What causes or exacerbates pain?

Common sense tells us that there is a link between our emotional state and how we experience pain. Whether it is the pain of childbirth or a tension headache, fear, anger, and even happiness seem to color our perceptions. Does our mental health and not just our transient emotional states, also influence how we experience pain?

Research does show that “The experience of pain is generated or modified by nociception, neuropathic symptoms, psychological and personality factors, genetic influences, past painful experiences, comorbid conditions, and expectations related to future pain.” (NCBI public access studies). One such study, on osteoarthritis, offers evidence that a variety of factors including mental health must be taken into consideration to understand and treat pain.

Osteoarthritis and Mental Health

Osteoarthritis (OA) is a common, debilitating disease that may cause intense pain. It affects nearly 12 per cent of Americans between 25 and 74 years old. Around 27 million Americans have been diagnosed with osteoarthritis of a joint such as knee, elbow, hip, neck, etc. OA is a degenerative joint disease, with inflammation, the wearing down of, and eventual loss of cartilage in the joints. Genes, weight issues, injury, bone and joint disorders, and metabolic disorders can all possibly lead to the disease of OA. There is no known cure and symptom relief is the general treatment.

The pain of osteoarthritis is usually episodic; some days are relatively pain-free, others are pain-filled, with varying levels of intensity. In the NCBI report, above, the researchers state: “We demonstrate an association between worsened measures of mental health and OA pain and risk of pain flares. General mental health is a modifiable component of health and may represent a new avenue for prevention of OA pain flares.” (NCBI; italics, ours)

In other words, what makes for common sense is confirmed by studies which show that mental health states affect one’s experience of pain, and might even worsen perception of pain. Stable mental health may empower a person to cope better with pain, or even prevent pain.

On the other hand, pain may exacerbate negative mental and emotional symptoms. Suffering with chronic (even intermittent) pain can lead to irritability, anger and even depression.

Treating the Physical and Mental Aspects of OA

While painkillers, weight management, gentle exercise, assistive devices, hydrotherapy, physical therapy and surgery (in some cases), are all commonly prescribed treatment approaches, complementary medicine also offers some important approaches that help not only with physical pain but with mental health as well.

Acupuncture and massage can be effective for pain, and can also help with relaxation. Other relaxation techniques such as meditation may also contribute to improvement in pain. For many Americans, prayer is the bedrock of pain management. A 2005 ABC News, USA Today, and Stanford University poll reported: “Nearly six in 10 Americans, 58 percent, say they’ve tried prayer to deal with pain, about as many as have taken prescription drugs. And of those who’ve tried it, half say prayer has worked very well for them in terms of pain relief — tying it with prescription drugs as the top-ranked approach for efficacy.”

One study showed that people who prayed were less likely to experience a variety of mental health issues, as reported here on PsychCentral.com.

Nutritional supplementation can also be helpful, though there are unfortunately many contradictory studies.

Dietary changes seem to be effective for many. Some people find that the nightshade foods (tomatoes, potatoes, peppers, eggplants, etc.) exacerbate pain significantly. Some are bothered by (conventional) dairy products, there are reports that dairy from pastured ruminants is less of a problem. Some people are sensitive to citrus.

Relaxation techniques obviously calm the mind and can help depression and anxiety, and dietary changes can lead to stabilization of a variety of physical and mental symptom. For example, avoiding all refined sugars can affect mood–even dramatically.

Awareness of the importance of mental health in the management of osteoarthritis pain is essential.

*Photo by James Heilman, MD