Psychological Problems Associated With Pain

We often think of the word ‘pain’ in physical terms; an aching stomach bug, a ringing headache, a debilitating backache. Although these irritating, sometimes chronic conditions may seem like physical annoyances, they are usually complicated by a different class of pain; mental distress. When physical manifestations of pain interact with mental disturbances, the results are often messy and difficult to manage. Health professionals define this as comorbidity. Comorbidity is what occurs when more than one disease or condition is present in the same person at the same time. The relationship between physical and mental pain is unfortunately stronger than we normally would guess. One particular condition which negatively impacts both mental and physical health is known as Complex Regional Pain Syndrome, or CRPS. Although considered a physical nerve condition, the psychological manifestations of pain which co-occur with CRPS can be devastating, ultimately making treatment a difficult conversation for both patients and doctors.

Rarely discussed outside of the medical community, CRPS is a very serious condition which deserves both awareness and recognition from the public. Specifically, CRPS involves severe burning pain, uncontrollable sweating, touch sensitivity, and changes in bone and skin. Patients with CRPS typically experience symptoms in the hands, legs, feet, or arms. Women are name a few.  For patients like Mr. Rodriguez, the dangerous cycle of anxiety, depression, and physical pain becomes a daily struggle, ultimately making it difficult to seek relief and hope.

It is clear that CRPS makes living a daily struggle, but it is unclear how this actually all got started. Understanding the biology of CRPS is complex; one explanation could be that both pain and neurological mood disorders such as depression share certain biological pathways and neurotransmitters (Bair et al., 2003). Consequently, biological, psychological, and social factors all play a role in relation to pain. Studies have shown that psychological disorders such as depression are often comorbid with pain severity, physical disability, and even early mortality (Kwon and Chang, 2013).

Another complication of psychological comorbidity is treatment; symptoms are often overlooked or misdiagnosed. For example, in one study which reviewed fourteen different studies that addressed both depression and physical pain, half of the patients with major depression weren’t properly diagnosed. Consequently, depression was not treated by primary care providers. (Bair et al, 2003). Although managing CRPS is somewhat of a gray area for doctors, common forms of treatment include tricyclic antidepressants (TCA) and physical therapy.

It is important that both patients and doctors explore a healthy, communicative, and open conversation about personal experience with physical and mental health. Patients as well as friends and family may seek support from the RSDSA for example, an organization which aims to provide education, advocacy, and help for those affected by CRPS. Executive director Jim Broatch claims that the main goal of the RSDS is to, “focus patients on improving their function not on chasing their pain to a zero-pain score.” Methods of focus include publishing stories of hope, advocating for face-to-face support groups, encouraging a healthy diet, as well as providing up-to-date information on treatment programs. Although the relationship between psychological and psychical pain may be complicated, it is possible to integrate a positive, health-centered system of recovery. Psychological comorbidity may complicate systems of physical pain, but scientists, doctors, and patients must engage in an open relationship built on trust, communication, and positivity to tackle the unpredictable nature of CRPS.

References

1. Alexander, G. M., Peterlin, B. L., Perreault, M. J., Grothusen, J. R., & Schwartzman, R. J. (2012). Changes in plasma cytokines and their soluble receptors in complex regional pain syndrome. The Journal of Pain, 13(1), 10-20.
2. Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity: a literature review. Archives of internal medicine, 163(20), 2433-2445.
3. Birklein, F. (2005). Complex regional pain syndrome. Journal of neurology, 252(2), 131-138.
4. Bruehl, S. (2015). Complex regional pain syndrome. Bmj, 351, h2730.
5. Kwon, J. K., & Chang, I. H. (2013). Pain, catastrophizing, and depression in chronic prostatitis/chronic pelvic pain syndrome. International neurourology journal, 17(2), 48.
6. Singh, J. A. , Lewallen, D. G (2013). Medical and psychological comorbidity predicts poor pain outcomes after total knee arthroplasty. Rheumatology. 52(5), 916-923.