Emotional triggers of pain experience

Dr Michelle King expands on how our emotions can increase or decrease our pain experience.

A common misconception is that if you’re feeling pain it means you must have hurt yourself. With cancer, pain experience can make you fear that the cancer has spread. However, it’s this very fear that can cause your pain levels to rise. 

Your experience of pain is caused by, not only physical factors, but emotional and social factors too. 

Most people have all experienced how stress can trigger a headache or make their stomach feel in knots. When you are worried about your finances or your ability to work, your pain can become worse too. 

Think about how young kids experience pain. If they’re happily playing, they won’t notice that they have stubbed their toe and that it has started bleeding. In fact, they will only start to cry once you draw attention to their blood. But had you just refused your kid a treat and he went and knocked his elbow against the chair, the amount of pain he would be experiencing will be equal to the volume of his screams and tears. 

Luckily, the opposite is true too. Reducing your stress levels, managing  negative thoughts and emotions can decrease your experience of pain. 

An important concept to grasp to manage your pain is that you can have tissue damage without feeling pain. Think about the last time you noticed a bruise and wondered how it got there. You hurt yourself at some point in the daytime without noticing the injury. 

Endogenous opioid system

The reason for this is that your body produces its own opioids, called endorphins. When you feel happy and relaxed, your endogenous (produced by your body) opioid system is working effectively and can block out signals that are coming to your brain which have the potential to be perceived as painful. 

When you are worrying too much and fearing that the worst is going to happen (catastastrophising), it makes your endogenous opioid system less effective. 

In fact, if you are always catastrophising about your pain, it can affect this system in such a way that your pain medication becomes less effective, and you end up needing higher dosages.

What can you do?

I know it is something you hear often but doing basic things to keep your stress under control will help you experience less pain. Eat a balanced, healthy diet and exercise. Exercise, even if it is going for short walk, or gentle stretching can help reduce pain. Get enough sleep. Poor quality broken sleep has been shown to make your pain worse the next day. 

Start keeping a diary with a list of all the things that make your pain worse. For example, worrying about your cancer coming back; fighting with your husband; not getting enough sleep. 

Then make a list of all the things that make your pain better. For example, calming baths; spending time with friends; listening to good music. 

The idea is to become aware of what your triggers are for making your pain worse and to do less of this. If you realise that there are certain things that frequently come up but you can’t get them under control then get a therapist to help you. Talking to a psychologist or psychiatrist can be helpful in reducing your stressors. 

Focus on the list of things that make your pain better and do more of these. 

If you overdo things and your pain flares up, pick one or two things from your list of things that make you feel better to get your pain back under control. 

Speak about your fears

A palliative care professional has special training in helping you manage your worries and concerns directly related to your cancer, whether it is about how to put together an end of life plan or a living will or just talking to someone who is comfortable with speaking about death and dying.