Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Feeling Their Pain

feelingFeeling the misery of others is a dubious task. Many patients feel that none of their friends, family or prior co-workers appreciate the extent and intensity of their pain. These patients may find themselves placed in chronic pain support groups, just as there are groups for other human conditions from smoking to gambling. However, the question must be asked as to whether support groups enable the patient a new means of feeling, coping or merely encourage the patient to focus upon the pain. For example, if the pain support group is one of the few activities in which the patient engages, then s/he would be prone to focus upon pain between sessions as part of socializing with the group; seeing the group as “friends” who can share an obsessive focus upon pain.

The patient’s greater concern is that those who prescribe treatment cannot appreciate their experience of pain. “How does my doctor know? He did not have this injury, these surgeries, these limitations or have to live the life that I do. Yet he decides how this pain should be treated.”

There is a study (Molecular Psychiatry advance online publication 29 January 2013; doi: 10.1038/mp.2012.195) that suggests successful pain treatment is related to the clinician’s ability to empathize with the patient’s experience of pain. The operative word here is “successful” treatment since it is quite easy to treat pain with a dispassionate assessment of what the patient is experiencing. “The physician’s ability to take the patients’ perspective correlated with increased brain activations (in the physician) in the rostral anterior cingulate cortex, a region that has been associated with processing of reward and subjective value.”

The article went on to suggest that “physician treatment involves neural representations of treatment expectation, reward processing and empathy, paired with increased activation in attention-related structures…neural representations associated with reciprocal interactions between clinicians and patients; a hallmark for successful treatment outcomes.”

This research suggests that those who treat pain successfully do, indeed, relate at a neurological level with what the patient experiences when coping with pain. Thus the patients who feel that those treating him/her do not appreciate their degree of suffering may be correct.

Successful pain management or treatment may be related not only to the procedure being used, but belief in the success of the procedure and empathetic understanding of the ongoing emotional status of the patient.

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