How Psychological Elements Influences Pain Perception

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Any person suffering from chronic pain can tell you how debilitating it can be to deal with pain every day. Many people think of pain from a physiological perspective, thinking of it as due to problems associated with the mechanics of the patient’s body. What many do not realize, however, is that there is a psychological component to pain that can seriously impact the way a patient senses and responds to their symptoms.

The psyche of a patient can influence the patient’s pain perception and can, in fact, override the frequency, duration, and intensity of pain symptoms that patients experience. As more research and studies are being conducted, it is becoming more apparent that there is a very real mental and emotional component associated with every patient. These psychological components can dramatically impact a patient’s health by influencing the way they sense and respond to chronic pain.

The Patient as a Whole

Health and sickness cannot be isolated to a certain area of the body. An illness or condition rarely affects only one organ system. The same is true for pain. While the physiological symptoms may be isolated to an area of the body, for example, lumbar or knee pain, there is an undeniable mental element that affects how the patient reacts to the pain. For example, psychological states such as depression, stress, fear-avoidance, or pain catastrophizing are often associated with chronic pain patients.

For this reason, it is important for all health care professionals to take into account the psychological and physiological states of chronic pain patients to provide a more well-rounded and holistic treatment plan. This article will further investigate the more common psychological states that manifest in chronic pain patients.

Pain Catastrophizing

Pain catastrophizing is a psychological state that is described as an exaggerated negative mental attitude in response to pain that is either anticipated or real. In simpler terms, it is the tendency in patients to exaggerate or magnify the intensity and seriousness of their pain. These are the patients who constantly report a “10/10” on the pain chart for every symptom. That is not to say that their pain is not legitimate or real; instead, it suggests that patients with chronic pain tend to report higher levels of pain because that is what they have come to expect.

It has been found that patients who exhibit pain catastrophizing have reported feelings of helplessness, anxiety, and emotional distress in association with their pain, feelings that permeate into other aspects of their life beyond health, for example, their social or personal lives. Pain catastrophizing has been positively correlated with increased depression and anxiety level, and negatively correlated to positive emotions such as hope and optimism, important emotions that are necessary for the healing process according to many studies.

It is unclear whether pain catastrophizing leads to depression, anxiety, and stress, or if these are all elements that impact the onset of each other. Regardless, it is clear from many studies that chronic pain patients exhibiting pain catastrophizing are not in the proper mental state to begin the healing process, which sends these patients into a never ending cycle of pain and mental distress.


It has been clear for years that a patient’s mood can greatly impact their pain perception and overall quality of life. Positive mental emotions have been associated with lower self-reported pain intensity ratings and decreased pain perception. Conversely, negative mental emotions such as fear, anxiety, and depression have been shown to magnify pain intensity and actually impede pain management treatments.

One of the most dangerous psychological states found in chronic pain patients is depression, which has been well established through research to correlate to higher self-reported pain intensity levels in patients. For example, patients suffering from chronic lower back pain in addition to depression were found to self-report longer pain periods and higher intensity pain than patients with identical lower back pain but depression-free.

Similar to pain catastrophizing, depression can greatly impact the quality of life of chronic patients in all aspects of their lives, including health, emotional, and social factors. Severe depression in response to chronic pain can lead to fear avoidance states such as kinesophobia, the fear of movement in response to anticipated pain or suffering. As a result of these severe states, depression levels only increase due to a decrease in a patient’s perceived ability to perform daily activities, and the depression manifests in higher perceived pain intensities.

Combating the Mental Aspect of Pain

While the psychological element of pain seems elusive and difficult to reverse, many therapies exist that have been shown to greatly increase moods and emotions in chronic pain patients. Mindfulness-based stress reduction exercises (MBSR) as well as cognitive behavioral interventions used by psychiatrists specializing in chronic pain patients has been should to effectively reduce states of pain catastrophizing and fear-avoidance.

Other mental exercises geared at improving the psychological state of chronic pain patients include relaxation, yoga, meditation, and positive thought reinforcement techniques, as of which have shown positive results in reducing the mental stress associated with pain, as well as reducing depression levels and pain intensity ratings.

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