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Chronic Pain and Mental Health: The Mind-Body Connection

man-holding-injured-knee

When we are in pain, it is hard to focus on anything else. Pain becomes a focal point, and our job, family, friends, and activities we normally enjoy take a back seat. We become trapped in a painful world. It’s not surprising at all that pain, depression, and anxiety are highly correlated.

But correlation is not the same as causation. Which means it isn’t clear in many cases which came first—the physical or the psychological pain. Nor is it clear which is more important to treat. It is a classic chicken-and-egg situation, where our mental state causes or exacerbates pain, and the pain conversely causes the depression or anxiety to continue or worsen. Given the ambiguity of cause and effect, it is essential that both the physical and psychological parts of this pattern receive adequate treatment.

There is significant evidence that even pain that can be attributed to a physical condition or injury can be intricately connected to our state of mind. This has been my own experience. Years ago, I suffered for a number of years from chronic tendinitis in my wrists. There was inflammation and very real pain associated with using my hands to type, or even to open doors or jars. I was treated with physical therapy, massage, and chiropractic, all of which helped to some degree. But the pain kept returning, and I had to severely restrict my activities to prevent it. I got voice-recognition software, an ergonomic work station, regularly wore splints on both wrists, curtailed activities such as knitting and gardening, and still had debilitating pain on a regular basis.

Then I came across an interesting book written by a doctor of rehabilitative medicine, John Sarno. In his work with people who had undergone back surgery, he discovered that there was very little relationship between the severity of the objective problem (a bulging disc, arthritic vertebra, etc.) and the level of pain experienced. And he noted that other people who had the same conditions, as shown on their x-rays and MRIs, experienced no pain.

Dr. Sarno’s book, Healing Back Pain, addresses the psychological factors that produce pain in the body. He shows how stress and suppressed anger manifest in physical conditions that cause pain, and he has helped thousands of people overcome pain without any medical intervention. I read his book, and using his techniques I all but eliminated my wrist pain. I now type as much as I want and don’t restrict my activities, and I experience only occasional, fleeting pain. Pain does not affect my life in any significant way anymore. I highly recommend Dr. Sarno’s books, and his second book, The Mindbody Prescription, addresses other sources of pain and illness.

I recognize that there are circumstances where pain is not due to psychological factors, as it clearly was in my case. However, a person’s mental state still has a huge impact on the perception of pain and the degree to which pain impacts quality of life. Individuals with chronic illness or who experience pain on a daily basis need to learn coping strategies to minimize the impact pain has on their daily life, allowing them to engage in activities they enjoy and not let illness or pain define who they are.

When I work with people experiencing pain, the focus is on exploring the origin of the condition, what makes it better or worse, and how pain impacts thoughts and emotions. Often, giving voice to unacknowledged feelings and needs can rob pain of its power in your life. Giving yourself permission to take better care of yourself, and eliminating self-limiting thoughts and behaviors, can help prevent chronic pain from defining who you are, and help you find a way to be yourself again.

References:

  1. Sarno, M.D., John E. Healing Back Pain: The Mind-Body Connection. New York, NY: Warner Books, 1991.
  2. Sarno, M.D., John E. The Mindbody Prescription: Healing the Body, Healing the Pain. New York, NY: Warner Books, 1998.

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© Copyright 2013 by Meri Levy, MFT, therapist in Lafayette, CA. All Rights Reserved.

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Comments
  • Gwen August 21st, 2013 at 11:09 AM #1

    I strongly agree that one’s state of mind can heavily play a role in how much they hurt and how significantly they allow the pain to play a role in their lives. But I also think that to say that too much also allows some to point the finger of blame at those who truly do have a physical ailment and chastise them and say that they are not hurting at all. There are those people who honestly live in pain on a daily basis for no real known reason and it impacts their lives in a very negative way. They are thought to be real mental cases and when it is viewed like this it truly diminishes what they are feeling and it makes others think less of them. We should not minimize how they feel simply because we do not understand what they are feeling. I recognize and so do a lot of them that a positive mental state of mind can help them to better accept and come to terms with what they are experiencing. But please do not allow our own misunderstanding of what they are feeling allow ourselves to tell them that what they are feeling is not real. Let us instead help to reiterate to them that getting to a more positive state could indeed help them to maybe feel better and let’s be that conduit to help get them there.

  • FT August 21st, 2013 at 8:59 PM #2

    I agree that sometimes the two are inter related.But not all the time…an injury is isolated from mental health and I don’t get how something like that can be related..any research or study in this area (and no I haven’t read the book yet).thanks.

  • Meri Levy, MA, August 21st, 2013 at 11:25 PM #3

    Thanks for the insightful comment, Gwen. It is extremely difficult to know when psychological factors are playing a significant role in the experience of pain. I would never want to diminish anyone’s experience — pain is very real, whether the root cause is biological or psychological. Pain is rarely imagined, or “all in the mind.” Rather, in many cases the body responds to psychological stressors, causing real changes in function that lead to pain. The goal is to address both the physical and the psychological causes of pain, so that the whole person can recover and feel well again.

  • keith w August 22nd, 2013 at 3:53 AM #4

    When I am really stressed at work, I have this old back injury that always comes back and rears its ugly head.

    That’s the only time that it really seems to bother me, but when it does I can always seem to pinpoint it down to the fact that I am going through a really stressful time at work and I am not dealing with it too well.

  • Kat August 22nd, 2013 at 7:10 AM #5

    This is a good blog but I totally agree with Gwen. I can personally attest to this with my back and hip pain. I used to be a very active woman and it came to a sudden halt with degenerative disc disease and hip issues. I often feel misunderstood. I am a very resourceful person though and I am open and positive to all avenues and suggestions to reduce this daily pain.

  • Tina August 22nd, 2013 at 7:39 AM #6

    Gwen – Well said!

  • Colorado Mind & Body Counseling August 22nd, 2013 at 10:56 AM #7

    One of the most difficult parts of Mind & Body Counseling is allowing the patient to make the connection between physical/mental pain. Once they draw those lines, huge gains can happen quickly.

  • Meri Levy, MA, August 22nd, 2013 at 11:58 AM #8

    I really appreciate the feedback. Pain is a very triggering subject for a lot of us. Of course, whenever you injure yourself or become ill, pain is a signal that there is something wrong. But when pain is chronic and interferes with an individual’s quality of life, it is worth looking into potential psychological factors that might be contributing.

    I know myself, that I would have gotten angry if someone had told me that my chronic tendinitis was psychological in origin. And yet psychological techniques helped tremendously. I encourage anyone struggling with chronic pain to read Dr. Sarno’s book. It may not help, just like many of the other treatments you’ve undoubtably tried. But it’s probably the cheapest remedy out there, and if it does help, it is truly priceless.

  • paulina August 23rd, 2013 at 10:34 AM #9

    I can’t imagine ever having to tell someone that yes, I believe you when you say that you hurt, but a lot of this could be in your head too.

  • Michala August 26th, 2013 at 4:03 AM #10

    But I know that for me it is often a big game of mind over matter. I tell myself that I am going to feel better and pretty soon I am.

  • Levi B January 18th, 2014 at 12:33 PM #11

    I can’t imagine ever having to tell someone that yes, I believe you when you say that you hurt, but a lot of this could be in your head too.

    ^agreed

  • rekha March 20th, 2014 at 3:44 AM #12

    Good post…Chronic pain is pain that persists or progresses over a long period of time. Chronic pain typically has persisted for at least 3 months.

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