Chronic Pain and Mental Wellness
The CDC reports that chronic pain is one of the most common issues for which adults seek medical care and that it is linked with anxiety, depression, substance dependence, and reduced quality of life. An estimated 20.4% of US adults struggle with chronic pain.
We typically discuss chronic pain as a “body” issue…but is it just a “body” issue? Our experience of pain is entirely constructed within the brain. This is not to say that one’s experience of pain is not real. It is simply that our brain creates our experience of how our body feels. Chronic pain is therefore a mind-body issue.
The experience of chronic pain has two aspects: the sensory-discriminative aspect and the cognitive/affective aspect. The sensory-discriminative component is the intensity, quality, and location of the pain while the cognitive/affective aspect involves one’s attention, fear and anxiety, and anticipation of the pain. The sensory-discriminative and cognitive/affective components of pain are somewhat determined by an individual’s unique traits and life experiences. This translates to: what is painful to one person, may not be painful to another.
Let’s talk about the body’s stress response to understand more of how chronic pain impacts mental wellness (and vice versa). When someone experiences distress, a part of your brain called the amygdala becomes activated, alerting the hypothalamus that the brain feels threatened. The hypothalamus activates the sympathetic nervous system, getting your body ready for fight-flight-freeze. Your body then releases epinephrine (adrenaline) which causes your respirations, blood pressure, and pulse rate to increase. Your adrenal glands may then release cortisol if your brain continues to perceive a threat, extending your body’s stress response. While cortisol is a helpful hormone, if released for prolonged periods of time (like chronic stress), it can be very detrimental to our bodies.
When someone experiences unmanaged chronic pain, their body and mind remain in a persistent state of stress. Chronic pain and chronic stress become a seemingly never-ending cycle, with one’s stress increasing their pain and one’s pain increasing their stress. This can seem like a dire situation for so many who experience chronic pain. Many individuals seek pain management, typically opioid medications, to help reduce the experience of their pain, 21-29% of whom misuse their prescriptions, with 8-12% of those individuals developing Opioid Use Disorder. For some individuals, opioid treatment may be too high risk and they may desire to treat their pain in a more holistic manner, reducing their reliance on medications.
There is increasing evidence that the utilization of mindfulness-based practices can aid individuals in managing their chronic pain. The consistent practice of meditation and other mindfulness-based practices has shown to decrease amygdala activation (the first step of your body’s stress response) and with long-term practice, can even decrease cortisol levels in the body. Mindfulness teaches us to approach our present experience, including pain, with a nonjudgmental and curious attitude. Therefore, if we can learn how to approach our pain in a less distressed manner, we may be able to decrease our experience of the pain. As stated previously, pain and stress tend to increase one another, so can’t we assume they can also decrease one another? Mindfulness can help us accept that pain is a part of life, but suffering does not have to be. It is important to note that mindfulness is not a cure for chronic pain but a tool that one can utilize amongst many other tools to help them in managing their experience of chronic pain and their mental wellness journey.
If you are interested in how mindfulness-based practices and holistic psychotherapy can aid in the management of chronic pain, feel free to schedule a complimentary 15-minute consult with me to see if Wildwood Counseling would be a good fit for your needs.
References
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Ahmad, A. H., & Abdul Aziz, C. B. (2014). The brain in pain. The Malaysian journal of medical sciences : MJMS, 21(Spec Issue), 46–54.
Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. DOI: http://dx.doi.org/10.15585/mmwr.mm6736a
National Institute on Drug Abuse. (2020, June 10). Opioid Overdose Crisis. from https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis
Rosenblum, A., Marsch, L. A., Joseph, H., & Portenoy, R. K. (2008). Opioids and the treatment of chronic pain: controversies, current status, and future directions. Experimental and clinical psychopharmacology, 16(5), 405–416. https://doi.org/10.1037/a0013628