Emotional Impact Of Pain Experience
Maris Pasquale, LMSW, has been the social worker for Hospital for Special Surgery’s Ambulatory Care Center Pain Management Service for the past two years, working with patients who have chronic rheumatologic and orthopedic pain concerns.
Before presenting on the impact of the individual pain experience, Ms. Pasquale opened up the workshop with a brief exercise based on mindful meditation, a practice which has been integrated by many doctors into western medicine. Mindful meditation involves focusing the mind in a way to increase awareness of the present moment. She explained the importance of this experience as a potential method to cope with pain that can be easily done anywhere, even on the bus.
She first asked members to sit up straight, close their eyes, and put aside all thoughts of the future and past. She then asked them to stay in the present and focus on an awareness of their breathing in the present.
The exercise could be done from a couple of minutes of just focusing on breathing and letting your thoughts come and go, but being aware of the current state you are in. She pointed out that this exercise can be most helpful during stressful times, such as holidays or events.
As the exercise was completed, she opened a brief discussion of how everyone felt about this exercise. Members were pleased with how this brief exercise helped them feel less stressed and more focused. Again, Ms. Pasquale emphasized how easy and beneficial this exercise is and how it could be done anywhere.
The Experience of Pain
Many different factors influence the experience of pain, which is different for everyone. These include:
* Spiritual beliefs
* Socio-economic status
* Emotional response
* Support systems
* Life before pain onset
Other factors can include a learned response that can be related to the response of your family. Parents, for example, can teach their child how to respond to pain, and this can be a lingering reaction throughout different experiences and interactions with others. Also, societal and medical care systems can impact the pain experience. For example, you may not have access to the care of a physician who is an expert in managing pain.
Additionally, changes in disability; your societal, social, or family role; daily routines; job loss; and sleep disturbance can be factors that can attribute to constant pain, otherwise known as chronic pain. These factors can cause distress in addition to the pain experience. Studies show that when you are experiencing emotional distress, it increases pain and causes it to last for a longer period of time than expected.
Some common emotional responses to pain can include anxiety, depression, anger, a feeling of being misunderstood, and demoralization.
According to a 2004 study, individuals who are experiencing chronic pain in primary care settings have a higher probability to experience anxiety and depressive disorders than those who are not.(1)
Ms. Pasquale emphasized the importance of recognizing whether these factors are prevalent in your life. If they are, it’s important to seek help from your primary care doctor or social worker, or call 1-800-LIFENET, a multilingual crisis intervention hotline.
Emotions and the Chronic Pain Cycle
Pain is influenced by feelings of depression, anger, and anxiety. They all affect one another in the pain experience. For example, anxiety is a better predictor of functional limitations than physical findings or even pain severity and duration. You may experience muscles tightening because you might be experiencing an emotional reaction, such as anxiety or anger, and that may result in increased pain.
Being aware of and trying to maintain control over your emotions can be important in decreasing depression and anxiety, and can be helpful in understanding any anger that can be challenging in coping with pain. Patients may in some situations feel stigmatized when they demonstrate intense emotions like these in the context of their treatment.
Impact of Pain on Identity
How you identify yourself to others is an important element of your individuality, and having chronic pain and not knowing when it will ever go away, if ever, is a huge issue that can change the course of your identity.
If you are experiencing chronic pain, you might not be able to do certain tasks or fulfill certain roles that were once common, and that can feel disempowering.
Where and how people derive value in their identity is culturally informed, including gender, ethnicity, and socioeconomic status. Depending on what roles or characteristics are most valued to an individual, impairment in that area will most affect his or her identity.
For example, someone who feels culturally that physical strength and ability is extremely highly valued may feel the impact of the pain experience more significantly if it impairs this ability and he or she can no longer complete the same physical tasks.
Similarly, the invisibility of pain can be isolating, especially when outwards appearance may remain the same.
Impact of Pain on Family
As you experience pain symptoms, either acute or chronic, this can shift family patterns. For example, a parent might not be able to fulfill certain tasks anymore and another parent might take over, which may cause confusion amongst other family members.
Also, other factors may include increased stress, financial burden, effect on sexuality and other intimate relationships, and potential resentment in the relationship.
Impact of Pain on the Medical System
According to another study in 2005, patients report that their doctors are not acknowledging their concerns because they may not agree with their “medical interpretation of pain.”(2) Also, on the other hand, patients may feel that there are other factors that may lead to their pain, which their doctors might happen to overlook.
When patients are given a different treatment that is not effective, they often share their experience with their doctor but may feel stigmatized as “symptom magnifiers and complainers.” As a result, patients feel stressed in this predicament and don’t know what to do or where to go when they feel like they are not being heard or taken seriously.
Coping with Pain through Education and Spirituality
It is important for you to ask for any educational materials that can be helpful to understand the symptoms of pain and how to reduce pain, as well as effective methods to acknowledge your feelings and communicate them to others.
Also, many people find it effective to bring spirituality into their life as a way of coping with pain. Several studies have shown that spiritual belief can help reduce pain. If you so choose, you should be able to feel comfortable to share this component with your health care providers and let them know which methods you feel are helpful to the pain experience.
Maladaptive Pain Beliefs and Ways to Address Them
As we experience pain, we may have many different beliefs of how we should live our life with the pain we are experiencing; these beliefs may be maladaptive and might hinder our functioning level. In other words, the normal coping and adapting mechanisms used by those with chronic disease can often inadvertently harm them, both physically and psychologically. According to a 2007 study, these maladaptive beliefs can cause higher pain, poorer physical functioning, depression, stress, and more disability.(3)
Ms. Pasquale pointed out that striving to have a sense of control in managing your pain is helpful. Gaining control can mean finding more resources to understand the impact of pain, such as patient education about how to live with pain, communicating to your doctor about your different concerns and challenges, and accepting your situation.
Because the experience of pain is subjective and unique to each individual, this education and communication is pivotal to help manage and cope in the best way for each person.