Pain and Emotion


The relationship between physical pain and emotion is complicated and can be very interesting. It’s important to be curious about how physical pain and emotions affect you. Understanding the connections between feelings and pain will help you manage your pain better.

Pain will almost always make a person feel bad. It is hard to be cheerful when you hurt.  It’s also true that your mood or emotional state can have a lot to do with how much you suffer with pain when you are hurting. And, if you live with pain every day, anything you do that affects your pain level will also effect emotional feelings, and vice versa. In this section, we want to explore this very important connection between pain and feelings.

Pain produces unpleasant feelings, which is part of why it is useful to us. On other pages of this website (see The Nature of Pain) we talk about the fact that pain plays such an important role in our day to day survival. Our ability to hurt protects us from more injury. It makes us rest and take care of the body part that has been injured. Pain works for you because it is an unpleasant emotional experience as well as being a physical sensation. Whenever you have an injury, part of the pain signal goes to the area of the brain where the emotional part of pain is experienced. As a rule, pain is something you want to stop. Pain always causes you some amount of suffering. This is a big part of the reason that it is such a great warning signal. It’s possible that if pain were not so uncomfortable we might simply ignore it, with some very bad results.

Negative emotions make pain feel worse. There is another side to the relationship between pain and emotion as well. While pain usually makes our mood more negative, it is equally true that unpleasant emotional events tend to worsen our experience of pain. My toothache is likely to cause me more discomfort for example after an argument with a friend or during times that some stress in my life is getting worse. If you have chronic pain, this can be a big problem. Major depression and clinical anxiety are much more common among people with chronic pain than they tend to be in the general population. Obviously, living with chronic pain will tend to worsen your mood and your experience of depression or anxiety. Once again, it also goes in the other direction as well: as depression and anxiety become more severe, the way you feel pain will also changes for the worse.

The role of emotion in daily life

It’s natural to think life would be better without any kind of pain. Well, we talked about how physical pain keeps us from making an injury worse, or quieting down so our body can heal. But wouldn’t we all be more peaceful or content if we did not have so many emotions all the time? This idea is what makes characters like Mr. Spock or Lieutenant Data from the Star Trek series so interesting and popular. Although an emotionless life would mean we’d miss out on joy and happiness, it would also spare us emotional pain and suffering.  However, since we are humans (and not Vulcans or robot androids) we can count on being forever full of our many different feelings.

It is interesting to think about why humans have such a tremendous capacity for feeling.   Every human language has all kinds of words and stories that describe in great detail the endless possible ways we can have of our human feelings. For example, to feel ‘aggravated’ is not quite the same thing as being ‘vexed’, though we recognize that they each have to do with anger and frustration. In fact, in English there are many hundreds of words that are used to convey all the different shades of anger, fear, loneliness, sadness (and so on) that we are capable of experiencing. Each of these words describes a different emotional experience or feeling state.

So why do humans have the ability to feel and express so much different emotion? An unknown number of poets, lovers, philosophers, behavioral scientists and just plain folk have asked this question over the ages. We offer the following as a partial answer to the question:

The emotional reactions that we have to daily life events – especially the negative emotional reactions – provide us with the information that we need to be able to take the best care of ourselves.

In other words, the anger that you feel when you are treated badly by someone or the sadness you feel in response to a significant loss, both give you drive and direction that you need to take care of yourself, because something wrong or bad has just happened to you. The emotion is a signal to you that moves you into action; you are  driven by your discomfort or unhappiness. And it gives you specific information about what to do to make yourself feel better. The emotion directs you toward a specific course of action since the way that you look after yourself when you’re angry is likely to be different than what you would need to do if you were frightened or lonely.

This way of thinking about emotion, the idea that it gives you the information you need to take care of yourself, is important for a number of reasons.

To begin with, feelings happen automatically in your nervous system, like a reflex. They ‘just come up’ without any conscious effort, or control for that matter. You do not get to choose the emotional reaction you are having in a particular situation. If you could choose your feelings, why would you ever choose anything other than deep contentment or peaceful satisfaction? There are people who claim to have control over their emotions. What they really mean is that they have learned to more or less ignore the internal feelings, or to not act out the feelings they are having in ways other people can see. Human beings are not actually able to stop having feelings about what happens to them.

In addition to understanding that feelings are always going to happen in response to the events of your life, you can count on the fact that the type and the intensity of the feelings you experience are always just right. In other words, you don’t experience anger when the more appropriate emotion would be sadness. Also, the amount of anger you feel is always an accurate reflection of what’s happened to you.

You may be surprised to hear that. Many of us are taught to “rein in” our feelings. We usually have a sense that anything more than the mildest, most polite expression of feeling is “too much”. Many people live with a kind of anxiety that our emotions will somehow get the better of us. It is as if we somehow learn that having feelings or experiencing feelings in a visible way is not really OK. Many people are very uncomfortable with powerful emotions, and given a choice would prefer to avoid strong feelings — their own as well as others.

Feelings are natural, always present and unavoidable. It is helpful to keep in mind that when our feelings seem excessive, the real problem is that we don’t have an accurate understanding of what is really going on in the moment. For example, if you catch yourself feeling extremely angry with a co-worker over what really was a very small slight or negative comment, you can count on the fact that all that anger is really about something else, in addition to their remark. Rather than assuming that the anger is somehow excessive, you can instead be curious about what else is going on with yourself. You can put your energy into understanding what all that emotion in you is really about. This curiosity is a way of getting to know yourself better. The bottom line is that you can trust that your emotions will give you the information you need to know about what is important to you.

The connection between feeling and pain

To understand the relationship between pain and feelings, you need to recognize that emotions are as much a part of your physical body as they are a mental feeling event.  Emotions arouse the part of the nervous system that controls automatic physical functions such as heart rate, blood pressure and blood flow. This means that each emotion we experience has a unique physiological pattern or chemical pathway that is a little bit different for each of us. Some people get a little queasy in response to stress for example while others may get a headache or tight shoulder muscles. This pattern of reactions is important because pain can also increase in response to autonomic nervous system arousal.  As muscles tighten and blood flow patterns change in response to emotional upset, you may find yourself hurting more just because of those physiological changes. In fact, there is good reason to think that the increase in back pain that you might feel in response to significant sadness, anger or fear is mainly a reflection of the fact that emotion is as much “physical” as it is “mental”.

The physiological connection between pain and feeling plays out in a second important way as well. We know that any physical or nervous system event that influences activity in the brain is almost certain to affect our emotional experience as well. For example, we know that patients with chronic pain are far more likely to have problems with major depression than patients who are pain free. Until recently we have explained this observation mainly in terms of the huge negative impact that pain has on overall quality of life. Obviously, chronic pain is enough to depress anyone. Since we now understand that depression symptoms arise when a person isn’t making enough of particular brain chemicals, we are beginning to get a more complete picture about the effects of pain on mood and other symptoms of depression. It seems that the chronic transmission of pain signals in the limbic system of the brain actually causes you to have less of these important brain chemicals. This drop in mood-related chemistry levels is probably the root cause of clinical depression. It is almost unavoidable for people with pain. As transmitter levels fall, pain will feel worse.  This is why physical pain tends to be such a big problem among people with a primary complaint of depression. The good news is that medicines that treat depression by increasing the levels of the brain chemistry that creates your moods (such as Cymbalta, Effexor and possibly a new medicine call Milnacipran) can also be useful for decreasing pain.

In addition to its relationship with clinical depression, chronic pain is often associated with severe anxiety. Many pain patients have longstanding histories of panic attack or other anxiety disorder. Anxiety produces more autonomic nervous system arousal and, in many cases, worse physical pain. In addition, many painful conditions begin with a traumatic injury so that later post traumatic stress disorder (PTSD) symptoms can also be a problem.  It is not unusual for people with severe anxiety to have difficulty distinguishing between the emotional discomfort due to their anxiety and the combined physical and emotional discomforts associated with their pain problem.

You don’t have to have severe anxiety disorder to experience the stresses and strains that are a part of normal emotional life for all of us. The normal, common stresses of life will typically worsen pain perception as well. A great deal of research has been done looking at the effects of normal stress on physical health. It is clear that major negative life events, such as a divorce or bankruptcy, will significantly worsen all kinds of chronic health problems including pain. Perhaps more important though in the big picture is the effect of ‘daily hassles’: paying bills, a car that won’t run, noisy neighbors. These kinds of chronic low level stresses can contribute to daily patterns of tight muscles and high blood pressure and can keep sore body parts tight, stiff, inflamed and painful.

In summary, it is clear that feelings and physical pain share some of the same wiring and chemistry in the body, and that changes in one nearly always produce similar changes in the other. Because of this relationship, there is really no way to effectively manage chronic pain without having a well developed set of skills for attending to and managing your emotions as well.

Practical steps for managing emotions when pain is a problem:

These practical suggestions are all based on the following conclusion:

We need to learn to use emotional information effectively in order to be able to manage pain effectively.

  1. Re-read this material (or similar material) until it really sinks in that the experience of pain is nearly always tied to your ongoing and current emotional state. How much you hurt and how badly you suffer with a given amount of pain will be determined in large part by your mood and emotional state at the time.
  2. Practice being brutally honest with yourself about the nature and intensity of your feelings. On a regular basis, ask yourself, “What do I happen to find myself feeling right now?” This way of asking the question points up the fact that we do not choose our feelings. Learning to honestly label feelings takes practice. Many people in our culture, especially men, have been carefully trained to deny, ignore and mislabel feelings, with the result that taking care of yourself is much more difficult.
  3. Also practice paying attention to the question, “What is it I want right now?” Very often our emotions are pointing us in the direction of what it is we most want or need in order to take good care of ourselves.
  4. Improve your skills for managing daily hassles, stresses and strains. There are a number of excellent self-help references devoted to this topic. Classes or groups on stress management are often available in the community, or you can get help from an individual counselor.
  5. Get help for your depression and anxiety. If you are concerned that you may be having symptoms of clinical depression or anxiety, talk with your regular medical provider. He or she may want you to consult with another professional or may suggest starting you on an appropriate medication.
  6. Learn to act appropriately in response to your feelings. A very effective set of tools for managing difficult feelings involves physical movement. Take a walk to blow off steam or just get out and enjoy the fresh air. Also, make an effort to get in the best shape you can, particularly with regard to aerobic fitness. There is no question that aerobic activity is the best long term treatment for depression and other mood problems and it is a great stress reliever.

It is well within your power to effectively manage emotions related to pain. As always, it all depends on what you do.

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