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Chronic Pain, Arthritis, and Psychology

Have you heard of the “biopsychosocial”model of chronic pain?

Through years of research, the biopsychosocial model has come to stand out as the most widely accepted model for conceptualizing and treating chronic pain.

So what is this model? The biopsychosocial model highlights something that many people intuitively understand,- that the mind and body are inextricably connected.

From a biopsychosocial perspective, there are 3 components that impact not only the experience of pain, but also the ability to manage and successfully treat pain while living a full life.

Diagram of health

1.The first component is the biological component, which includes the physical and neurological aspects of pain.

For example, joints, muscles and pain receptors in the brain, etc. are all part of the “bio” in the biopsychosocial model. People are pretty familiar with the physical aspect of pain, but if we stop there, then we really do miss the big picture of the pain experience.

2. Next we come to the “psycho” part of the model, and I’m not talking about Norman Bates.

This refers to the psychological factors that significantly contribute to our experience of pain, such as our emotions and cognitions (thoughts). Now this is not to say that pain is “all in your head” (although pain receptors are in our brains so, in a way, pain kind of is all in our heads and very real, but I digress).

Have you ever noticed how two people can experience the same physical injury but seem to react in two very different ways? I know I have. Not only have I seen people report different levels of pain in reaction to similar injuries, but the pain impacts their daily functioning, activity level, and life satisfaction in very different ways.

That’s the psychological aspect of pain. Did you know that the thoughts you have about your pain can actually increase or decrease the intensity of pain you perceive? Yes, that’s what I’m talking about and it’s true.

Additionally, co-occurring mental health illnesses can also impact pain.

On the one side of things, chronic pain can precede and lead to the development of a variety of mental health concerns, such as depression and anxiety. However, mental illness can also precede or coincide with pain.

Regardless of which came first, mental illness and chronic pain tango with one another in such a way as to exacerbate both conditions. Even if you do not have a mental health illness, you do have emotions and thoughts, so you can’t ignore this component.

3. Finally, we come to the third component in the biopsychosocial model of pain, or “the social aspect.”

familyThis includes social factors that can impact pain, such as life stressors, relationship conflict, cultural expectations, social support or isolation, etc. Think of the stereotypical “tough guy”who is in pain, but you would never know it because he rarely mentions it so he can keep up the tough image. He may even be at risk for further injury because of it.

Or, picture the corporate executive who is juggling multiple high profile projects at work, facing a possible relationship break-up at home, and just found out that a loved one is ill. With all of these social stressors, this person’s pain level will likely increase.

Believe it or not, social factors do significantly impact our experience of pain and our functioning in pain.

The “bio,” “psycho,” and “social” components are quite intertwined, and each feeds off of and influences the other to create this thing called pain. So what happens if treatment only targets one component of this web, say the biological component? Well, the psychosocial components go untreated and you are really only getting one piece of the pain relief pie. And, at least in this metaphor, you are going to want the whole pie.

By treating pain from a biopsychosocial model you will maximize not only your pain relief, but your ability to engage in life to your fullest potential.

But how can you treat pain from a biopsychosocial model? How do I target the psychosocial aspects and incorporate that into my overall pain management treatment plan?

Enter the psychologist. Psychological interventions are now recognized as effective additions to pain treatment, including arthritis pain management.

A large scale meta-analysis of several research studies found that patients with arthritis who received psychological interventions reported significantly lower levels of pain than the patients who did not receive psychological interventions.Not only was their arthritis pain reduced, but the researchers concluded that there is “ample evidence for the additional benefit of [psychosocial] interventions over and above that of standard medical care,” and these results extended to secondary psychological (e.g., anxiety, depression, coping), physical  and biological (i.e., joint swelling, overall disease activity) functioning as well.

The psychological intervention that stands above the rest as the most frequently used, effective treatment for arthritis is Cognitive-Behavioral Therapy for pain management/pain coping skills training, but other interventions (e.g., biofeedback, hypnosis, stress management) may also be beneficial.

Whether you choose to utilize a psychologist or simply pursue coping mechanisms on your own, such as meditation, exercise, or confiding in someone close to you, it is important to recognize all three components of the biopsychosocial model.

If you feel a psychologist is right for you,The Medical Fitness Network can help you find a qualified, experienced psychologist in your area to help you maximize your arthritis pain relief and enjoy life the way you desire! Let a psychologist be a part of your health care team.