The Psychology of Pain: For Patients and Practitioners

In terms of biopsychosocial treatment, providers must know that it’s critically important to look at all the factors that are affecting a patient’s pain condition. Any time we pigeonhole ourselves in any one category--whether it’s the medical piece, the psychological piece, or the physical piece--we’re losing sight of the bigger picture. So, everybody needs, and would benefit from, that biopsychosocial paradigm. How much does each component vary from one individual to the next? It’s critically important that providers are looking at things from that paradigm, as they look at the etiology of pain and the treatment of pain and the perpetuation of pain. As for psychologic vs psychogenic factors, there’s sometimes a misconception that when you bring psychology into pain, you’re doing it because the pain is just in the person’s head or the pain is not real. There are some pain conditions that are rooted 100% in psychogenic factors where it is related to psychiatric issues. Even if that’s the case, though, that person’s experience of pain is still real. There’s really not any such thing as pain that doesn’t exist or pain that’s not real. It’s just that what’s causing it could be something different. But that’s just a small number of patients that have that type of true psychogenic pain. What we know of with virtually all patients living with pain is that psychological factors can directly influence the onset and the maintenance of the pain condition. Even if it’s not what caused the pain, we know that depression, anxiety, stress levels, sleep patterns, activity patterns, all these things can affect the overall pain intensity and how engaged a person is with life. And so, we have to take a look at these things if we want to help patients move forward. Even though a patient’s pain may not be rooted in 100% psychogenic factors, psychological factors can always affect the pain that a person has and influence that bottom line.