How Emotional Distress Makes Chronic Pain Worse
/By Pat Anson
Many chronic pain sufferers bristle at the notion that pain is “all in their head” or that it has psychological origins.
They’re not going to like some recent headlines in the news:
“Chronic pain is not just in your head, but it is in your brain”
“Mental defeat can worsen chronic pain, researchers say”
“This Common Mental Disorder Has a Strange Link to Severe Chronic Pain”
“New Study Finds Link Between Difficulty Identifying Emotions and High Chronic Pain Levels”
Yikes. It’s almost like the headline writers wanted to insult pain patients, as much as they want to inform them.
I found the last headline intriguing though, if only because it introduced me to a new word: alexithymia.
Alexithymia is a personality trait characterized by difficulty in identifying or describing emotions. If someone is always “at a loss for words” and can’t express their feelings to others, it could mean they have alexithymia.
About 10% of the population has alexithymia, which is more common in men (no surprise there), and people who have autism, post-traumatic stress, or depression.
Researchers at Johns Hopkins Medicine wondered if there was a connection between alexithymia and chronic pain. They enrolled over 1,450 people with various chronic pain conditions in a two-year study to answer a chicken-and-egg question: Does chronic pain cause alexithymia or does alexithymia make chronic pain worse?
“Prior studies have shown that alexithymia tends to be higher in people who have chronic pain. However, we did not know whether alexithymia leads to worse pain, or whether worse pain leads to alexithymia. We also have not had a good understanding of why these two distinct processes were related,” said senior author Rachel Aaron, PhD, Associate Professor of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine.
Aaron and her colleagues had patients fill out questionnaires to see how well they identified their feelings and described their emotions. They also asked participants about their pain, anxiety and depression levels.
The research team then used statistical modeling methods to see if emotional difficulties could predict pain outcomes.
The study’s findings, recently published in the journal American Psychological Association, show that patients with higher levels of alexithymia at the start of the study developed greater psychological distress one year later. That emotional stress had a profound impact. After two years, those same patients had greater pain interference – meaning their daily functioning and quality of life were worse.
Alternatively, researchers found that chronic pain did not predict or cause alexithymia. That supports evidence that emotional processing difficulties are a risk factor, but not a consequence of chronic pain.
“Greater difficulties identifying one’s own feelings can lead to greater symptoms of psychological distress, including symptoms of depression and anxiety,” says Aaron. “This in turn can lead to greater difficulties managing chronic pain. These findings highlight the role of considering alexithymia in psychological treatment for chronic pain, and how it might lead to psychological distress.”
Aaron led a previous study, which found that 40% of adults with chronic pain have clinical symptoms of depression or anxiety.
How do you treat alexithymia? Various types of psychotherapy can be used, such as Cognitive Behavioral Therapy (CBT) or Emotion-Focused Therapy (EFT), to help patients recognize and express their emotions in healthier ways. Creative therapies can also be used to help people express their feelings through journaling, art, music and dancing.
There are no drugs that specifically treat alexithymia, although antidepressants and anti-anxiety medications can treat co-occurring conditions like depression or PTSD, which may help improve emotional processing.
