Words (and thoughts) CAN Hurt You: Biopsychosocial Factors in Pain Management
People with multiple sclerosis experience pain and depression more commonly than the average population.1 Both pain and depression are influenced by physical, chemical, and structural changes, as well as other biopsychosocial factors, including health behaviors, genetic factors, emotional health, biological factors, activity level, sleep habits, stress, cognitive issues, and social factors. Experiencing depression or pain with MS is significant because these can have an impact a person’s disability and health-related quality of life.2
When you experience pain, you may start looking for causes and gathering information. Your brain will remember both the good information and the bad information. Your understanding of the problem can affect you in different ways. Sometimes, you may learn a “poor understanding” of why you hurt, or foster a threatening image in your understanding of your pain. For example, if your back hurts and your doctor or physical therapist said “you have the spine of a 90 year old”, or “your spine is unstable and out of alignment”, or “it’s a wonder you don’t have more pain based on this awful MRI,” you may have an exaggerated understanding of the threat to your body that your pain represents.
Pain can be amplified by what others say to you and affect your emotions. Pain can make you feel more dependent on your health care provider, your therapist, or your family members. A fearful understanding of how pain may result from daily life choices can, in fact, prohibit you from making those life choices and falsely inhibit your understanding of what you actually can do.
If you are mistaken that the threat to your affected body part is more than it really is, then your brain will release chemicals that can amplify signals from that part of your body and can actually make the pain worse! 3
There is evidence that education about pain physiology can lead to changes in pain beliefs, reducing the conviction that pain is associated with harm and that pain is necessarily associated with disability.4 With a better understanding of the causes of your pain, and with normalizing the amount of stress related to the perceived feelings of pain, your brain activates what is called “descending inhibition” and releases pain- relieving chemicals (rather than more amplifying chemicals).5
Imagine you just had an MRI of your spine. Think of the difference between being told you have “degenerative disease” and being told you have “normal age-related changes.” That’s a big difference looking at the same picture. It’s the difference between thinking your body is under attack and thinking that things will calm back down with time and gentle movement.
If you understand that your pain is a result of nerve hypersensitivity and that you are not in danger of falling apart or under a real physical threat, then you can feel more confident and safe. If you think you are fragile, you may not be as active or mobile as you should to actually help the problem.
There is some good news in understanding the "biopsychosocial factors" of many of the factors noted to contribute to pain and/or depression. They are all factors that you can do something about!
Biological factors can be treated with medications such as antidepressants. Antidepressant medications work with your body’s own neurotransmitter systems to make them more effective.6 Lack of pleasure with activities can be addressed with behavioral therapies; the stressors of work and home-related issues can be addressed with family support and vocational rehabilitation. Decreased physical activity and the negative effects of a sedentary lifestyle can be changed with exercise and structured levels of participation in physical therapy.7 Physical activity has multiple benefits for people with MS and may also help improve depression.8 Negative thoughts and emotions, as well as poor pain coping habits, can be changed with cognitive behavioral therapies. That is a lot to consider, but it is not a mountain of issues you have to climb alone. These are all part of the ongoing conversation you participate in with your healthcare team and the people important to you in your life.
To learn more about how pain may be associated specifically with fearful thoughts about MS, read this brochure from the National MS Society.
- Major Depression in multiple sclerosis: a population –based perspective Patten SB, Beck CA, Williams JV, Barbui C, Metz LM. Neurology. 2003 Dec 9;61(11):1524-7.
- Bashir K, Whitaker JN. Handbook of Multiple Sclerosis. 2002.