Presented by: Beth Darnall, PhD
Clinical Associate Professor of Anesthesia
November 5, 2015
More than 100 million Americans suffer from chronic pain, making it the country’s leading public health problem. But part of the difficulty of dealing with pain is that it’s not just a physical concern, and everyone experiences it differently.
“Pain in the body is processed in the brain, which is where psychology fits in,” said Beth Darnall, PhD, a clinical associate professor of anesthesiology, perioperative, and pain medicine, who spoke at a presentation sponsored by the Stanford Health Library. “Clearly there’s a connection.”
Pain is defined as an unpleasant sensory and emotional experience. When you prick your finger, pain serves an important purpose—warning you of potential danger—a “harm alarm”—and then diminishing when the appropriate response is made. Chronic pain, however, is more complex and is intrinsically involved with emotion, said Dr. Darnall, a psychologist who is involved in extensive studies to more fully understand this connection. The brain’s perception of pain is shaped by factors that can increase or decrease the experience, such as expectations, anxiety, fear, depression, or early life experiences about pain. Culture and religion also play a role.
Power of Emotion
“Emotions are part of the reaction to pain and determine how much you suffer. Though it’s not intuitive to think of pain as emotional, it can help you gain better control over the experience,” she said. “It’s important to identify emotions since the psychological condition predicts the threshold and response to pain. Negative emotions can impede the ability to focus on what we can do to help ourselves feel better.”
Studies found that people with persistent anger experienced greater pain and reduced function, and strategies to reduce anger have shown positive results. A sense of injustice or feeling victimized by the circumstance of pain also increase the perception of pain. A nine-week course on compassion cultivation was found to be effective for reducing pain and anger.
“Stress and negative emotions such as anxiety or dread can make pain perception stronger. In fact, studies have shown that the dread, or apprehension, can activate the same regions of the brain as actual pain and can actually be worse than the pain itself. Research in neuroeconomics, a field that seeks to explain human decision making, found that the dread of pain violated classical decision-making theory. This was shown in pain experiments where participants could choose to either experience less pain later or more pain sooner: Participants preferred to experience more pain sooner than experience less pain in the future—because the dread of future pain is actually painful.
On the plus side, positive feelings like love can reduce the sense of pain. A well-publicized study found that when participants looked at a photo of his or her beloved, they felt less pain, an implication that positive emotions have a measurable analgesic effect.
Escalating the Condition
Social factors also have been shown to influence pain intensity and emotional distress—people with few social interactions demonstrated higher levels of emotional distress.
A key factor in increased perception of pain is what Dr. Darnall called pain catastrophizing—the tendency to focus solely on pain in exaggerated terms and to feel helpless about it. This overfocus heightens emotional responses to pain and shapes brain patterns, setting the stage for stronger symptoms and more intense pain: In brain imaging studies, people who pain catastrophize show different neural patterns even at rest. Catastrophizing is a reliable predictor of who will develop chronic pain later on and treatment response to all types of medical treatments. It also predicts how people will respond after surgery, she said, and indicates those who tend to need more medication, more time in the hospital, and delayed recovery.
“Catastrophizing is like putting gasoline on a fire. It’s a huge negative influence,” she said.
Skills for Control
Dr. Darnall applies a number of proven strategies to help people deal with various aspects of chronic pain. Skills for coping like cognitive behavioral therapy (CBT) and mindfulness meditation can help break the pain-stress cycle and impart a sense of control over the situation. While many individuals benefit from several weeks of CBT, a study found that mediation training to self-regulate was equally effective after just 20 minutes daily for four days. She developed a two-hour class that teaches the relaxation response and other skills to help pain catastrophizers gain control over their mind-body connection. She and Sean Mackey, PhD, chief of the Division of Pain Medicine, are leading a new NIH study to determine the mechanisms of how these skills work.
Her goal is to help reduce the amount of medication chronic pain sufferers have come to rely on by teaching skills in self-regulation of thoughts, feeling, and stress control. She suggested expanding the “tools’ in the mind’s medicine chest to include:
- Mindfulness-based stress reduction
- A pain psychologist with specific training in chronic pain
- Recognizing and addressing catastrophizing
- Exercise to improve health and mood
- Sleep hygiene
- Positive relationships
- Positive attitude focused on abilities, not limitations
“The mind-body connection is a powerful factor in how to manage pain,” said Dr. Darnall. “There are choices we can make. We need to be aware of how all these pieces fit together and harness tools that give us the ability to dial pain up or down.”
About the Speaker
Beth Darnall, PhD, is a clinical associate professor of anesthesiology, perioperative and pain medicine. An expert in treating and investigating chronic pain, she is the author of Less Pain, Fewer Pills, published in 2014, is finalizing another book called the Psychology of Pain, and has a column in Psychology Today online. Dr. Darnall is the co-chair of the American Academy of Pain Medicine’s Task Force on Pain Psychology and received a presidential commendation from the American Academy of Pain Medicine in 2015. She received her PhD in clinical psychology from the University of Colorado at Boulder, did her internship at Southern Arizona VA Healthcare System, and completed a fellowship at The Johns Hopkins University School of Medicine.
About the Stanford Pain Management Center
Clinicians and researchers at the Stanford Pain Management Center and the Stanford Systems Neuroscience and Pain Laboratory have made major advances in the understanding of chronic pain as a distinct disease that fundamentally alters the nervous system. Their work has helped to map the specific brain and spinal cord regions that perceive and process pain, which has led to the development of a multidisciplinary treatment model that translates basic science research into innovative therapies for more effective, personalized treatments for patients with chronic pain. The Center is designated as a Center of Excellence by the American Pain Society.
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About Dr. Darnall
https://med.stanford.edu/profiles/beth-darnall and http://bethdarnall.com