“Pain and the Mind connection” – Psychosomatic illnesses - Dr Shreedhar Archik

Dr Shreedhar Archik - Orthopedics Surgeon Mumbai Dadar

PAIN AND THE MIND – PSYCHOSOMA, PAIN MANAGEMENT & PSYCHOTHERAPY

The International Association for the Study of Pain’s widely used definition states: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” We all know that there is much more to pain than the visible or invisible body or tissue damage. And most of the times it is not the pain itself, but what is does to you that is the most damaging part.
Pain, of course, is always both a physical and an emotional experience. For instance, if I hit my head accidently, in addition to the physical pain, I am also likely to either blame myself or someone else.
When people feel physical pain, the same areas of the brain get activated as when people feel emotional pain: the anterior insula and the anterior cingulate cortex.
When you are in pain, it is natural to feel angry, sad, hopeless, and depressed. Pain can alter your personality, disrupt your sleep, and interfere with your work and relationships.

Can body pain come from the mind? Apparently, Yes!!

Clinical research data from the last several decades has strongly concluded that this type of pain, the one that originates from the mind, does indeed exist. It is called psychosomatic pain; “Psychosomatic” comes from the Greek words for “mind” and “body”.
Psychosomatic pain is pain that doesn’t only originate from physical causes (as opposed to, say, bleeding from a cut originates from purely organic causes).
Psychosomatic pain can be just as excruciating as any other pain. For one thing, it is very real: it occurs in the body, through bodily mechanisms
What makes it “Psychosomatic” is that it is related to emotional problems (i.e. it may originate from emotional problems, or be aggravated by emotional problems). The theory behind this is that any negative emotion that does not get an outlet or completion tends to store itself in different parts of our body. Over a period of time this shows up as body pain.
The word “psychosomatic” is often misunderstood to mean: “it’s all in the mind”, i.e. “it’s not real, and it’s imaginary”.
Because the Psychosoma argument is so powerful, I also want to be careful to point out what it doesn’t mean:
– It doesn’t say that “everything is in the mind”.
– It doesn’t negate the value of ideas and rational thinking. This would be absurd.! It’s just that, if we were to only pay attention to logical thinking, we would be cutting ourselves off from a major portion of our resources, especially, our deeper unconscious mind. Our goal is to combine both.

CASE STUDY : A 25 year old IT professional was referred to me with symptoms of shoulder pain. All investigations like x ray and CT Scan were normal. Despite doing physiotherapy, making nutritional changes and lifestyle changes, in addition to taking painkillers for a period of more than 6 months, the pain refused to go away!
That is when her orthopaedic physician recommended she seek psychological help. During therapy sessions, she revealed her feelings of loneliness and isolation. Strained communication with her spouse and her in laws was the primary reason for this. Once we worked through these unhealthy communication patterns and established healthy ones, her shoulder pain lessened and then vanished. The shoulders are the body area that is psychologically associated with “burden carrying”. As she learned how to “unburden herself” by ensuring healthy communication, she regained pain free shoulders!

Is there any scientific reason for Psychosomatic Pain?
Russian space scientists were the first to discover that every time you have a thought or feeling, it triggers the release of tiny chemical proteins called neuropeptides (NP). Without neuropeptides, your body could not function. Hormones are neuropeptides, as are endorphins, cortisol, and adrenalin. Altogether, your body produces about a thousand different NP’s, each with its own unique function
Positive emotions will elicit beneficial NP’s such as endorphins or oxytocin. Negative emotions will elicit NP’s that are helpful when an immediate response or action is required, but become harmful when released over a prolonged period of time. An example of this is the stress hormones cortisol, adrenalin and norepinephrine. These NP’s trigger your ‘fight-or-flight response.’ That can be helpful if you need to fight or run. But, over time, even low levels of these stress hormones start to damage your body.
So, any prolonged negative mental state will inevitably weaken a correlating area of your body. By the time you see symptoms, you’ve probably held that state of being for quite some time.

DEPRESSION AND PAIN:
Depression is very common among people who have chronic pain. Pain can cause depression or make existing depression worse. Depression can also make existing pains worse.
If you or your family members have or have had depression, there is a greater risk that you could develop depression from your chronic pain. If your pain does not subside even after following orthopaedic advice, do get yourself screened for possibility of a depression. Even mild depression can affect how well you can manage your pain and stay active.
Another very common reason for developing Body Pains in the current fast paced world is STRESS.

STRESS – A NEW AGE PAIN:
Given the hectic pace of modern living, it may be virtually impossible to not experience any stress! Many a times, it’s also difficult to recognize that you’re experiencing stress or anxiety. Because of the mind-body connection between your mental health and physical health, stress or anxiety often appears physically as vague pains and aches in the body. Here are some common physical symptoms of stress or anxiety that you may not realize are psychological in origin:
• Frequent headaches: we tend to work out mental stress through clenching of our jaw; tensing our facial, neck, or shoulder muscles; or grinding our teeth. these are physical responses to stress that could cause headaches.
• Restlessness, tapping your foot or hand. Stress or anxiety can cause this common nervous habit.
• Gastrointestinal distress. Some people are inclined to storing their stress in their gut/stomach leading to diarrhoea, constipation, nausea, or upset stomach.
• Eczema. Stress and anxiety increase inflammation of the skin, which can trigger or worsen eczema.
• Insomnia, nightmares, sleepwalking, or disturbed sleep: sleep is known to be one of the best natural antidotes to stress. If you are experiencing a disturbed sleep pattern, it could indicate the presence of stress. Chronic stress increases rapid eye movement (REM) sleep and decreases slow-wave or deep sleep, disrupting cell and body maintenance and repair.
• Frequent illnesses. Stress promotes overproduction of hormones that regulate your immune system and affects your ability to produce the white blood cells that fight infection, thus weakening your immunity levels and increasing susceptibility to illness. If you find that you are frequently falling ill, it could indicate that you are experiencing some stress.
• Panic attacks. Persistent stress that remains unresolved over a long period, has the potential to cause panic attacks. A panic attack is characterized by difficulty in breathing, increased palpitations, excessive sweating etc.
• Frequent mood swings: Stress or anxiety also can affect your mood and make it more difficult to regulate emotions, causing irritability or mood swings. People who are stressed or anxious may have difficulties with concentration, decision-making, and memory as well.

PSYCHOSOMA IN CHILDREN AND ADOLESCENTS:
Like described in an earlier segment, Psychosomatic symptoms are those that do not have any organic or physiological causes. They are linked to stress.
In the last decade or so, the number of children and young adults who are diagnosed with psychosomatic illnesses is on the rise.

REHABILITATION COUNSELLING FOR SPORTSPEOPLE:

After an injury or accident, some athletes may be ready physically, but are not prepared mentally to return to their sport, which could result in the following:
• Decreased confidence which could lead to a decline in performance.
 low motivational levels.
• Feelings of stress and anxiety due to lack of confidence in their physical condition
Fear of re-injury and fear of returning to play

These fears in a lot of cases are masked, and, given the huge pressure on the athlete to return quickly to the game, are therefore trivialized and supressed.
Sports rehab counselling enables the mind to speed up the recovery of lost muscle memory, thereby aiding in a more holistic and a long term recovery plan.

 

Progressing and
rehabilitation – Psychological Interventions
Psychological treatment provides a safe, non-drug based treatment for your pain directly by reducing high levels of physiological/bodily stress that often aggravate pain. Psychological treatment also helps improve the indirect consequences of pain by helping you learn how to cope with the problems associated with pain.

Most people find they can better manage their pain after just a few sessions with a psychologist. Those who are experiencing depression or dealing with a long-term degenerative medical condition may benefit from a longer course of treatment. Together with your psychologist, you will determine how long treatment should last. The goal is to help you develop skills to cope with your pain and live a full life.
Widely used psychological treatments are:

• Talk therapy: Talk therapy offers a structure to identify and deal with negative thoughts and stressors. It facilitates building healthy and productive thinking.
• Relaxation training: Deep relaxation has been associated with healing and pain reduction, this traditional can be achieved through the breathing techniques of Yoga, pranayam.
• Stress/anger management: Stress can make pain worse or at times is also the root cause for the pain in itself. Stress management treatment can help you understand the relationship between stressors and your pain and teach you ways to manage these stressors to ease pain.
• Pain coping skills training: You can improve your quality of life significantly simply by learning how to accommodate your life to pain. These skills are very valuable life lessons.
• Hypnotherapy: this therapy has proved to be effective in many cases of pain management and it works not only at the conscious level but also at the deeper sub-conscious levels.
Tips for coping with pain:
Consider the following steps that can be helpful in changing habits and improving your quality of life.
• Stay active. Pain — or the fear of pain — can lead people to stop doing the things they enjoy. It’s important not to let pain take over your life.
• Know your limits. Continue to be active in a way that acknowledges your physical limitations. Make a plan about how to manage your pain, and don’t push yourself to do more than you can handle.
• Exercise. Stay healthy with low-impact exercise such as stretching, yoga, walking and swimming.
• Make social connections. Call a family member, invite a friend to lunch or meet up over coffee with a friend you haven’t seen in a while. Research shows that people with greater social support are more resilient and experience less depression and anxiety. Ask for help when you need it.
• Distract yourself. When pain flares, find ways to distract your mind from it. Watch a movie, take a walk, engage in a hobby. Pleasant experiences can help you cope with pain.
• Don’t lose hope. With the right kind of psychological treatments, many people learn to manage their pain and think of it in a different way.
• Follow prescriptions carefully. If medications are part of your treatment plan, be sure to use them as prescribed by your doctor to avoid possible dangerous side effects. In addition to helping you develop better ways to cope with and manage pain, psychologists can help you develop a routine to stay on track with your treatment.
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