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The impact of mental health on pain


In light of national mental health awareness day earlier in the week I wanted to write a quick blog to highlight the impact that your mental health can have on your physical health and more specifically on your pain experiences.


Pain is individual. What one person finds painful, another may find relaxing. Take sports massage for example, some people leave feeling refreshed and revived and others feel beaten up. I like to link this to interpretation of spiciness in food: One woman's vindaloo is another's korma! So don't assume that everyone feels things the same way you do (If we were all the same the world would be boring).


All pain is processed in the brain, whether you've dislocated your shoulder or have chronic neck ache. Our peripheral tissues do not have the ability to produce pain, they do however have the ability to stimulate nerves that carry pain messages to the pain (through C fibres). These messages are then interpreted in the brain and a sensory or motor response is given. Pain can be present even in the absence of actual tissue damage.


A great example of this is a story I heard in a TED talk: A man was out walking in the outback when he felt something sharp on his leg, he jumped up and screamed in response to pain, realised he'd been bitten by a snake and was taken off to hospital. This same man was out on a walk a few months later when he felt something on his leg, he jumped up and screamed only to realise it was only a twig that brushed his leg and he carried on walking. Why did he react like this to a twig? Because he has previous experience of something potentially deadly in the same setting and his brain interpreted it as a snakebite due to a heightened awareness of potential danger in this area despite there being no snakes near by (heightened state of sensitivity in the nervous system leading to a lowered pain threshold). Pain signals are necessary as when there is tissue damage we need to know how to respond but we also need to know how to filter out irrelevant stimulation (our brain cannot possibly process all the information around us at once and finds ways to 'shortcut' to the right output). Your brain can produce irrational reactions to stimulus in the same way it can produce irrational fears.



Now add in the following factors, which are known to heighten our nervous system sensitivity and ask yourself how this may impact on your brains processing of stimulation:

  1. Lack of sleep

  2. Increased stress - home, work, social life etc.

  3. Anxiety

  4. Depression

  5. Loneliness

  6. Fatigue





My tips to help this:

1. Seek professional support to ensure an assessment is completed to rule out any sinister pathology or underlying causes of pain - This does not always mean or require imaging (In fact, in most cases imaging is not indicated)

2. Don't be ashamed to admit that your mental health impacts your pain. It is not 'made up' or 'all in your head', it is simply an imbalance between the messages your brain is receiving from your surroundings and body tissue and the output it is giving. It can be improved and it can be addressed.

3. Find positive coping strategies for chronic pain that may also improve mental health - talking therapies, mindfulness, relaxation breathing, exercises, socialising with loved ones, hot baths etc.

4. Avoid passive coping strategies that may feed further into the downwards spiral - Alcohol, lack of ownership of ones health, avoiding physical activity etc.





there is so much more that can be said about this topic and I have tried to just scratch the surface of my understanding, its not always an easy thing to explain and treat but patient education and understanding is so important in developing an effective management plan. There is a lot of information and support out there, here are some of the sites I direct my patients too:

https://www.flippinpain.co.uk/

https://www.painrevolution.org/

https://www.nhs.uk/live-well/healthy-body/how-to-get-nhs-help-for-your-pain/





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