Chronic pain and stress illness are complex. They are a mix of physical sensations and emotional responses. As explained previously, chronic pain differs from acute pain. Acute pain results from an injury or disease in the body. It is short-term, lasting usually up to three months at the most.
Chronic pain is persistent pain that lasts more than three months, despite medication or other forms of treatment. And can be either primary or secondary.
If there is no known medical reason for the persistent pain it is known as primary chronic pain. This includes syndromes such as Fibromyalgia, Migraine, and Complex Regional Pain Syndrome. Whereas pain caused by a medical condition such as cancer would be known as secondary chronic pain.
This article is the 4th of the series Stress Illness: The Complete Guide and will focus on the proposed causes of Primary Chronic Pain and Stress Illness.
In this series of articles, you’ll learn everything you need to know about Stress Illness. Each article addresses a different aspect (the physical, emotional, cognitive, behaviours, losses, and treatments available.) and builds to create a useful reference for those wishing to understand more about the complexities of Chronic Pain and Stress Illnesses.
Does Pain Equal Damage?
In the Western world, we have been socialised to believe that if we experience physical pain, there is something wrong with the body. And, that the intensity of the pain, equals the amount of harm to the body. Although this can be the case, it is not always. Dr Chris Barker runs a pain clinic in Ainsdale, Merseyside. He explains,
"Our traditional model of thinking about pain is about MRI scans and looking for structural things - the problem is we interpret that to mean that's going to be the cause of pain." (https://www.bbc.co.uk/news/health-61309962 accessed 13/05/2022).
In fact, the definition of pain as adopted by the International Association for the Study of Pain (IASP) is,
"An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." (https://pubmed.ncbi.nlm.nih.gov/32694387/ Accessed 13/05/2022. Emphasis added).
Pain is an Emotional Experience
So, pain, especially chronic pain is also an emotional experience and does not have to be caused by tissue damage. This is further understood when considering neuroscientific research that shows that acute pain and chronic pain have a different signature in the brain.
Baliki et al (2006, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177069/ Accessed 13/05/2022) demonstrated that acute pain shows up as activity in the insula. Whereas, for longer-term pain the medial prefrontal cortex (mPFC; including rostral anterior cingulate) where more activated. This was area is ‘known to be associated with negative emotions, response conflict, and detection of unfavourable outcomes, especially in relation to the self.’
Pain is Affected by Thoughts
In a study by Tor Wager and colleagues in 2015, they demonstrated that pain can be modulated by thought and emotion. This is unlike other sensory information such as vision or sound, which are processed in distinct brain regions. Pain is more complex (https://www.newscientist.com/article/dn26799-brain-signature-of-emotion-linked-pain-is-uncovered/ Accessed 13/05/2022).
The experiment by Dr Wager showed that pain intensity could be controlled by instructing participants to imagine the heat applied to their arm as a warm blanket on a cold day. These thoughts enabled the scientists to tell how much of the subject’ pain was neurological and how much was physical, given the different brain regions that lit up in fMRI scans (https://journals.plos.org/plosbiology/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1002036 Accessed 16/05/2022). Essentially, this is evidence that chronic pain has a different signature in the brain, than acute pain. It shows up as emotional pain, rather than physical pain.
The Emotional Pyramid
This research fits with the experience of chronic pain and stress illness clients describe. They nearly always suffer more negative emotions than the average population. The most common faced by this population I have identified as the Emotional Pyramid. With those that are most accessible discussed earlier in therapy, and those more difficult, hidden emotions, addressed later in the process.
Most Accessible Anxiety
Depression, Frustration, Guilt.
Least Accessible Shame, Jealousy, Rage, Hatred, Disappointment.
Emotion Vs. Physical Pain
We can consider whether this is cause or effect. Which came first, the strong negative emotion, or the strong negative sensations?
Once both are established it is hard to decipher and looks more likely a mutual transference. Pain feeds anxiety. Anxiety feeds pain. Ad Infiniti. However, initially either can start the process.
What Causes Chronic Pain or Stress Illness?
An acute pain can turn chronic if the individual experiences events that increase negative emotions that feel overwhelming during the time the body would normally be healing (six weeks to three months post injury).
If in this period the person suffers emotional trauma, grief, or chronic stress, then this could increase the likelihood that the mind will continue to produce pain signals related to the wound, to elicit attention and care.
Or this can work the other way. A person suffering emotional overwhelm due to chronic stress, trauma, or grief, then notices a physical symptom (pain or unpleasant sensation) and the two are associated together in the mind.
If the person has not been taught, or ignores, the emotional messages to take care of themselves whilst in this vulnerable state (emotionally and physically), then the signal is often intensified by the mind.
This is often misinterpreted as the painful/unpleasant bodily symptom needing a physical cure, and the individual continues to search for answers via physical healthcare. However, this adds to the emotional burden and increases the frustration further.
How to Start to Recover
Once the individual is able to recognise that their pain is caused due to not being taught how to appropriately recognise, and relate, to their own, or other people’s, emotions, they are able to start the journey to recovery.
A better understanding of emotions enables us to make better relationships with ourselves, others, and the world around us. It helps us to get an immediate summary of what is happening, void of cognitive and societal influence.
Over dependence on the cognitive mind has led to us trying to think ourselves out of ‘problems’ that were not solvable by thinking. For example, chronic physical pain. It only leads to a habit of worrying and causes more anxiety.
By learning to listen to, and understand the language of emotions, the symptoms stop having to scream. As we stop battling our mind and body, symptoms reduce in intensity and frequency.
If you would like to learn how to start to understand your emotions (emotional intelligence -EQ), then I have created a handout, 'Improve Your EQ - SAFELY'
Next time I’ll be discussing how we develop a number of behaviours in an attempt to manage physical and emotional symptoms.