Independence Back Institute
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Wilmington, NC 28412
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Why Do People Respond Differently to Pain?

A common experience:
I worked the same job for over 20 years. I was a good employee, hardworking, professional, and dedicated. Also, all of my life I have been a fairly physical and active person. I played sports; went to all of my children’s games, plays, and recitals; and was very involved in the community and church. Of course I had aches and pains but normally just shrugged them off to declining age and a hard physical life. But my pain steadily got worse. Doctors frequently told me I had a pulled muscle or arthritis. And for 10+ years of going to the chiropractor, numerous massages, and months of physical therapy my pain was manageable with some degree of improvement. But one day I rolled over and could barely move. The pain was just unbearable. X-rays suggested something about degenerative disc disease and bone spurs, supposedly pressing on nerves causing severe pain. In attempts to avoid surgery, I again participated in physical therapy, tried epidural and cortisone injections, and numerous other medications, but nothing was completely helping my pain. It is hard to believe the doctors cannot find exactly why I hurt and fix it. And now they are suggesting that I see a psychologist; don’t they believe I hurt? It’s not all in my head.

For many the origination or cause of pain may differ but the process that one goes through is common. The experience of ongoing pain and reaction to disability not only affects the individual but also those around them. Many report feeling hopeless, totally dependent, and angry at what their pain has done to them and their family. No, it was not suggested that you see a psychologist because someone thinks the pain is all in your head. By and large, whether you were in an accident, experience pain following multiple surgeries, or suffer from disease, the experience of pain is a psychological experience (Smith, 2004). There is no simple correlation between the severity of an injury and the pain that many of us experience.

Some severe injuries produce no pain at all, while absent limbs may provide a person with excruciating pain and discomfort. Thus pain is not merely a simple matter of transmitting impulses along nerve pathways to some specific pain center in the brain. There is no such location. Instead when pain is experienced many brain areas are involved, ranging from the frontal lobes, motor and sensory areas, to the midbrain, and cerebellum. Pain perception is the response of the whole brain and not just one area (Campbell, 2000). As a result pain is easily affected and intensified by varying emotions, stressors, hormonal changes, and thought processes, just to name a few.

Some 45 million Americans are plagued by headaches. Up to 80% will experience back pain during their lifetime. Over $4 billion is spent each year on over-the-counter medications alone. This being said, pain issues are prevalent and are the most common reasons patients either enter healthcare settings and/or self-medicate (Smith, 2004). Generally pain functions as a protective device alerting us to danger or injury, and priming us for escape. So if I burn my hand or even bang my elbow, pain would signal me to remove my hand from the hot object or my elbow away from the obstruction. This type of pain is commonly referred as acute pain.

When we are out of danger or the tissue damage has healed pain diminishes. However this is not always the case. There are a number of situations where pain persists or is thought in excess of identifiable injury and tissue damage. Examples are often seen with back pain, headaches, arthritis, and angina (Smith, 2004; Eccleston, 2001). When pain becomes chronic it is more than just a physical and minor emotional impediment. It typically results in disability, which can be physical, emotional, and financial. Most if not all activity stops.

We experience various emotions ranging from anger, anxiety, and depression, and often a sense of loss. We perceive ourselves as completely disabled, unable to do or be the person we once were. We may push away those we care about, feeling like we are nothing but a burden to others. As our pain persists we become more and more inactive. We may see ourselves at the complete mercy of our pain, no longer feeling any sense of control over our lives. We are stressed financially too, unable to work and dependent on a system of disability or worker’s compensation. We often feel that, if only we could end the pain then all would return to normal; the depression would lift and we would be the person we once were. But this is rarely the case. The question is asked, which came first, the pain resulting in loss then depression, or did underlying depression cause the pain? Many would easily say that one’s pain and disability led to loss and depression, as well as other emotions, but researchers and healthcare personnel believe that this is not easily determined.

But why do people respond differently to pain? Why is it that some individuals who received seemingly minor injuries become totally inactive and dependent, while others who may be more severely hurt appear to take a positive attitude and are better able to manage their pain? Without attempting to settle this question of the “chicken or the egg,” many would agree that when someone experiences stress and/or has tremendous emotional baggage associated with physical pain, healing is an extremely slow process.

In conjunction with ongoing medical care, psychological treatment is often introduced to assist with the emotional toll one experiences from daily pain. Often goals are designed to help manage the pain cycle. Pain from increased activity. To develop skills to minimize pain.

To learn to maximize activity and positive life experiences despite physical limitations. Techniques typically used may involve traditional psychotherapy, cognitive-behavior treatment, biofeedback, hypnosis and relaxation, and/or fundamental breathing exercises. Factors such as disability, financial stress, loss of work, and problematic family dynamics are also frequently a part of treatment. Given all of these aspects of pain and disability, not to mention the chemical processes associated with emotions and hormonal levels, it is easy to see how pain, especially persisting and enduring pain is indeed psychologically based. The course of treatment to best address these many factors would be a multidisciplinary approach, focusing on physical limitations, pain, and related psychological issues.

**Campbell, 2000. Book review of P. Wall, Pain: The science of suffering.
**Eccleston, 2001. Role of psychology in pain management. British Journal of Anaesthesia. Vol. 87.
** Smith, 2000. Pain: Double trouble. Psychology Today. July/August, 2004.


Independence Back Institute