The psychological response to pain
09/04/2023
Pain is a leading reason for patients seeking medical care and can be one of the most disabling and costly conditions. We hope to give you a small insight to pain and an awareness of how we can provide support.
From an insurance point of view, the costs involved with injury claims are impacted by the extent of injury, the time taken to recover and any additional costs that result from their injury. Early intervention is key to reducing the total recovery period and thus, reducing the overall cost of a claim, where possible.
We know that pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors. It is a combination of these aspects that can affect how that pain is perceived and how well you are likely to respond to treatment.
From a physical point of view, the pain mechanism is straightforward. For example, when you sustain an injury, such as an ankle sprain, certain processes are initiated.
When we sense the pain that is associated with the injury, sensory receptors send messages to the spinal cord and brainstem, and then to a part in the brain called the thalamus. This is where the pain sensation is registered, the information is processed, and the pain is felt.
What is not discussed as much is the emotional and psychological response to injuries. People differ greatly in their capacity to manage emotions, particularly their emotional reaction to pain. According to studies, some patients appear to be more sensitive to pain than others. This sensitivity and the perception of the injury can lead to a variety of emotional responses.
Using a sporting example, Olympic athlete Dame Kelly Holmes from the UK suffered from severe depression because of her Achilles tendon injuries that she sustained while training for the Olympics. A study of 353 male athletes from a mix of sports found that 51% of them showed symptoms of depression after being injured and 12% became moderately to severely depressed.
Emotional responses to pain
Other emotional responses to pain include fear, anger, guilt and frustration. For example, if you dislocate your shoulder there may be the fear that you may not be able to regain your range of motion in that joint again to return to normal function. Anger and frustration can be linked to loss of function and quality of life. These feelings can easily spill over to those close to us, such as family and friends, and our attitude in returning into the workplace. An individual may not physically be able to return to their normal duties at work, or the psychological impact from the injury could cause significant delays in returning to the workplace if not treated.
Lack of mobility may lead to lack of socialising opportunities, which can result in increased feelings of isolation and social withdrawal. Even if socialising opportunities exist, depending on the severity of the injury, individuals may feel anxious, scared, or shutdown in social situations. Clearly, people want to avoid this, which can result in further social withdrawal.
As you can see these negative feelings and emotions can have a detrimental effect on any recovery programme, especially when you consider that it can take 12 to 16 weeks to recover from a shoulder dislocation and six to nine months to recover from an ACL injury.
Therefore, managing the psychological responses to pain is just as important as the physical treatment that you will work though. Cognitive Behavioural Therapy (CBT) is a very useful mechanism to help people work through these responses.
CBT is an approach to treatment that helps you identify unhelpful thought and behavioural patterns. The idea is that once you notice these patterns, you can then change them and develop positive coping mechanisms.
Psychological management of pain
So how can this help your psychological management of pain? Studies have shown that this form of therapy can improve your quality of life. It focusses on reducing pain and distress by modifying how you perceive the pain, avoiding maladaptive behaviours such as avoidance, withdrawal, self-harm etc.
Techniques involved in CBT include goal setting, imagery, and positive self-talk. Imagery can be used within a rehabilitative program to allow an individual to envision themselves to be fully recovered by the end of the process, which can aid motivation.
Goal setting is a method of encouraging adherence to rehabilitation programs. It helps to break down the duration of the rehabilitation time by utilising short-, medium- and long-term goals. This has been proven to be very effective in terms of motivation, managing expectations and reducing anxiety.
The key point to emphasise here is that when you do have an injury that results in any type of pain, it is important to consider a multi-faceted, holistic approach to its management. Zurich’s rehabilitation Team has a wealth of experience of guiding an individual through their rehabilitation journey by not only assessing their physical injury but also taking into consideration the psychological impact this may have on them also. By doing this we are greatly increasing their chance of returning them to pre injured state and enhancing their physical and mental well-being in a good time frame.
Download our 'Psychological Self-Management Guide for Injured Parties', which has been put together to provide some useful, bite-sized information on common psychological symptoms and/or conditions.
