Is There a Chronic Pain Personality?
By: Dr. Christine Bradstreet
Tags: Mindset, Health, Pain, Medicine, Chronic Illness

Chronic pain is notoriously difficult to treat. Traditional medicine as well as the allied healthcare fields of physical therapy, chiropractic, acupuncture, and massage all have poor long term outcomes.

That leaves both patients and clinicians discouraged.

For the record, chronic pain is ongoing and usually lasts longer than six months. Acute pain can be mild or severe, but it lasts only a moment or up to 3–6 months.

According to the Centers for Disease Control and Prevention, chronic pain affects approximately 20% of the United States population. It’s a leading cause for medical visits, and its estimated financial burden is $560 billion a year in direct medical costs alone.

Those numbers don’t take into account the financial and emotional burden of chronic pain on the individuals experiencing it.

The tricky thing about chronic pain is that the pain is felt in the physical body, it’s not necessarily a physical problem.

Chronic pain starts as a physical problem, like an injury or overuse, but the pain continues long after the time required for the tissues to heal.

People with chronic pain will insist and argue that they have scar tissue, eroded cartilage, nerve damage, or abnormal joint alignment, but the catch is, those things exist in nearly every adult. But not every adult has chronic pain.

This begs the question, is there a chronic pain personality?

There’s decades of evidence that says there are specific personality traits linked to chronic pain. And there are also other personality traits that are linked to an enhanced placebo response. I’ll talk a bit about that second statement later.

People with chronic pain are more likely to have a personality disorder. 51% of people with chronic pain have one personality disorder, and 30% have more than one. For comparison, only 21% of people with acute low back pain have a personality disorder. Interestingly, only 10–13% of the general population is estimated to have a personality disorder.

In broad terms, people with chronic pain tend to overreact to stress or disease in a way that’s unique to their personality traits. Personality, in turn, is accentuated by chronic pain.

There are a few key traits associated with chronic pain.

Risk avoidance and fear of pain lead to increased pain. This is thought to be a result of action by the amygdala. That’s the fight or flight portion of the brain. You can read more about how the amygdala affects the health of your physical body here:

Anxiety, neuroticism, harm avoidance, catastrophizing, and hypochondriasis all are linked to increased chronic pain, while agreeableness, and ego resilience are linked to enhanced self regulation of pain.

Cloninger’s temperament and character inventory.

Researchers in the 1980s studied personality traits and chronic pain. They concluded that enhanced harm avoidance and diminished self directedness are the most pronounced factors in the personality traits of people with chronic pain.

Harm avoidance shows up as being fearful, pessimistic, and sensitive to criticism, along with a tendency to seek reassurance.

A decrease in self directedness is expressed as difficulty defining and setting meaningful goals or having a sense of life purpose, having low motivation, and difficulty with adaptive coping.

These traits are found across a variety of chronic pain disorders like fibromyalgia, headaches, migraine, TMJ disorder (temporomandibular pain), and musculoskeletal disorders.

Personality and the placebo effect.

Volumes have been written on the placebo effect. In short, it’s a real thing. Thinking a drug or procedure will benefit you is enough to receive the benefit, even if the drug or procedure was a sham.

A patient is given a sham pill but told the pill eliminates pain, and brain scans show activation in the part of the brain that controls the opioid response.

Brain imaging studies show a link between physical pain and negative emotions. The link is that internal opioid activity modulates the pain experience as well as negative emotions.

A few personality traits are linked to an enhanced placebo response.

Self control and anger regulation lead to greater pain relief. People who rated themselves as high in agreeableness and ego resilience, but low in neuroticism had higher pain relief when given the placebo.

Anger and hostility were the traits most highly associated with a poor placebo response. Anger was linked to a decrease in opioid receptor function.

Since many common drugs and procedures designed to relieve pain perform no better than placebo, having a strong placebo response is helpful, and less dangerous, and less expensive.

The keys to chronic pain are in the mind, not the body.

The pain you feel is real, but it’s not coming from where you think. It’s not coming from your body.

You get to decide if you choose to feel empowered or defeated by the notion that you hold the key to recovery.

I think this is empowering news. It puts you in control of something that can feel very out of control.

Focus your efforts on a healthy lifestyle while you dig deep into enhancing the personality traits that diminish pain and resolving the traits that increase pain.

If you need help, turn to an expert in the mindset of pain.

For a deeper dive into the numbers, you can read more at the links below:

New evidence for a pain personality? A critical review of the last 120 years of pain and personality.

Personality characteristics and chronic pain: why some people feel pain worse than others.

Personality and Pain Relief

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