Why discussing mental health is important in responding to physical pain.
People everywhere who struggle with chronic pain face personal and societal barriers that limit their access to quality mental healthcare. This issue is exacerbated by the limited awareness of laypeople and healthcare providers on how the mind and body are interconnected.
More often than not, pain has both physical and psychological origins. Backpain is one classical example of this. Psychologist Dr. Ron Siegel (2013) illustrates how psychological stress, mindset, and backpain all reinforce one another through his “Pain Cycle Diagram” below.
In this model, backpain could initially be traced back to either stress or physical injury. Stress can lead to the back muscles tensing, which leads to back pain. Or injury could induce stress, which in turn leads to back pain.
Depending on our culture and our experiences witnessing others struggle with backpain, we may carry assumptions about what having backpain would mean for the rest of our lives. “My back is forever damaged” is one such assumption that can lead to panic. Purely medical explanations for backpain can also add to this panic. Panic can tense our back muscles adding to the backpain. The more convinced we are by such an assumption, the more we restrict our movement, which in turn will make our back muscles less flexible and add to the pain. Psychological support would involve helping the person gradually increase their activity levels while reassessing the restricting assumptions.
Aside from the psychological barriers to dealing with pain described in this model, many people face additional familial and societal challenges when there is no medical explanation for the pain. Some families and providers brush away the person’s experience by claiming that the pain is “all in their heads” or that the person is trying to “seek attention” or looking to feed an addiction to pain killers. While concern for possible addiction is valid, this concern shouldn’t have to include discounting the supports that are needed to cope with both the pain and the possible addiction. Regardless of the presence or absence of addiction, physical pain from purely psychological origins, with no signs of physical damage, is rare.
In some cultures and families, the only acceptable way for a person to get emotional support is through sharing about physical pain. This may be the case because openly expressing certain emotions may be stigmatized in that culture or family. The person reaching out this way may not be directly aware that this is the reason why they are doing so. They may not have access to an emotional vocabulary due to stigma preventing it from developing. As social beings, it is normal that we humans would want “attention” to have our full humanity embraced. Just because something has a positive gain to it doesn’t mean that either the mental or physical suffering isn’t real.
Regardless of whether the pain has a medical explanation or not, the very experience of prolonged pain in and of itself can invite psychological distress. Such experiences shouldn’t be minimized, otherwise, people will be discouraged from seeking mental health support out of concern that their experience will be minimized even by the therapist.
Unfortunately, even when well-informed medical providers refer patients to therapists, people may still be discouraged by the stigma against mental health as well as lack of access to qualified professionals who have had experience with this area. They may interpret the doctor’s referral as discounting their experience with physical pain. It is thus important for more mental health awareness campaigns to highlight the links between mental health and physical pain, for communities to provide services that are accessible to everyone regardless of their circumstances, and for more mental health training programs to address the lack of professionals working in pain management.
References:
Siegel, R., Urdang, M., Johnson, D. (2013). The chronic back pain cycle, Backsense.org. Retrieved from: https://www.backsense.org/bscycle_pg.htm
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