The Emotion–Pain Connection

Chronic pain and negative emotions often exist in a circular relationship, each making the other worse. Break the cycle.

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Although it may feel like it’s coming from your joints, pain – particularly the chronic pain common to arthritis – is also an expression of your state of mind. If you’re depressed or anxious, you’ll very likely hurt more than when your mood is lighter or more balanced.  The fact that pain itself is depressing and worrying only makes the problem worse.

Chronic pain and emotions are so intertwined, in fact, says psychiatrist and palliative medicine physician David Buxton, MD, that’s it’s often hard to tell where one ends and the other begins. People with depression, for example, have about three times the risk of those without it of developing chronic pain. And, those with chronic pain have about the same increase in risk for winding up with clinical depression.

“People who tend to be depressed or anxious are more susceptible to pain,” says Dr. Buxton, clinical assistant professor of medicine at Virginia Commonwealth University and director of the private Center for Palliative Psychiatry, both in Richmond. Depression and anxiety can intensify feelings, including pain, hopelessness and sadness, he says. “Mentally, emotionally and physically, everything sensory, including pain, ratchets up.”

Multiple studies of osteoarthritis, rheumatoid arthritis, lupus and fibromyalgia show that people who experience more negative emotions also report more pain. Not surprisingly, people with these conditions also have substantially higher rates of depression and other mood problems compared with those without arthritis and related conditions.

Relieving depression and anxiety makes people feel better physically, too, and most types of medications used to treat these conditions can also be prescribed to help relieve pain.

Advanced imaging of brain processes is helping scientists understand why the mind-body connection is so strong.

Pain and the Brain

“Pain-related signals reach the brain through multiple pathways, but pain is constructed in the brain,” explains Tor Wager, PhD, director of the Cognitive and Affective Neuroscience Lab at the University of Colorado at Boulder. There, he and other researchers use techniques like functional magnetic resonance imaging to look at the brain pathways that generate and regulate pain and emotion.

“All of the regions targeted by pain-related signaling from the body have other functions – some help regulate blood pressure and other aspects of physiology, others participate in creating strong emotional responses, and yet others help you learn what to do and not do in the future. So, pain-related signals interface with other brain processes in many ways,” he says. 

The way people interpret and cope with their emotions and pain, for example, drive the patterns created by the brain. These patterns shape how we remember our pain, and those memories, in turn, strongly influence what we feel in the present, says Dr. Buxton.

Another way to put it, says Wager, is that, “our level of fear of pain and the narrative we tell ourselves about pain can influence how our brain learns to deal with it across time.”

Fortunately, says Buxton, our brains are very “plastic,” meaning they respond eagerly to retraining, redirection and reframing. This can help break down problematic, and sometimes literally painful, mental patterns.

Calming Mind and Body

Cognitive behavioral therapy (CBT). People with arthritis can use CBT to reshape their response to chronic pain and unhelpful thought patterns, says Dr. Buxton. “CBT, which teaches people to recognize and change negative thought patterns, can also really change the way people view the world and how they’re coping,” he says. Studies have shown, for example, that six weeks of CBT improves depression, fatigue and feelings of helplessness in people with rheumatoid arthritis.

Psychologists and other therapists currently deliver CBT, but researchers are looking at ways to expand people’s access, including internet-based CBT.  Rheumatology nurses are also being trained in the technique.

Mindfulness practices. Meditation, yoga, tai chi, acupuncture, and similar practices can help direct and distract the mind away from a focus on pain. These are powerful tools for reducing the impact of chronic discomfort, says Dr. Buxton.

Exercise. Regular physical activity relieves depression and anxiety about as well as many prescription antidepressants. In people with OA, RA, and other types of arthritis it also relieves pain and improves mobility. It’s hard to get moving when you’re pain, but the Arthritis Foundation has many good suggestions for people with arthritis to start.

Learn more about the emotion-pain connection on our Breaking the Pain Chain Toolkit.

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