Psychophysiological Pain?! Never Heard of It!

Do you experience pain that no medical doctor has been able to understand? Have you been made to feel like you are making your pain up or have you been looked at with skepticism? Perhaps you have been told that you are just seeking out pain medications? You are not alone.

Suffering from chronic pain has become an epidemic in the last decade. Many Americans experience unexplainable pain and have not been able to find relief. Unfortunately psychotherapy is not a form of treatment that many people with chronic pain typically seek out as they are afraid that this may invalidate their pain or that they may be viewed as “crazy.” These beliefs are NOT true and in many cases psychotherapy is just what they person may need to bring them some relief. Let’s explore.


The Subjective Experience of Pain:

Measuring and understanding the intensity of a person’s pain is a tricky phenomenon, and can leave a lot of room open for people being left feeling misunderstood and helpless. The pain a person feels is not something that can be objectively measured. People have different thresholds for pain and these thresholds may even differ from time to time within a single individual.

Although pain is experienced in the body, psychological factors have a great influence on how intensely pain is felt at a given time. For example, distraction, meditation, and visualization are all cognitive techniques that have been found to alleviate pain. Similarly, certain psychological factors, such as difficult emotions can at times exacerbate pain. This is NOT to say that the physical pain felt is not real. The pain is real and is actually experienced in the body. What this does mean however, is that there are circumstances that require a psychological treatment of pain as opposed to a physiological one. There are incidents when unnecessary drugs, surgeries or intrusive treatments could be avoided. This concept requires some further elaboration.


The Facts:

Most people, regardless of if they experience pain or not, have abnormalities in their spine, which can be indicated by MRI. In the U.S. there has been a tendency to attribute an abnormality on an MRI as being causal of the pain, but this is not necessarily always the case. For example, a study in the New England Journal of Medicine looked at 283 patients in a randomized controlled trial and compared surgery as well as prolonged conservative care for people with sciatica and lumbar disk herniation. After one year, all the patients had MRI's and the MRI's between those who no longer experienced pain and those who still did were indistinguishable (El Barzouhi et al., 2013). This suggests that the structural abnormality could not sufficiently explain pain because then everyone with the abnormality would be feeling the pain. This is just one study of many which supports the need for understanding additional psychological factors that could impact pain intensity.

A proper treatment of pain must include a full medical work up, including blood work, radiology, and any prior physician reports. It can be dangerous to assume that one's pain must be caused by a psychological factor(s) without first ruling out a medical cause. However, when a diagnosis cannot be made and the pain is not secondary to a chronic illness, it is wise to consult with a physicist who is experienced in making differential diagnoses between pain due to medical conditions and what is called psychophysiological disorders. It cannot hurt to have a consultation with such a medical professional, especially if serious drugs, surgery or invasive treatments can be avoided. 


Psychophysiological Disorders:

If you have been to a number of medical doctors and no medical rationale for understanding your pain has been provided, psychotherapy with a psychologist experienced in dealing with people who have psychophysiological disorder can be extremely beneficial. It is important for people to understand that psychophysiological pain DOES NOT mean a person is making the pain up or that s/he is "crazy" or mentally ill. It DOES NOT mean that an emotion directly makes a person feel the pain. It is a complicated process where the body is working very hard to push certain emotions out of consciousness, which results in physiological changes, such as decreased oxygen to certain areas of the body where the pain is being experienced, as well as other changes. Psychotherapy can help a person come to terms with the specific emotion or set of emotions that is being avoided, and can help a person to understand what has contributed to the need to avoid the emotion(s). These insights in and of themselves can alleviate the pain. 

As always, the contents of this newsletter should not be taken to be specific advice to any given individual and is not meant to replace the advice of one's medical or mental health provider. Always consult with your medical or mental health provider regarding your medical or mental health. 
If you would like to read more about psychophysiological pain, you might enjoy the following book:
Sarno, J. (2007). The divided mind: The epidemic of mindbody disorder. Harper Collins Publishers: New York. 


El Bazouhi et al., (2013). MRI in follow-up assessment of sciatica. New England Journal of Medicine, 368, pp. 999-1007.