Dr. Julia Kim, Clinical Psychologist, discusses the role that the brain plays in understanding the experience of pain.
Pain is not all in your head but part of it is. By head, I am referring to your brain. With advances in neuroimaging and neurophysiology, we are beginning to understand that the experience of pain is a complex process. It is affected by somatosensory, structural, chemical, cognitive and emotional changes in the brain. Unfortunately many people think of all in my head as a reflection of only psychological factors. While there are psychological factors involved, it is not the only aspect.
Brain imaging shows differences between the effects of acute and chronic pain on the brain. Chronic pain stimulates changes in the central nervous system (CNS comprised of the brain and spinal cord). The brain’s ability to form new connections in response to injury or changes in the environment is called neuroplasticity. Your brain and spinal cord serve as the main “processing center” for the entire nervous system and control how your body works, including experiencing pain. Changes in processing pain can result in heightened experiences of pain. Chronic pain also provokes structural changes in multiple areas of the brain that are involved in cognitive and emotional processing. This increases the potential for changes in cognitive and emotional states such as fear, anxiety, anger or depression.
So what does this all mean? It means pain has the ability to change how the brain processes it and change the brain’s emotional response, increasing the intensity of one’s experience of pain. The brain’s ability to transform in response to chronic pain helps us to understand that our reactions may also be altered due to changes in our brain so it is partly in our heads!
Pain, whether new or chronic, can make life difficult and unbearable at times. Pain is an invisible and subjective experience. There are no objective tests to measure pain and not all pain is the same. This makes it difficult for doctors, family and friends to understand your experience. But, that does not mean your pain is not real.
Treating pain, like any other ailment, requires understanding the cause, how you experience symptoms, and how you respond to treatments, activity level, emotions and stress. When we are in pain we automatically respond in a way to minimize it. We move less, we guard the affected area, we socialize less overall, we tend to stop participating in life as we know it. While it makes sense why this would be the initial response (immediate relief) these responses typically exacerbate pain. If we don’t move, we get stiff and weak. If we guard certain areas, we become imbalanced which could lead to further injuries. If we isolate ourselves because it’s too hard to go out or focus on something else, we spend more time thinking about pain which makes it all-consuming. Once the cycle starts it doesn’t really matter which came first, the chicken or the egg. It’s in motion.
How can you break this cycle? Doctors frequently recommend psychotherapy in conjunction to other treatment modalities. Psychotherapy focuses on all of the above to help you take control of your pain, as opposed to pain being in control of you. The goal is to break the cycle and not have pain consume so much of your energy. Pain likes to be in control which can lead to stress, anxiety and depression. A psychologist can help you take control of your life by implementing strategies to reduce pain, such as learning how to monitor your body and adjust your activities accordingly, and finding more effective ways to cope with stress which intensifies pain.
While pain may be partly in your head, you also have tools in your head to help you reduce your pain! Be pro-active. Accept that part of pain is in your head and help re-wire your brain to reduce pain.
For more technical information about pain and changes in the brain:
Schweinhardt, P. & Bushnell, M. C. (2010). Pain imaging in health and disease – how far have we come? The Journal of Clinical Investigation, 120(11), 3788-3797. doi:10.1172/JCI43498.
Dr. Julia Kim is a Clinical Psychologist at Hospital for Special Surgery. Dr. Kim is the first Clinical Psychologist to formally work within the HSS family and her focus is to develop an Integrative Care Program, designed to incorporate psychological services to a multi-disciplinary care team. She works closely with physicians and surgeons to optimize the best possible medical outcome.