For Pain Patients, the Physical and Emotional Are Intertwined

Areas of the brain that process physical pain share real estate with our emotion centers, making a multipronged approach to pain treatment essential.

No doubt many people suffering from chronic pain have heard the phrase, “It’s all in your head.” The reality is that all pain — whether caused by a broken leg or fibromyalgia — is processed in the brain, right alongside parts of the brain that regulate emotions.

This overlap between emotion and pain, however, is not a roadblock to better health. Instead, it can provide a pathway for people to gain control over their chronic pain.

“I’ve found that being positive and optimistic, staying hopeful, and really focusing on helping other people has been a wonderful way to get through it,” said Ashley Boynes-Shuck, a blogger and health advocate from Pittsburgh, Pa. She has been coping with juvenile idiopathic arthritis and chronic pain since she was ten years old.

Pain and Emotion Share Real Estate in the Brain

The emotional component of pain has recently received more attention in the scientific community. For example, a new definition of pain by the International Association for the Study of Pain describes it as an "unpleasant sensory and emotional experience."

At the heart of the matter — or more precisely, the head — is that the brain has evolved a certain amount of overlap between its emotion and pain centers. This economy of design allows the brain to efficiently process a wide range of sensations, such as a bruised knee, a cut finger, anger, and sadness.

“The areas of our brain that are associated with sensory perception, they share real estate with the areas of our brain that are involved in the processing of emotions,” said Dr. Beth Darnall, a pain psychologist at Stanford University and author of Less Pain, Fewer Pills.

Pain is processed in the brain. As a result, aches from an injury or surgery can linger long after the body has healed, as the sensations shift from short-term pain signaling the actual injury to long-term, chronic pain that exists independently.

In a 2013 study in the journal Brain, researchers followed a “group of patients over a year that started out with acute pain and ended up with chronic pain,” said Dr. David Hanscom, an orthopedic spine surgeon with the Swedish Neuroscience Institute in Seattle, Wash. “You could see the pattern of neurological synapses go from an acute pain center to more the emotional center connected with the limbic system.”

In addition, inflammation in the body — as occurs with conditions like rheumatoid arthritis and fibromyalgia — continues to generate pain signals in the brain, even in the absence of a physical injury.

Negative Emotions Can Drive Pain

Because emotions are intimately connected to the sensory centers of the brain, what we feel emotionally may determine, in part, what we experience physically in our bodies.

“I’ve noticed, just in hindsight, that those times where I was more in a worse place emotionally about my illnesses were also times that I wasn’t as motivated to exercise, and I wasn’t as motivated to go out with friends, and things like that,” said Boynes-Shuck.

People with chronic pain often avoid exercise and social interaction, two activities that can sometimes provide relief. Certain emotions are more likely to feed this cycle of pain.

“What pours the gasoline on the fire — in this case, the 'fire' is your pain processing circuitry in your brain — is that negative emotional experience," Darnall said. "Feelings of fear, of anger, of sadness, of depression.”

Moreover, the pain itself can fuel negative emotions. Waking up each day with debilitating aches that won’t go away can lead to frustration, resentment, and stress. People with chronic pain — who number around 100 million in the U.S. — are also more likely to develop mood or anxiety disorders. At the same time, depressed patients have three times the risk of developing chronic pain. The result is a cycle that is difficult to break.

“You really don’t want to go out of the house,” said Lisa Harris, of Waynesville, Ohio, a mother of two who was diagnosed with psoriatic arthritis, a painful joint condition, when she was 35 years old. “For one, you hurt so bad. Activity does help, but you’re also in so much pain … So you don’t want to go out with your friends and go visit family, and things like that, because you can’t do the things that they do.”

Emotions Can Provide a Way Out of Pain

Understanding that emotions play a role in how we experience pain may provide some comfort.

“Just knowing something, it’s helpful,” said Darnall, “but it’s only going to make a difference in your life to the extent to which you acquire skills to really start to control these pieces, [which] are functioning to influence your experience and your suffering.”

There are many options for dealing with chronic pain, from being evaluated by a pain physician or pain psychologist to trying methods like biofeedback, acupuncture, and yoga. Exercise of any kind is an excellent treatment for pain.

“It’s different for every person, based on their age, their condition, all of these things,” said Darnall, “but it’s about personalized medicine and finding the balance for that person.”

“I’ve found that being positive and optimistic, staying hopeful, and really focusing on helping other people has been a wonderful way to get through it." — Ashley Boynes-Shuck

The best approach is to tackle the pain from many angles and seek help from medical professionals, many of whom have survived their own battles with chronic pain.

As a spine surgeon, Hanscom experienced almost 15 years of chronic back pain, which led him to search for alternatives to surgery. He outlines his roadmap to pain relief in his book, Back in Control, which includes better sleep, stress management, and pain medication, along with shifting the brain away from long-ingrained pain pathways.

“What you’re doing with simple mindfulness meditation type tools is you’re simply shifting away from those [pain] pathways onto different pathways,” said Hanscom. “Then as you, with repetition, start nurturing the non-pain pathways, at some tipping point most people engaged in the process really go to pain-free.”

But when asked where emotions fit into chronic pain, Hanscom hedges. “It’s all about emotions, but it’s a little bit more subtle than that,” he said, giving the example of anxiety, which can alter how the body responds to pain through the effect of stress hormones. “We look at anxiety actually as a neurological reflex or mental reflex, rather than an emotion,” he said.