How the Mind Relieves Pain

Researchers are learning more about the powerful role that emotions play in our experience of pain. We spoke with Dr. Laurence A. Bradley, PhD, professor of medicine at the University of Alabama at Birmingham, who has published several studies on the association between pain and emotion in arthritis patients.

Q. How do emotions influence the perception of pain?
A. Anxiety and depression can enhance the perception of the severity and unpleasantness of pain in part because the same neurotransmitters that influence mood also influence pain. Emotions may even help influence the function of the immune system. For example, negative emotional states and exposure to stressors can increase the release of proteins produced by the immune system called cytokines that help promote inflammatory responses.

Q. Are there other ways that the mind affects the ability to deal with pain?
A. Many of the brain regions involved in processing the intensity and unpleasantness of pain are also involved processing emotional states as well as cognitive activity such as learning, memory, choosing coping strategies, and other functions involved in managing chronic pain and illness.

Q. So chronic pain may reduce your ability to plan ahead to manage your disease?
A. Yes. Fatigue, sleep disturbance, and difficulty in concentrating often accompany chronic pain. These problems may interfere with one's ability to plan ahead to cope with increases in pain or the worsening of symptoms as well as to take pain medications correctly.

Q. Easing pain, then, may improve both your emotional state and your ability to cope and plan. What holistic treatments are most effective in easing pain?
A. Hypnotic suggestions have been studied primarily in laboratory settings using healthy persons but they do temporarily change individuals' ratings of pain intensity and unpleasantness, and actually produce changes in the activity of brain structures involved in processing these aspects of pain. In contrast, acupuncture, acupressure and massage have been studied using patients and they often are effective in reducing pain, although the relief is generally short-lived.

Q. Do some treatments produce long-lasting benefits?
A. Relaxation training, biofeedback and cognitive-behavioral therapy (CBT) have been associated with longer-lasting improvements. CBT refers to a package of interventions, usually involving 10-12 treatment sessions, that provide education, training and practice in effectively using pain coping strategies (e.g., relaxation skills), and skills for maintaining one's improvements. This treatment, in particular, has been shown effective in reducing pain and negative emotional states (e.g., depressive symptoms) among patients with rheumatoid arthritis and knee osteoarthritis. It also has been shown to improve ability to perform activities of daily living among patients with fibromyalgia.

Q. Several recent studies have found placebos (inactive pills) to be about as effective as some drugs and popular supplements for most patients. How does the placebo effect work?
A. Placebo effects generally produce improvements in pain or emotional states that range from 20 percent to 40 percent of those produced by active treatments. Placebo effects on pain are associated with increases in endogenous opioids or dopamine, the body's natural chemicals that normally inhibit pain in the brain. However, placebo effects usually last for shorter periods of time than those produced by active treatments such as medication.

Q. Many physicians focus on pharmaceutical and surgical treatments and seem uninterested in complementary and alternative treatments. How can patients get their doctors to be more open to these possibilities?
A. The best way to do so would be to provide evidence for complementary treatments such as newspaper reports of studies that have been published in scientific journals. Information from the Internet should be supported by findings that have appeared in mainstream scientific publications.

Q. What mind-body interventions can people do safely and effectively at home to help manage pain, stress, fatigue and other symptoms?
A. Most mind-body interventions are best learned from a professional such as a licensed psychologist or nurse practitioner. Several ongoing studies are now looking at whether the 10 to 12 face-to-face training sessions in standard programs can be reduced with materials such as DVDs and workbooks for patients to use and practice at home. Over the next two or three years, many of these self-management training programs may become available to patients.