did not have an emotional response. Pain may bring up fear, worry, anger, frustration, sadness or anxiety. All of these “negative” types of emotions can shift the processing and perception of the brain tremendously. And as I am sure you are thinking - it is unfortunately not a positive shift!
There is research that shows that when pain becomes chronic or ongoing - that it is perpetuated by heightened and sustained activity of the emotional centres of the brain.1 This means that often we need to be targeting these emotional and psychological aspects of chronic symptoms may be vital in helping you to make improvement in your situation.
Additionally, there is research to suggest that chronic symptoms impair your ability to regulate negative emotions. That is a bit of a double whammy. Chronic symptoms become perpetuated by the emotional parts of the brain and they also impair our ability to regulate negative emotions.
You can begin to see now how many people with chronic pain struggle to make progress with their symptoms when they are trying to figure this all out on their own without any support to guidance. It may feel like the cards are unfairly stacked against you and at the same time, knowledge is power.
When you move from unaware of what influences pain and symptoms to becoming aware of what can influence them you gain the perspective shift that opens up opportunity for change.
Emotions influence our brain and body
Emotions have direct impact on the autonomic (fight or flight vs rest & digest systems), endocrine (hormone systems) and immune systems. Many of these effects involve stimulation of the sympathetic nervous system such as releasing cortisol & adrenaline (stress hormones), increasing muscle contraction and increasing anxiety. None of that makes coping with pain easier.
Indeed, emotions can directly influence pain processing in the brain causing negative effects on pain intensity and reducing your perceived ability to cope. Negative emotions increase the likelihood that sensations in our body are perceived as painful. Not ideal.
As a simple example - if I am feeling worried about the neck pain that I'm feeling Vs if I am terrified and panicking about the same neck pain - I will likely have a very different experience of that pain.
The pain itself might not have changed but my experience of it most definitely has. Panicking and being terrified will cause my nervous system to sink my shoe onto the gas pedal even harder and create more uncomfortable sensations in my body in the form of more fight or flight activity. Yikes!
Or another example; I have some ongoing back pain and I have just been made redundant at work. I’m feeling pretty upset and worried about my future and as a result of this, my pain is likely to feel worse or affect me more.
When pain is present and we have a negative emotional response, this is likely to shape out behaviour. I may choose to lie up on the couch and run circles in my mind about how unfair it is for me to have pain again, or I may fall off track with the healthy eating habit I’ve been working on because I feel like I need some comfort at that moment.
While none of these are ideal and likely lead to being more self-critical and potentially more negative emotions, this happens every one of us. If you had a Birds Eye view to view yourself when you have pain, it’s likely that you would see yourself doing things (behaving) differently than you think you would!
Learned behaviour
When in pain, we have to do something to minimise it, right?
If we seek help from a professional we will get treatment or medications and hopefully they help. If we don’t, maybe we “take to the bed or sofa” for a few days until it passes. Whatever way you’ve found to be effective usually becomes a learned behaviour that will be triggered into action when the context is right - aka when pain appears again.
Makes sense - but that’s not all…
When you are in pain and your back hurts, the way you adapt how you move to get in and out of bed, to get into the car, to sit down and stand up to a seat - these things also change. Maybe you rightly or wrongly associate different tasks as being triggers of your pain.
“I don’t hoover any more because it kills my back”
“I can’t squat because my knee gets sore, so instead I just walk”
All of this is also learned behaviour. It’s usually this stuff that is forgotten about over the long term. Those ways of getting in and out of the bed that never change even when pain isn’t present. It’s usually a “well this worked for me so maybe I will keep doing it, just in case pain will come back if I do it normally”.
In a lot of cases these altered patterns of behaviour will partially or fully disappear when pain is no longer present. That’s normal. Fear leaves it's mark on the human brain though, and in my clinics I often find that many of those altered behaviours will hang around - usually without the persons awareness of this.
I have no evidence for what I'm about to say but I will say it anyway.
I often wonder if the subtle ways that pain changes our behaviour become the ways that reinforce the need for protection when pain becomes chronic.
Do these altered ways of moving and completing day to day tasks become associated with threat/fear avoidance and does the unconscious repetition of these cement the need for protection into daily life? I think it might.
If we can work on identifying these and changing them, perhaps they open up new ways of living with pain that might lead to symptom improvement.
My invitation to you is simply to use this blog to have a little think about how pain may have changed your behaviour. Are there things that you do, that are different now, because of pain? Might those things hold the seeds of further progress?
Move freely.
David
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Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review
https://pubmed.ncbi.nlm.nih.gov/28146315/