This study involved individuals with chronic low back pain where the subjects were asked to lift a heavy bag and rate their pain levels and tolerance. Then they randomly had their moods altered and were asked to lift the heavy bag again. The researchers used music and ambience lighting to effectively alter the participants moods either positively or negatively. Can you guess what happened?
“…Results of the experiment indicate that depressed and happy moods altered the reported level of pain and actual pain tolerance in chronic pain patients in the predicted directions. – Tang et al 2008
Based on hundreds of studies to date, we can conclude with great certainty that a person’s emotional state has a direct impact on their pain experience.
I personally hate horror films and avoid them but imagine that you’re intensely watching a horror movie and a friend comes from behind and gently taps you on the shoulder. You may be frightened by the tap and over-react. You see, it’s not about the gentle tap; it’s about the context where the tap occurred.
The brain continually scans for danger, interpreting information from the body and the surrounding environment deciding when to sound a warning alarm… the fight or flight response and pain!
When a person is in a fight-or-flight mode, they are much more likely to observe other stimuli through that same dangerous lens, be it when bending, lifting a bag or when simply sitting down and doing “nothing”.
PTs, often place too much emphasis on finding “flaws” in the body and not enough on calming the brain, particularly the amygdala.
The amygdala is involved in “threat detection” by processing emotions such as fear and anxiety… an emotional alarm system.
However, in our society it is more acceptable to have a physical illness rather than an emotional illness. We generally stigmatize pain that may be perpetuated by the amygdala versus a physical injury to the body.
“I have a broken ankle”, “I’ve torn my rotator cuffs” or “I have 2 herniated discs” are shared with others with no shame… yet, “my pain is from fear and anxiety”, would carry with it shame and even denial of the possibility.
Insinuating that “the pain is all in the head” is considered a great insult to anyone dealing with acute or chronic pain. As a society and as healthcare providers, we urgently need to change that narrative. It is denying people the proper care and further adding to the exponential increase in the prevalence of chronic pain.
When we deny and suppress feelings of fear, grief, anger, and stress, they end up living in the body and getting expressed as pain or any unwanted symptom from fatigue to IBS.
Admittedly, as PTs, addressing various psychological issues such as depression, grief and anger are beyond our scope of practice but “FEAR” is FULLY IN OUR SCOPE OF PRACTICE TO ADDRESS.
In conclusion, our primary goal as PTs must not be to address pain, but to address “fear”, as FEAR FUELS PAIN.
Far too often patients see PTs who add more scenes to their “horror film” by blaming their ‘bad’ posture, weak core, tightness, pelvic rotation, L4-5 hypomobility B.S. etc.