Your Psychology Affects Your Response to Medical Treatments and to Pain Medications

Many people think about pain psychology as being a way to help them cope with pain.  In this sense, the thinking is that psychological factors – depression, anxiety, fear– happen in response to pain.  While this is true, an important part of the equation is often overlooked:  that psychological factors can predict how well pain treatments actually work.  That’s right:  your thoughts and emotions are so powerful that they can determine how well opioid medication works or how well surgery works.

For people with chronic pain, one of the most important factors is pain catastrophizing.  Pain catastrophizing is a psychological pattern of responding to pain with distressing thoughts that ruminate and magnify pain, combined with feelings of helplessness about pain.  While pain catastrophizing is related to depression and anxiety, it is on its own a powerful predictor for outcomes related to pain.  People who catastrophize have more severe pain, require more opioid medication, and have reduced response to multidisciplinary pain care.  Several studies have examined how catastrophizing impacts response to surgery.  People who catastrophize are much more likely to develop post-surgical chronic pain.  This tells us very clearly that psychology isn’t just about learning to cope better with pain:  psychology actually determines whether pain develops, how bad it gets, and how well pain treatments work.

Brain imaging studies show that catastrophizing is associated with attention to pain, anticipation of pain, and negative emotions related to pain—all of which serve to worsen pain at the neural level.  In other words, catastrophizing lights up the same areas of the brain associated with the experience of physical pain.

To be clear:  If you have pain it is not your fault, nor is it a marker of deficiency of some sort.  However, in the context of chronic pain, having good control over thoughts and feelings is more important than ever—otherwise you may unwittingly make your pain worse!  While nobody chooses to have chronic pain, it is important for you to understand that you are participating with their pain with their thoughts, emotions and choices.  A pain psychologist helps people learn behaviors and ways of thinking that support good pain control.  Using various strategies you can dampen pain signaling in the brain and therefore improve your response to other pain treatments.

Living with chronic pain is stressful.  More than that, chronic pain causes your body and the brain to change in unhelpful ways—ways that actually make your pain worse.  Your brain and the body respond to pain with a “stress response” – rapid heart rate, shallow breathing, tight muscles, agitated thoughts.  Over time, these stress responses become the default mode, such that even when your pain is relatively low the shallow breathing patterns remain, the muscle tension remains, and so forth.  In this sense, chronic pain stores stress in your body and brain. One of the first things clients learn with a pain psychologist is how to lessen pain suffering by using relaxation skills to calm the nervous system, thereby dampening pain signaling in the brain.  Used regularly, you can “remind” the brain and the body to release the stored stress, and this leads to greater control, greater comfort, and fewer pills.  And, with the brain and the body calmed, you will be more effective at making good choices regarding self-care and stress management.


Beth Darnall, PhD

Clinical Associate Professor, Stanford University School of Medicine, Division of Pain Medicine.
Author of the forthcoming book, “Less Pain, Fewer Pills: Avoid the dangers of prescription opioids and gain control over chronic pain © (Bull Publishing).
Her column, “Ask Dr. Beth, Pain Psychologist” is a regular feature on the National Pain Report.