Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: August 2009

Chronic Pain: The Relationship between Physical and Psychological Health

Erin Hadley, PhD


Pain is a complex sensation that involves physical, emotional, cognitive, behavioral, and cultural factors, and the experience of pain is often closely connected to psychological distress. Chronic pain, in particular, can take a toll on the wellbeing of those who suffer from it. This newsletter article will provide information about the relationship between chronic pain and mental health, and discuss strategies for coping with psychological symptoms associated with pain.

Pain is a common issue for most of the general population. According to a study by the US Center for Health Statistics, 32% of the U.S. population reported symptoms of chronic pain over an 8-year period. Additionally, a World Health Organization study of 25,000 patients found that 22% reported pain on most days during a 6-month period. Over centuries, researchers have investigated the physical, mental, and cultural origins of pain, but because of its complex nature, it is nearly impossible to distinguish between its physiological and psychological components. Numerous studies have documented the relationships between neural pathways that relay information about both physical and psychological pain, and chronic pain is associated with changes in brain chemistry that are similar to changes associated with psychological conditions such as depression and anxiety (Marazziti, Mungai, Vivarelli, Presta, & Dell’Osso, 2006).

The National Pain Foundation reports that people with chronic pain often report feelings of depression, anxiety, sadness, loss, anger, and low motivation. They may feel isolated and misunderstood, since many painful conditions are not easily visible to others, and they may also experience a sense of loss of control over their lives. Finally, because pain can be difficult to assess, some patients begin to feel that their symptoms are "all in their heads," leading to increased feelings of hopelessness and frustration. Such feelings can have far-reaching effects on individuals' enjoyment of life, productivity, relationships with family and friends, and work experiences.

Individuals with chronic pain develop depression at higher rates than the general population. The prevalence of depression in people with three or more pain symptoms is 12%, as compared to 1% prevalence in those without pain or with one symptom (Dworkin, Von Korff, & LeReshe, 1990). People with both chronic pain and depression also report greater pain, reduction of perceived control over their lives, and increased reliance on passive coping strategies (Magni, Schifano, & Deleo, 1985). Anxiety is also an issue for those living with chronic pain; research indicates that at least 50% of patients exhibit anxiety symptoms and 19% are diagnosed with an anxiety disorder (Fishbain, Goldberg, Meager, Steele, & Rosomoff, 1986).

Seeking treatment is the first step in reducing psychological distress and gaining control over the experience of chronic pain. Psychotherapy can help alleviate symptoms of depression and anxiety by providing patients with coping strategies and stress management techniques. Additionally, psychotherapy can explore the impact of chronic pain on people's emotional wellbeing and their relationship with others. Support groups may also provide a social network for those who feel isolated as a result of their chronic pain. Sometimes, medication may be useful or necessary to manage psychological symptoms, and psychiatrists can be an important member of a patient's treatment team. Other medical providers, such as pain specialists, nurses, physical therapists, and occupational therapists can work together to address the effects of pain on patients’ psychological, physical, and social functioning.

In addition to receiving counseling, The National Pain Foundation offers the following suggestions to manage chronic pain and psychological distress:

  • Keep a diary to record changes in pain and emotions, and bring it to doctors' appointments.
  • Identify a support network, which may include family, friends, and support group members. Online support groups are also available for people in pain.
  • Seek information through books, reputable websites, and organizations.
  • Set realistic treatment goals.
  • Stay active. With a doctor's advice and approval, begin a low-impact exercise program that focuses on stretching, such as yoga.
  • Use stress management techniques regularly, such as guided imagery and focused breathing strategies.


References:

Dworkin, S.F, Von Korff, M., & LeReshe, L. (1990). Multiple pains and psychiatric disturbance: An epidemiologic investigation. Archives of General Psychiatry, 47, 239-244.

Fishbain, D.A., Goldberg, M., Meager, B.R., Steele, R., & Rosomoff, H. (1986). Male and female chronic pain patients characterized by DSM-III diagnostic criteria. Pain, 26, 181-187.

Magni, G., Schifano, F., & DeLeo, D. (1985). Pain as a symptom in elderly depressed atients. Relationship to diagnostic subgroups. European Archives of Psychiatry and Neurological Sciences, 235, 143-145.

Marazziti, D., Mungai, F., Vivarelli, L., Presta, S., & Dell’Osso, B. (2006). Pain and psychiatry: A critical analysis and pharmacological review. Clinical Practice and Epidemiology in Mental Health, 2, 31-42.