My goal was to maintain or improve their function, despite chronic pain.” Well, that’s not life, that’s not function. “Patients would say to me, ‘I’m fine as long as I don’t move from that recliner.’ Many were afraid to cook, drive, go to the mall. “If you perceive yourself to be disabled, you’re going to act like it,” she says. Darnall says that when patients learn how emotion, expectations, beliefs and context all fit together, “they know there is a pathway for them to gain more control.”Īpril Vallerand, PhD, a pain researcher and professor at Wayne State University in Detroit, says that a sense of powerlessness helps shape her patients’ perceptions of pain. These are essential to changing pain patterns because they help break the pattern of ruminating on pain and they trigger the release of feel-good endorphins and the body’s natural opioids. Many with chronic pain agree, noting that when they’re “in a worse place emotionally,” they’re less motivated to exercise and see friends and family. Positive emotions can significantly lower pain when patients stop focusing on how bad they feel. And depressed people are three or four times more likely to develop chronic pain than others. (Listen to the Live Yes With Arthritis Podcast: Wellness in Challenging Times.) Two-thirds of patients recently surveyed for the Arthritis Foundation’s Live Yes! INSIGHTS assessment said they felt depressed. Negative emotions are like gasoline thrown on the fire of pain, not only making chronic pain much worse, but even causing it in some cases, says Beth Darnall, PhD, a pain psychologist and associate professor at Stanford University. This shared neural network has been called nature’s “economy route,” because it allows the brain to process a lot of sensations at once. Pain and emotion circuits overlap in the brain. CCK has been shown to reduce or block the action of opioid medications and even acupuncture, which may help explain why people who are anxious or depressed are harder to treat. There’s less research on the nocebo effect, but evidence suggests negative expectations and beliefs increase anxiety, which in turn causes the release of cholecystokinin (CCK), a hormone linked to anxiety, creating a self-perpetuating loop. How does this happen? Many studies show that positive expectations or beliefs change brain chemistry, Atlas says, causing the body to produce pain-blocking chemicals like opioids and dopamine. In other words, if you expect something to hurt like the dickens, it probably will. Similarly, positive expectations can tone down chronic pain, and negative expectations can ramp it up. Likewise, if you have a history of ineffective treatment, this might lead to negative expectations that worsen symptoms,” she explains. “If you have a history of beneficial treatment with a certain doctor, this might enhance your expectations for a positive outcome. Atlas says just stepping through the door activates beliefs and expectations you’ve developed through experience. Here’s what science has found, and how it can work in real life.Ĭontext is the setting where something happens – your doctor’s office, for example. This is how people with chronic pain get locked in self-perpetuating pain, but evidence suggests that it’s possible to tone down an overly sensitive brain and moderate chronic pain messages. And depending on the person’s emotions, beliefs and expectations, the brain will likely keep registering an aching knee day after day. Scientists say the more the brain processes pain, the more perceptive it gets until it’s always on high alert. But in chronic conditions like osteoarthritis (OA), where there’s no quick fix for, say, cartilage loss in the knee, the parts of the brain that send and receive danger signals become more sensitive over time. This system works pretty well for acute pain, like an injured toe. If it decides the signals are worth paying attention to, the pain volume is cranked up until the problem is resolved if not, pain is put on mute. When you stub your toe, your peripheral nervous system sends signals to your brain, which then decides how much danger there is. Pain is a complicated warning system to protect you from harm.

Signal path think about your mind