When someone says they are in pain, chronic pain even, we should believe them.
That may sound controversial to some, but it’s important that treatment of any kind of pain, emotional or physical, be treated with curiosity, not judgment.
Why do people feel judged?
Some well meaning people, maybe a medical professional, family member, or friend may say, “Oh, that pain you’re feeling is psychosomatic” or “That’s all in your head.” It is a hurtful thing to imply that someone is making up the pain or that there’s really nothing wrong with them.
A psychosomatic illness is actually one where there is a physical cause for an illness or condition and that psychological or emotional factors make it worse. For example, with pain, there is usually a physical cause (an injury or damage to part of the body), but troubling thoughts or difficult and painful emotions also make the pain more intense or longer lasting. This is especially true when someone has chronic pain.
Many clients I see in my practice are referred because of a physical injury, a disc in their back is inflamed or is pressing on a nerve. Even if the injury is healed as much as it can, the emotions and attitudes we have about that pain, especially stress, depression and anxiety, can make that pain much worse, which is psychosomatic pain.
How does stress amplify pain?
Stress is a very common reaction to pain. When pain becomes ongoing, the stress compounds. It affects many parts of a person’s life.
For example, let’s say you have a work related injury, and you can’t go to work. You might be feeling pressure from your boss and your co-workers to return. They might ask, “Why aren’t you here, you look fine?” Your company doesn’t want their workers compensation insurance rates to go up, and they need to get the work done, so they’re trying to get you back to work too.
Because you’re not working and sick leave won’t last forever, the idea of losing income, employment and health insurance can make things feel heavier and difficult to address. “What am I going to do, if I can’t work?” could be a constant refrain in your mind.
Instead of hobbies and relationships with loved ones that you found enjoyable and relaxing, you have friends and family who wonder when you will be back to your old self. You may not be able to exercise or share intimacy with your spouse. It may become hard to sleep.
Usual routines are replaced with healthcare visits, and you may not be physically able to contribute to the home or feel like you want to be around other people. Instead of a positive demeanor, you are easily frustrated, angry, sad, worried, and alone. It’s easy to see how this stress can make the pain much, much worse.
How does reducing stress affect pain?
The good news is that there is a lot we can do to reduce stress and turn down the volume on the pain itself. We may not be able to fix a permanent injury but if we dissect our thoughts and beliefs about the pain, we can make that pain better in many cases.
I know it is hard to believe. But our minds are wondrous things, capable of changing neural pathways and learning news ways of processing information. We can use this to our advantage, for example, by using Cognitive Behavioral Therapy, which is a type of psychotherapy approach that focuses on coping strategies and ways of thinking that can give relief relatively quickly.
As I mentioned before, the experience of pain involves more than a physical sensation. Our thoughts, beliefs and attitudes contribute to how intensely we feel it. There’s no denying that we have a mind-body connection and everyone can benefit from understanding how it works, especially when they have a physical condition like chronic pain.
If you hit your thumb with a hammer, it definitely hurts. You might also feel scared because it was unexpected and the pain was acute. Maybe you’re thinking: “Oh my gosh, that hurts so bad. I’m gonna die or not be able to use my finger again.” Maybe the pain is so sharp, you swear or feel your eyes tear up.
Consider the different experience an adult has who has likely done this before versus a child who injures their thumb for the first time. An adult knows the pain will be temporary, and they’ll feel better in a short time. At worst, they might lose a fingernail, but it will grow back and heal. A young child knows none of those things, which can explain why they are inconsolable when something like it happens. A parent can help them navigate that and understand what is going on and what to expect.
What types of beliefs or patterns hurt healing?
If we focus on the negative or “catastrophize” – meaning we focus on the “worst case scenario” (a catastrophe – it can make pain worse over time.) It’s a human reaction to being overwhelmed. We all do it at one time or another.
Another belief many of us have is that if we feel pain, we should stop moving because whatever we are doing, it will make the pain worse. That’s really not always true, though.
As an example, one person I know has a back condition that is very painful for him when it flares up. Ironically what helps him feel better is moving around and going for a walk even if it hurts to start. Over time, now that he knows what to expect, he knows that movement through the pain gives a payoff of less pain in the long-run. It makes it easier for him to work through setbacks when they occur.
Knowing what to expect and having reasonable expectations can give a lot of relief. This belief can translate to feeling less pain.
Negative thoughts create feedback loops
A health psychologist can help you identify patterns of thinking and emotions so they don’t become habitual. There’s nothing our brains like more than a habit.
Pain is real and it can also have its own feedback loops. You can become more sensitive to pain. When that happens, a small amount of pain can feel like a large amount of pain. We want to turn the volume down – reduce the sensitivity. That is something that can happen over time and with effort.
If you’re having lower back pain and having trouble lifting certain things, a person’s inner dialogue could sound like this: “Oh my gosh, am I ever going to get better? Am I ever going to be able to go back to work? This is horrible. You know, people think I’m crazy. People think I’m weak.” This type of thinking can increase someone’s stress, anxiety and depression. This is how pain can become self-reinforcing and make someone feel even worse than they did before.
A positive attitude can short circuit negative thoughts
Simply being aware of your emotions can be a way of short circuiting this process and giving yourself some grace. Remind yourself: “What’s really going on here? Is there something bothering me in my life right now?” And then realize, “Oh okay, that’s why my pain is worse right now. I’m stressed.” That puts you in the driver’s seat and you can do something about that. A psychologist with a health specialty can help you identify and work through these thoughts.
Your attitude can make a big difference. This involves looking at the thoughts you’re having and then evaluating if those can help. Ask yourself, is this the only way to look at this circumstance? Or are there other ways that can be more helpful and can reduce stress?
We want to change that inner dialogue to something like this: “Right now I’m having trouble working. But that doesn’t mean that that’s going to be the case all the time. I have a care team that is going to help me – physical therapists, physicians and a health psychologist. Even if that’s not going to completely cure the pain, it can make it better sometimes.” It may be hard to imagine what a positive outlook can feel like at first, but if you give the process time, I have seen it help people immeasurably.
A partner who will validate your experience
Reductions of stress can help you have a new outlook on life. These changes can translate to reductions in pain. Even small reductions can make a big difference in someone’s life. Chronic pain can disrupt a person’s life in many unforeseen ways. The good news is that there are many opportunities to find ways through all of those complications.
There are many ways to find relief and many ways to cope with chronic pain. Each person is going to go through that process differently, which is why having a health psychologist at your side can help you find emotional relief for the pain you may be feeling that will likely help your chronic pain.
If you’d like to talk about how psychotherapy with a health psychologist can help, reach out to me and set an appointment. Your pain is real, and I am committed to helping you understand and work through the mental health part of the equation. This doesn’t mean chronic pain is all in your head, but it does mean that you can use your head to make the pain and your life better.