Many people think about pain psychology as being a way to help them cope with pain. In this sense, the thinking is that psychological factors – depression, anxiety, fear– happen in response to pain. While this is true, the important part of the equation is often overlooked: that psychological factors can predict how well pain treatments actually work! That’s right: your thoughts and emotions are so powerful that they can determine how much pain you have, how well opioid medication works, how well surgery works, and even how well physical therapy works.
For people with chronic pain, one of the most important factors to evaluate and treat is pain catastrophizing. Pain catastrophizing is a pattern of responding to actual or anticipated pain with distressing thoughts that involve ruminating on pain, having a hard time focusing on anything but the pain, feeling helplessness about the pain. While pain catastrophizing is related to depression and anxiety, it is a distinct and powerful predictor for outcomes related to pain. People who catastrophize have more severe pain, require more opioid medication, and have reduced response to multidisciplinary pain care. Several studies have examined how catastrophizing impacts response to surgery. People who catastrophize are much more likely to develop post-surgical chronic pain. This tells us very clearly that psychology isn’t just about learning to cope better with pain. Instead, your psychology powerfully interacts with other factors and contributes to the development of chronic pain, and in part determines how much pain a person has and how well pain treatments work.
Brain imaging (fMRI) studies show that catastrophizing is associated with attention to pain, anticipation of pain, and negative emotions related to pain—all of which serve to amplify pain at the neural level. Catastrophizing lights up the same areas of the brain associated with pain processing and thereby amplifying the pain experience and suffering. It is important to learn information and skills that dampen pain processing in the brain—otherwise you may unwittingly make your pain worse!
While you did not choose to have chronic pain, it is important to understand that you are participating with your pain with your thoughts, emotions and choices. A pain psychologist will help you learn behaviors and ways of thinking that dampen pain processing in your brain, thereby supporting good pain control and improving your response to a wide variety of medical and physical pain treatments.
At Stanford University we have developed and researched focused, single-session treatment for pain catastrophizing (in the Systems Neuroscience and Pain Lab: www.snapl.stanford.edu). This research was published in April 2014 in the Journal of Pain Research (Darnall BD, et al). Our results suggest that in as few as 2 hours you can learn how to stop catastrophizing and develop your own personalized plan to gain control-- in doing so you will ensure your brain is fit to have the best response possible to all of the treatments your doctors are trying. Stay tuned for more on this topic!