# Pain psychology

Pain psychology is the study of psychological and behavioral processes in chronic pain. Pain psychology involves the implementation of treatments for chronic pain. Pain psychology can also be regarded as a branch of medical psychology, as many conditions associated with chronic pain have significant medical outcomes. Untreated pain or ineffective treatment of pain can result in symptoms of anxiety and depression, thus it is vital that appropriate pain management occur in a timely fashion following symptom onset.
Mental health-related difficulties can arise as a result of pain, or can pre-exist and worsen during the course of chronic pain, thus causing one to seek out or be referred by the patient’s healthcare provider for pain-relief treatment. Pain psychology aims to treat the person in pain rather than strictly the pain itself. A pain psychologist’s job is to work with the mental health issues that can be feeding into the physical pain that the patient is experiencing, and help them manage and reduce the effect it has on their lives.

## Introduction

Pain is one of the most common sensations for which individuals seek medical attention. Pain is an uncomfortable physical sensation that may manifest with different presentations. This sensation is a complex experience that involves both physical and psychological components. The perception and experience of pain can be influenced by a variety of bio-psychosocial factors, including genetics, emotions, cognitions, and social context. Coping with intense forms of pain can lead to psychological feelings like depression, anxiety, and stress. Research has demonstrated that psychological factors can significantly impact our experience of pain as well. Emotional state plays a critical role—negative emotions like fear and anxiety tend to intensify pain, while positive emotions can alleviate it. Moreover, more complex emotional experiences, such as empathy, which involve both emotional and cognitive components, can also influence how pain is felt and processed. Additionally, cognitive functions such as attention and memory can either increase or decrease pain. Pain perception can diminish cognitive abilities, particularly in areas like working memory. Factors such as sleep deprivation can exacerbate pain, lowering pain thresholds and making it more difficult to manage. People with chronic pain may also overestimate their cognitive and emotional impairments, which further affects their daily functioning.

## Pain and Cognitive Function

Pain perception is significantly influenced by cognitive and emotional factors. Brain imaging studies have revealed that attention primarily modulates pain-related activity in the insula and primary somatosensory cortex (S1), while emotional states predominantly affect the anterior cingulate cortex (ACC). The direction of attention has been shown to alter pain intensity, with focus on pain increasing perceived intensity and distraction reducing it. In contrast, emotional states, particularly negative ones, primarily influence pain's unpleasantness without necessarily changing its perceived intensity. These findings have led to increased interest in mind-body techniques for pain management, including cognitive behavioral therapy, meditation, and relaxation procedures, which typically incorporate both attentional and emotional components. The effectiveness of these approaches is supported by evidence showing activation of distinct neural pathways: attention-related pain modulation involves a cortical network including the superior parietal cortex, while emotional modulation engages a pathway through the ACC to the periaqueductal gray matter (PAG) and brainstem.
Pain—whether physical or emotional—acts as a distraction, hindering the ability to focus, retain information, and perform daily tasks. Brain regions like the dorsolateral prefrontal cortex and orbitofrontal cortex, which are involved in pain perception and coping, are often altered in those with chronic pain. These changes are especially pronounced in the Default Mode Network, which plays a key role in working memory and emotional regulation, further impacting pain management and mental health.
Cognitive reserve, which refers to individual differences in cognitive abilities and mental flexibility, plays a critical role in how people cope with chronic pain. Those with higher cognitive reserve are better able to manage pain and direct their attention, leading to less cognitive and emotional distress. Cognitive reserve can be built and maintained through activities that promote mental engagement, such as physical exercise, social interaction, stress management, a balanced diet, and cognitive training. These strategies not only help chronic pain sufferers cope better with pain, but they also enhance cognitive performance and mental resilience, even in times of stress or distraction. Importantly, these interventions offer benefits not just for those with chronic pain, but for anyone seeking to improve cognitive functioning and reduce the impact of pain.

## Initial Medical Intervention

Individuals experiencing chronic pain typically contact a physician first. A physician is able to provide a prescription to medications to treat chronic pain. The medications commonly prescribed are acetaminophen, topical creams/sprays (applied to the skin) that contain pain relievers, opioids (narcotics), sedatives to help with insomnia, and medical marijuana. These medications are temporary pain relievers, some being highly addictive; therefore, it is common for a physician to recommend lifestyle changes along with a pain psychologist or therapist for further treatment.
While individuals experiencing chronic pain typically contact a physician first, a pain psychologist will help address the mental effects that chronic pain causes. According to the American Psychological Association (APA), when a chronic pain patient goes in for treatment from a pain psychologist, they are asked various questions about their mental and physical health, their concerns about the pain they are experiencing, and a questionnaire may follow to keep track of any other information that may be needed to take note of. Once this initial process is done, a treatment plan is made specifically to meet the needs of the patient.

## Therapeutic Approaches to Pain Management

Pain treatments include a host of therapeutic techniques and methods such as active listening, medication, reflection, empathy, as well as behavioral techniques like guided imagery or meditation. A common treatment for pain is psychotherapy, also known as talk therapy. It has helped reduce patients’ pain, increased the contentment of their lives, and lowered the pain medication intake. An example of this presents itself in a study that was conducted on a group of workers in 1998 with chronic pain issues. Once they went through psychotherapy treatment, it resulted in decreased levels of depression and other conflicts, along with better control of their lives. What is learned from the therapy sessions can become useful tools for patients to use for future conflicts with chronic pain due to injury and/or a surgical procedure.
Pain psychologists offer various mental therapies that include cognitive-behavioral therapy (CBT), acceptance and commitment therapy, mindfulness training, meditation, and relaxation therapies. To look at the therapies offered by a pain psychologist more in-depth here are some of the treatments associated with CBT:
* Biofeedback and relaxation training (e.g., diaphragmatic breathing, progressive muscle relaxation, autogenic training, self-hypnosis, guided visual imagery) to reduce muscle tension and promote the body’s calming response
* General stress management techniques (e.g., time management, problem-solving skills, assertive communication)
* Health promotion (e.g., nutrition and exercise, sleep hygiene)
* Anger management skills training
* Increasing understanding of personality style and its contribution to the pain experience
* Activity pacing and reducing fear of pain and/or activity avoidance
* Increasing acceptance of the chronic nature of pain condition
* Reinforcement (i.e., “operant”) techniques to increase adaptive behaviors and decrease maladaptive pain behaviors
* Cognitive approaches to manage clinical depression and anxiety disorders
* Cognitive approaches to foster thoughts, emotions, and actions that are adaptive for managing a life with pain
The longevity of seeking pain psychotherapy varies from patient to patient. Some who are experiencing severe psychological issues alongside their medical issues may need to stay in therapy for a little bit longer. It is up to the patient and the psychologist to discuss how extensive the treatment needs to be.
* Pain management
* Psychogenic pain
* Pain Catastrophizing Scale

## Prevention

Chronic pain is a public health problem that is difficult and costly to treat. This pain can be induced from nerve damage, injury, and even repeated strain. There are very few findings on prevention of chronic pain. Treatment in acute pain can prevent chronic pain from developing. Many prevention studies suggest oral medications between 1 hour and 1 day prior to surgery. Other studies suggests that pain can be managed through a diet of anti-inflammatory foods. There is an increasing focus on mind-body approaches for pain management, with many chronic pain patients turning to techniques like cognitive behavioral therapy, yoga, meditation, hypnosis, and relaxation exercises to alleviate their discomfort. While these methods are multifaceted, they typically involve both cognitive elements, such as attention control, and emotional components. Research is steadily confirming that these therapies can be effective in reducing both acute pain and the development of chronic pain.