Chronic Pain: A Disease of the Mind
Photo by Bret Kavanaugh on Unsplash
There is a common misconception that chronic pain is just a physical sensation: distressing, but limited to the affected body part. This is an overly simplistic understanding of a disease which is estimated to affect 50 million U.S. adults. We must acknowledge that chronic pain is a truly debilitating condition that is experienced beyond the physical dimension. Like other chronic illnesses, It affects various aspects of life and can often lead to compromised psychological, social, and emotional well-being.
Living with chronic pain is a challenging and stressful process. Beyond physical discomfort, the adverse implications that pain can have on daily life are numerous and vary from person to person. Pain can prevent us from participating in our favorite activities, leave us dependent on others, lower our self-esteem, make us feel frustrated and isolated, disrupt our sleep patterns, and weaken relationships. It can reduce productivity, inflict financial hardship, cause fatigue, and instill feelings of hopelessness.
These are only a handful of examples that expand the definition of chronic pain beyond that of a localized somatic event. Moreover, the combination and long-term accumulation of these collateral consequences makes chronic pain potentially hazardous towards mental and emotional well-being. Multiple studies have concluded that serious psychiatric comorbidities, such as depression and anxiety, are likely to develop among individuals struggling with chronic pain.
This association between psychiatric disorders and chronic pain is especially concerning because of the dangerous cycle that it perpetuates. Not only can chronic pain contribute to the risk of psychiatric issues, but psychiatric disorders can also exacerbate pain perception, worsening the patient’s pain experience. In addition, certain psychiatric conditions can increase susceptibility to substance abuse disorder, increasing risk of opioid misuse and addiction. This cyclic link between chronic pain and mental health issues strongly indicates that treatment for chronic pain should include a psychiatric component to prevent the cycle from deteriorating the patient’s quality of life.
For this reason, the field of pain psychiatry has become more prominent in chronic pain management. There is even a greater tendency to address chronic pain as a disease of the brain, emphasizing the role that the mind plays in the diagnosis. Pain psychiatrists can support the patient in two ways. First, they can prescribe psychiatric drugs which hold pain-relieving properties. These medications, such as antidepressants, anticonvulsants, and mood stabilizers, can shift patients away from opioids and other narcotics. A study at Memorial Sloan-Kettering Cancer Center in New York showed that the antipsychotic olanzapine could provide sufficient pain relief to reduce patient use of opioid medications by 75%. There is also evidence to show that antidepressants can boost the analgesic potency of opioids, reducing the dosage of opioid required. Secondly, pain psychiatrists can use psychotherapies for pain management. Supportive psychotherapy and cognitive behavioral therapy can help the patient overcome feelings of guilt, helplessness, and despair that often come with chronic pain diagnosis. The ultimate goal is to help the patient develop healthy thinking mechanisms so that they feel more optimistic and in-control throughout their pain journey.
We need to remember that chronic pain is not a “symptom” that can be cured by a single pill. Instead, it is an experience that can greatly affect quality of life in many aspects. The field of pain psychiatry holds great promise and potential in expanding the treatment of chronic pain and in helping patients come to terms with their diagnosis. Appreciating chronic pain patients as individuals whose everyday struggles with pain can impact their mental health is necessary to ensure that patients are treated comprehensively and holistically so that their quality of life is prioritized and maintained.