Pain, a feeling so common, yet considered overwhelming, is often what we’re always trying to escape. However, did you know “How much of it do we feel could actually be a reflection of where we come from or who we are or how we live?” Let us understand more about “Pain”.
An unpleasant bodily sensation or a set of complex sensations that cause physical discomfort and emotional distress can be defined as Pain (Naidu & Pham, 2015). The concept of pain has historically been seen as a relationship between an underlying injury or pathology and consequential symptomatology, the latter expected to be proportional to the former (Meints et.al. 2020).
In recent years the focus is shifting towards recognizing a comprehensive model of pain, exploring its behavioural, social and psychological determinants. The interaction between these components may perpetuate and worsen the experience as well as clinical symptoms of pain. This holistic “biopsychosocial” approach is recommended as successful and must-in-use for pain assessment and management.
The biological factors associated with pain are plenty, beginning with age, gender, physical activity, underlying injury, comorbid disease, sleep, fatigue, and smoking status (Gatchel.et.al. 2020). Some of these may even reverberate or in turn inform social perceptions, for example gender. Several studies have indicated a higher sensitivity to pain, pain related expectancies, lower thresholds of pain and a greater ability to discriminate painful stimuli in women, as compared to men (Keogh, 2022; Fillingam et.al. 2009; Vallerand & Polomano, 2000). Biologically, it can be linked to hormonal play in women (Boerner et.al. 2018). However, socially, it may even be related to the constricted expression of emotion in males, corresponding to the notions of masculinity. For women, the higher pain sensitivity may even be a result of higher interaction with painful stimuli, for example the monthly menstrual pain. However, these are mere possibilities and anecdotal assumptions and warrant extensive investigation in this area.
Psychological Variables are surfacing as factors contributing to experiences of acute and chronic pain, especially clinical pain. They include depression, anxiety, stress, general distress, fear and rumination level of patients (Bilgin, Kesik & Ozdemir, 2021; Meints et.al. 2020). High levels of general negative affect is also associated with poorer outcomes for treatments targeting pain-relief (Meints.et.al. 2020). Associated with general negative affect is the phenomenon of Catastrophizing, which includes a combination of helplessness, rumination and magnification of problems. It is said to uniquely influence pain related outcomes with acute pain severity, enhanced pain sensitivity and higher likelihood of opioid use post surgical procedures.
Sleep, overlapping across the biological and psychological domain, is associated with pain. Studies reveal that individuals with sleep disturbances are more likely to develop clinically relevant pain, especially musculoskeletal pain. Additionally, sleep disruption and pain exert influence on each other. On the other hand, Physical activity is an upcoming treatment approach for people experiencing chronic pain. Physical activity is associated with lower pain severity ratings and improvement in psychological function as well as quality of life for people experiencing chronic pain (Geneen et.al. 2017).
An important psychological aspect which influences pain-related outcomes is Coping Mechanisms. Differences in emotional, behavioural and cognitive coping strategies may influence pain perception. Individuals who decide to attempt controlling pain or functioning despite pain (active coping) are more likely to show positive outcomes and better psychological adjustment (Stewart & Yuen, 2011). Alternately, giving up control of one’s pain, i.e. Passive coping is associated with increased pain and depression (Snow-Turek et.al. 1996).
This model also holds social factors accountable in the expression, perception and experience of pain. Social factors comprise race, ethnicity, culture, socio-economic status, ageism, education level, marital status, and employment status of an individual (Miaskowski et. al. 2020). Studies show differences in pain sensitivity observed across cultures, in both clinical and pain-free patients, indicating an association between culture and pain (Harthy et.al. 2015). The perception of pain in a particular culture may also influence reporting levels or expression of pain. Socio-economic factors, race, and ethnicity have a direct impact on psychological statuses of individuals belonging to different strata. Further, education level and employment status could also influence the level of social and psychological awareness, as well as social support when it comes to understanding physiological and psychological problems. This, in turn, could impact experiences of pain as well as pain related outcomes. Therefore, more exploratory research in these areas shall bear much needed insight.
Specific to patients experiencing the Covid-19 Pandemic, Bilgin and colleagues (2021) conducted a research to examine the factors predicting pain in individuals experiencing Covid-19 which revealed higher pain intensity in women and people with chronic diseases. Additionally, pain was felt more intensely by people who experienced fatigue and anxiety. Low physical activity was found to increase pain in patients with Covid-19, revealing the study’s contribution towards pain being viewed holistically, with respect to this novel disease as well.
Concluding this piece, it is interesting to note how many routine as well as non-routine factors, our psychological makeup and social frameworks could affect something as day to day and even chronic as pain. With limited research, and more anecdotal work, investigations in this area are highly recommended and shall definitely prove helpful.
Clinical and Research Intern, PsychLine.in.
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