Why being in pain can make us grumpy
One of my Telehealth patients recently asked me “Why does my back always hurt more when I’m having a bad day at work?” A good question, and one that comes up quite regularly in fact! My simple response to this is normally something like “Because pain is an absolute blighter, and likes to kick us when we’re already down” but I thought today I’d put pen to paper (or fingers to keyboard, these days) and explain why and how our mood and pain levels are linked.
Anyone who has experienced pain will understand one of the main issues with it is the emotional distress it causes- anxiety, fear, anger, and depression to start with, and quite often some guilt and frustration thrown in there for good measure. These emotions are one of the main reasons why we associate pain with suffering, and it won’t surprise you to find out that having negative thoughts about your condition is a key predictor of how well you’ll do with care (1)- those with high levels of negative thoughts tend to do worse. This is why we collect PROMs on all our chiropractic patients, so I can identify how you’re thinking and feeling about your back pain and help you take action against this from day one of your treatment.
I’m going to break down these psychological issues and talk about each one in turn. This will highlight how these feelings contribute to your back pain and, more importantly, how to overcome them.
Let’s talk anxiety and pain
Anxiety is linked to pain perception. People with persistent pain tend to have higher anxiety levels than the Average Joe. This could be because pain is felt more intensely when we’re anxious, or it could be that anxiety heightens our sensitivity to pain. There’s also physiological elements to being anxious which play a part too, such as increase in muscle tension, blood pressure, and sweating. These changes may stimulate the nerves in our body that are sensitive to unpleasant changes. It’s vital for anyone struggling with pain to understand that anxiety-pain-muscle tension form a triangle that all interplay with each other. Pain generates anxiety which increases muscle tension which in turn results in more pain. A vicious circle, isn’t it? (Or should that be triangle?) This can also continue long after the original injury heals, and it can be really tricky to identify what caused what. The good news is- it doesn’t really matter what caused it or what’s just a by-product. As long as we treat all of it during treatment, you should get better.
This is a big one. There’s anxiety and then there’s health anxiety. Which is the fear that bodily signs and symptoms indicate serious illness. Part of what makes health anxiety such a challenge for clinicians is dear old Dr Google, which has given rise to a group of so-called “Cyberchondriacs”. It’s really important that you focus on obtaining information from credible sources (such as NHS Choices) before you start diagnosing yourself. Above all, this is to prevent you from jumping to the worst case scenario and getting yourself unnecessarily upset!
“There are.. those who Google symptoms as simple as “headaches and nausea” or “twitching muscles”, only to find their concern turn to blind panic as they spot links to websites on rare and untreatable diseases. Research shows that these normally rational internet users latch on to the worst diagnosis and even if they visit the GP, they often remain convinced.”
If this sounds familiar, it’s likely that you’re exceptionally well-tuned in to what’s going on in your body. You might have a tendency to worry over everything and anything. Try not to. Like anything in life that is lavished with care and undivided attention, those negative thoughts and feelings grow and take over your life. Like a nasty little weed.
Next- Fear and worry.
‘‘Sleepless in the early hours, you make a nest out of your own fears – there must have been survival advantage in dreaming up bad outcomes and scheming to avoid them. This trick of dark imagining is one legacy of natural selection in a dangerous world. This past hour he’s been in a state of wild unreason, in a folly of overinterpretation’’ (2)
Fear could be termed “extreme anxiety.” It’s an extreme reaction that activates our fight or flight response and can give way to living in a state of constant stress (Read my blog about chronic stress here). If, like me, you enjoy the occasional horror movie, you’ll recognise the signs of fear- we turn pale (as blood flow is drawn to our vital organs to preserve life), we start sweating, trembling, and you can spot fear in someones face too. Fear is such a major factor in pain that it gets a pain perception model all of its own- the fear avoidance model.
Worry is the “what if”.
What if my back pain never gets better. What if I can’t play with my grandchildren any more. Or what if I can’t work? We don’t often think “What if my back gets better straight away”, we tend to focus on the negative. Worry is self-perpetuating as well, and the more we worry, the more anxious we get. And then we’re back to where we were earlier, talking about high levels of anxiety. Worry has an important day-to-day role- if you’re walking in a dodgy neighbourhood, worry is what keeps you alert to dangers. But if you’ve had back pain for 8 or 9 years, worry is serving no purpose as there’s no concrete threat for it to focus on. It’s just there- unnecessarily, in most cases. Worrying about pain tends to be more difficult to ignore than other types of worry too. (3) It’s more distracting, more intrusive, better able to make us avoid things, and takes up more attention than any other worry we experience- which is why pain is often more problematic at night as we’ve got little else to pay attention to.
Stress and Trauma
Just like anxiety, stress is a response to perceived threat or stressors in our environment (like grumpy bosses and deadlines). It tends to be linked to feeling pressured or overwhelmed. One study of stress markers (such as elevated heart rate) found that stress levels in white-collar workers increases by 50% during their working day. For blue-collar workers it’s a whopping 100%, which is thought to be due to high demands and low levels of control. (4) Given we know that stress levels can increase muscle tension, there’s a clear link between psychological stress and physiological reactions. Naturally, these can then give rise to pain.
What can be done about Pain and Low Mood?
You may think that there’s nothing that can be done to help you, when in reality there are many things that can help.
Firstly, we recommend taking charge of your pain. Learn more about it, read around the subject. We know that increasing your understanding of pain can help control, cope with and reduce the pain you experience.
Secondly- consider working with our Pain Management Coach, qualified Chiropractor Philippa. Find out how this can help you.
Thirdly- exercise. Exercise releases good chemicals (endorphins) that can make us feel better. Our experienced APPI Pilates Instructor Mel will work with you to design an exercise programme that will get you moving better and feeling great.
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2.  McEwan I. Saturday. London: Vintage Press; 2005
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