Historically, mental and physical health problems have been treated separately. However, a growing body of research shows clear links between these two aspects of human well-being. Stress, whether work-related or personal, can lead to muscle tension and neck or back pain. Mental health has a tangible impact on a person’s physical state, particularly for those suffering from chronic pain. But why is this so?
To fully understand this phenomenon, it’s crucial to look at the mechanisms of pain, which, although often perceived as simple, is, in fact, highly complex. Without going into the physiology of the thing, let’s try to break it down a little by looking at its various components.
The sensory-discriminative component is the easiest to understand. When a part of the body receives a painful stimulus, the nociceptors (neurons responsible for pain perception) send a signal to the brain, which interprets it as pain, an alarm indicating a potential threat.
Emotional and cognitive components add another layer of complexity. During the interpretation of the painful nerve impulse, these factors influence pain perception. Each person has a different experience of pain and different knowledge of the human body and its injuries. As a result, the same nerve impulse may be interpreted differently by different individuals. For example, an anxious person who fears pain will not have the same experience as someone who has already felt similar pain. A painful stimulus may, therefore, be perceived as more intense, due to both emotional and cognitive components.
Finally, once the pain signal has been transmitted and interpreted, a reaction occurs: grimace, cry, verbal expressions, etc. This is the behavioral component of pain. A person’s reaction is influenced by the other components mentioned above. A little pain may cause a child to cry, while a torn ligament in an athlete may lead to frustrated gestures in the dressing room after a match. Each person reacts differently, depending on a number of factors.
Whether new or persistent, all pain components are involved. However, their importance varies between acute and chronic pain. When acute pain occurs, the sensory-discriminative component mainly dictates the intensity felt. It’s logical that a fractured foot should be more painful than a small rock in the shoe.
In cases of persistent pain, the sensory-discriminative component is less involved, and sometimes even non-existent. Emotional and cognitive components play a more important role, influencing pain perception to a greater extent. Pain that has persisted for several months or years is more influenced by negative emotions, such as stress or depression, and by beliefs and understanding of the problem.
The longer a pain persists, the more it generates negative emotions, which, in turn, increase the intensity and unpleasantness of the pain. This can create a vicious circle that’s hard to break. The negative effects of stress and anxiety on breathing, posture and pain threshold are exacerbated by increased levels of cortisol (the stress hormone) in the blood. Mental health, therefore, has a major influence on chronic pain, which is far more complex than acute pain.
To effectively treat chronic pain, or at least reduce its intensity and impact on daily life, it is essential to consider the whole person. This is why the biopsychosocial approach is favored today for all types of injury or illness. It’s important to understand the physical and physiological causes of a problem, but we must never forget that there’s a person behind every injuries or illnesses. That person’s psychological state and goals must be taken into account to provide optimal care and break the cycle of chronic pain.
For healthcare professionals, whether you work in mental or physical health, never forget that you’re treating a person first!
