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  • Writer's pictureAnnelie

Chronic Pain Is Emotional Pain

The connection between repressed anger and pain



Chronic pain is a heavy burden. 85% of patients with chronic pain also experience severe depression.[1] Chronic pain is a major public health issue — approximately one fifth of the general population suffers from chronic pain in the U.S. and Europe.[2] Yet the healthcare system does not provide a standard of care that alleviates the pain sufficiently.


The difficulty with curing chronic pain

Why is chronic pain so difficult to treat? One answer lies in the mainstream definition of chronic pain as a form of somatic (physical) pain, rather than a form of emotional pain. Chronic pain has much more in common with emotional pain than with somatic pain, and so this mainstream categorization error results in approaches that miss the point.


Somatic pain vs. emotional pain

Somatic pain refers to pain that is perceived by nociceptors (pain receptors) in the body. The nociceptors send a signal to the brain. This signal is registered by the part of the brain responsible for that part of the body in which the nociceptor fired. Emotional pain, on the other hand, refers to pain that we experience from unpleasant thoughts and memories. The brain processes emotions in different parts of the brain than it does somatic pain. While the process by which emotional pain in the brain manifests itself in the physical body is complex, you can basically think of it as the reverse direction of somatic pain. Instead of pain in the body registering in the brain, pain in the brain registers in the body.


Somatic pain is acute pain

Think of somatic (physical) pain as acute pain. Acute pain is defined as pain in response to a present stimulus that causes the nociceptors to fire. Once the stimulus has subsided and the damaged tissue is healed, acute pain stops.[3]


What is chronic pain?

If the pain persists for more than 3 months after the stimuli has been removed, we speak about chronic pain.[4] Put another way, we qualify something as chronic pain when the pain lasts longer than the expected healing time.[5]


Chronic pain is emotional pain, not somatic pain – treatments have to adjust accordingly

When we misclassify chronic pain as somatic pain, the approach and treatment are then similar to those for acute pain. This brings often no, or very little, lasting relief to the patient.[6]


A paradigm shift

A paradigm shift began to occur when researches started to look at chronic pain as being less an issue of the body and more an issue of the mind.


“Chronic pain (…) is less somatic and more affective in nature.”[7]


Meaning, chronic pain is more similar to emotional pain than it is to acute pain. This idea is based on research that shows chronic pain and acute pain occur in completely different areas of the brain.[8]


In a 2013 study, MRIs of participants who had lower back pain for less than two month (still in the acute/ subacute pain phase) showed pain being registered in the lower back centre of the brain. Those participants who suffered from lower back pain for more than ten years (chronic pain phase) showed no increased brain activity in that region, however the chronic pain group showed heightened activity in the emotional centre of the brain.[9]


Pain is pain is not pain

Suffering from chronic pain means that the sensation is the same as — or very similar to —acute pain, but the area of the nervous system tissue that responds has changed over time.

“(T)he processing of painful sensations in the brain is short-circuited and results in a permanent sensation of pain. These feelings are what is known as chronic pain or, in some instances, neuropathic pain, reflecting that it is a disease state of the nervous system.”[10]


The mindbody connection

The driver of the pain is no longer damage to the tissue, but emotional responses. This phenomenon is also referred to as the “mindbody connection” and “mindbody pain,”[11] or most commonly as psychosomatic pain. With this in mind, treatment of chronic pain has to take into account the similarities of chronic pain and emotional pain. I would go so far as to say treatment has to directly address the emotions themselves in order to be most effective.


Psychosomatic pain is real

It is of utmost importance that we acknowledge that psychosomatic pain is real pain and not imagined pain. Even if psychosomatic pain involves no alteration in the organ that causes the pain (medically referred to as “functional pain”), the experience of the pain is real. It is not a phenomenon that is observed in overly sensitive or hallucinating people only.


Negative emotions keep the pain alive

As many of us have experienced or witnessed, the longer the chronic pain has been part of daily life, the harder it is to get rid of it. If you or someone you know has lived with the hardship of chronic pain, you will know that people suffering from chronic pain will not refer to their pain with gentle, loving emotions, but with frustration and anger – quite understandably so, right? Understandable, yes, but also unfortunate. Unfortunate not only because we wish for no one to be frustrated and angry, but also because these strong and negative emotions reinforce the pain and keep it alive.


Pain pathways

Responding to chronic pain with negative emotions enhances the pain, because the neurons that form the neurological pathways of emotional pain are the same as the “pain pathways”. Both, emotional pain and the physical experienced chronic pain support each other. “The affective associations of chronic pain manifest as increased anxiety, depression, and a dramatically reduced quality of life, as well as other cognitive and behavioural impairments”.[12]


How is it that chronic pain and emotional pain are upholding each other?

Two well-known physicians who have dedicated their careers to helping patients with chronic pain have crossed my path over the years: Dr. John E. Sarno, until recently a professor of Clinical Rehabilitation Medicine at the New York School of Medicine, and Dr. David Hanscom, a complex-deformity spine surgeon.

Prior to their ultimate callings to focus on patients with chronic pain, both of them made a living from spine surgery. At some point in their careers, both of them made the decision to abstain from performing surgery to treat chronic pain in most cases. Especially, so they say, chronic pain cannot be resolved by surgery unless the source of the pain is an actual physical disfunction. Most chronic pain, however, is not physical disfunction, but rather a misplaced expression of emotions.[13]


Repetitive negative thought patterns

As Dr. Hanscom explains, during chronic pain phases the patient repeats the same negative thought patterns and emotions over and over again and ceases to form new patterns. As a result, the brain atrophies. By repeating the same patterns, it becomes more difficult over time to form new patterns with regard to the site of pain or experience of pain. Psychologically speaking, brain atrophy results in a state of mind in which we have less comprehension and ability to pull ourselves back out of the cycle.[14] Since chronic pain and emotions are being processed by the same part of the brain, the neurons that fire together also make each other stronger. The negative thought patterns and emotions that go along with these patterns reinforce it further.



Anger and rage

Another way to look at the connection between chronic pain and emotions is offered by Dr. Sarno, who refers to chronic pain as a form of expression for emotional pain. He states that as an attempt of the mind to draw attention away from strong emotions like anger, anxiety, and symptoms of depression, it creates pain in other parts of the body. He refers to studies that show how in the parts of the body in which chronic pain is experienced, the level of oxygenation is lower than in parts without pain experience. Less oxygen causes pain in those parts of the body, and in Sarno’s research — there was no other discernible stimuli or reason for the lower oxygenation.[15]


Become familiar with the source of strong negative emotions and let them go

MDs like Hanscom and Sarno have had amazing success rates with curing chronic pain without drugs or surgery. Knowledge and awareness about the nature of chronic pain is both of their starting points. Hanscom recommends daily practices to eliminate the negative emotional feedback cycles and to reprogram the brain. He uses expressive writing, meditation, and sleep, combined with a new perspective on life. Sarno focuses on the psychological component of releasing the emotions that have been withheld or repressed. Becoming familiar with the source of anger and letting it go has helped his patients immensely.


What can you do, today?

  • · Meditation is the undisputed first step towards building stronger resilience and profound communication and cooperation between your mind and body. Meditation, like every other practice, is a process and can be learned and explored with an experienced, mindful teacher. Book an introductory meditation workshop with me.



  • Hypnosis is a direct path to your subconscious and a way of getting to the root of unresolved issues. Learn about your strong emotions, habits of thought, and patterns of action that you would like to be free of. Hypnosis is also a fast, results-oriented way of approaching challenges of the mind and body. Successful hypnosis begins with a preparation session to set your goals and learn about the process. Take the first step today and write me a message. (If you are new to hypnosis learn more and click here).

References:

Acute vs. Chronic Pain. https://my.clevelandclinic.org/health/articles/12051-acute-vs-chronic-pain, last visited June 10, 2020.

David Hanscom. Back in Control. 2017. Vertus Press, Seattle.

Herta Flor. Painful memories - Can we train chronic pain patients to ‘forget’ their pain? EMBO Rep. 2002 Apr 15; 3(4): 288–291. doi: 10.1093/embo-reports/kvf080, last visited June 10, 2020.

Bessel v.d. Kolk, MD, The Body Keeps the Score – brain, mind, and body in the healing of trauma. 2014. Penguin Books, NY.

Breivik H., Collett B., Ventafridda V., Cohen R., Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European Journal of Pain. 2006;10(4):287–333. doi: 10.1016/j.ejpain.2005.06.009.


James Dahlhamer, PhD; Jacqueline Lucas, MPH; Carla Zelaya, PhD; Richard Nahin, PhD; Sean Mackey, MD, PhD; Lynn DeBar, PhD; Robert Kerns, PhD; Michael Von Korff, ScD; Linda Porter, PhD; Charles Helmick, MD. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. Weekly / September 14, 2018 / 67(36);1001–1006.


Javeria A Hashmi, Marwan N Baliki, Lejian Huang, Alex T Baria, Souraya Torbey, Kristina M Hermann, Thomas J Schnitzer, A Vania Apkarian. 2013 Aug 26. Shape Shifting Pain: Chronification of Back Pain Shifts Brain Representation From Nociceptive to Emotional Circuits. doi: 10.1093/brain/awt211, last visited June 10, 2020.


A.R. Mansour, M.A. Farmer, M.N. Baliki, and A. Vania Apkarian. Chronic pain: The role of learning and brain plasticity. Restor Neurol Neurosci. 2014; 32(1): 129–139. doi: 10.3233/RNN-139003, last visited June 10, 2020.


John E. Sarno. The Mindbody Prescription. 1998. Grand Central Life & Style, New York, Boston.


Sheng, Liu, Wang, Cui, Zhang. 2017 Jun 19. The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. doi: 10.1155/2017/9724371, last visited June 10, 2020.

[1] Sheng et. al, 2017. [2] Dahlhammer et. al, 2018; Breivik et. al, 2005. [3] Acute vs. Chronic Pain. [4] Sheng et. al, 2017; Hanscom, 2017. [5] Hanscom, 2017. [6] Hashmi et. al, 2013. [7] Mansour et. al, 2014. [8] Hashmi et. al, 2013. [9] Hashmi et. al, 2013; Hanscom, 2017 [10] Flor, 2015 [11] Sarno, 1999. [12] Mansour et. al, 2014. [13] Hanscom, 2017; Sarno, 1999. [14] Hanscom, 2017. [15] Sarno, 1999. [16] Kolk, 2014.

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