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Chronic pain, mental health and mindfulness

By Kyle Dijon Hill MSCR, Affinity Patient Advocacy Board Member


Evolution has proposed pain as a type of signal in which one is unable to ignore. Essentially, pain is for the purpose of protection from threats to the body’s integrity, causing a prompt motivation to act in order to prevent serious injury. The intent is to ensure our well-being and not to torment us needlessly unless the pain is disassociated from its objective and becomes chronic.


Normally, pain is expected to settle down with time; in some cases, the brain continues to send out pain signals, prolonging the sensation and perception of pain. Chronic pain is described as pain that is persistent for weeks, months or even years following an initial incident. Sometimes, the chronic pain occurs without any inciting event or evidence of bodily damage. If pain becomes chronic, it can significantly reduce patient quality of life, causing depression, suicide, insomnia, impaired cognitive function, and other deleterious effects.


My personal experience with chronic pain occurred after a near-fatal car accident in which I sustained bilateral neck fractures, a complete femur fracture, a crushed pelvis, a fractured collarbone, and displaced ribs leading to internal bleeding. I spent 4.5 months in a cervical fixation device, or halo. The first few years after my accident were riddled with opioid-based medications; the pain was controlled, minus the toxic effects the overuse of pain medication had on my body and mind. It was not until almost five years after that when I began experiencing debilitating dispersed pain with weather changes; other times, this pain arrived with no discernible factors that led to it. The pain will often initiate catastrophic thinking, leading to symptoms of anxiety and depression.


Catastrophic thinking is broadly defined as an exaggerated negative orientation toward the actual and anticipated pain experience. This form of thinking causes an inability to divert attention away from the pain and hinders the ability to focus on other tasks requiring cognition. Negative thoughts began to surface about the future state of my body, feelings of inescapable everlasting pain and lasting debilitation. The depression, anxiety and pain fuel each other, snowballing into a mindset of helplessness and inadequacy.


I attest to being a chronic pain survivor due to mindfulness techniques and lifestyle adaptations that have allowed me to thrive among chronic pain. Yes, I still have debilitating pain and yes, I still deal with anxiety and depression because of it. But it is the mindfulness and lifestyle changes that have encouraged me to understand and accept my pain, as well as halt catastrophic thinking when it occurs, therefore lessening its detrimental effects on my mindset and mood.


Studies show that chronic pain entails structural and functional changes in corticolimbic brain regions such as the prefrontal cortex, ACC, amygdala, hippocampus, NAc, and PAC. These structural changes lead to shrinking of grey matter and veering of functional hyperconnectivity to emotional centers. Rodriguez-Raecke et al discovered that decreased grey matter volume was directly related to pain duration, indicating a 1.3cm3 loss of gray matter for every year of chronic pain.


Experiments conducted in women with early life abuse showed that mindfulness-based stress reduction techniques significantly increased pain tolerance, reduced cortisol and improved depression symptoms along with emotional regulation ability. Another study found that mindfulness meditation reliably reduces experimentally induced and clinical pain by engaging multiple, unique, non-opioidergic mechanisms that were distinct from placebo and vary among meditative training levels.


Mindfulness can be explained as a moment-to-moment awareness without judgment including elements of self-compassion and self-acceptance. Mindfulness approaches have been demonstrated to produce significant effects on symptom severity, pain intensity, depression, anxiety and even insomnia. Managing chronic pain and its mental health effects is specific to each individual but changes in lifestyle, including nutrition, exercise and daily mindfulness techniques has the ability to transform suffering into thriving.












Resources:



Andersen E, Geiger P, Schiller C, Bluth K, Watkins L, Zhang Y, Xia K, Tauseef H, Leserman J, Gaylord S, Girdler S. Effects of Mindfulness-Based Stress Reduction on Experimental Pain Sensitivity and Cortisol Responses in Women with Early Life Abuse: A Randomized Controlled Trial. Psychosom Med. 2020 Nov 30. doi: 10.1097/PSY.0000000000000889. Epub ahead of print. PMID: 33259351.



Crombez, G., Eccleston, C., Van den Broeck, A., Van Houdenhove, B., & Goubert, L. (2002). The effects of catastrophic thinking about pain on attentional interference by pain: No mediation of negative affectivity in healthy volunteers and in patients with low back pain. Pain Research & Management, 7(1), 31–44. https://doi.org/10.1155/2002/576792


Rodriguez-Raecke R, Journal of Neuroscience. 2009;29(44):13746–13750. doi:10.1523/jneurosci.3687- 09.2009.



Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995;7:524-32.



Willekens B, Perrotta G, Cras P, Cools N. Into the moment: does mindfulness affect biological pathways in multiple sclerosis?. Frontiers in behavioral neuroscience. 2018 May 22;12:103. Pain Rep. 2019 Jul-Aug; 4(4): e759.



Yang S, Chang MC. Chronic Pain: Structural and Functional Changes in Brain Structures and Associated Negative Affective States. Int J Mol Sci. 2019;20(13):3130. Published 2019 Jun 26. doi:10.3390/ijms20133130


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