Pain Management Myths and Facts: What You Need to Know
Posted by Improving Lives Counseling Services, Inc. | Mental Health
More than 30% of Americans report experiencing pain in the past three months. This figure includes those who visited clinics, saw doctors, or utilized telemedicine. It does not account for the 38% who purchased over-the-counter pain medications or the 70% who visited emergency rooms in the past six months. Whether facing mild discomfort, chronic pain, or severe conditions, daily life can be significantly impacted, and many are simply seeking relief. At Improving Lives Counseling Services our counselors and therapists utilize cognitive behavioral therapy and mind-body techniques to support health-conscious individuals, those with health anxiety, and people with medically diagnosed pain conditions.
HOW PAIN WORKS
Pain is a complex physiological process involving multiple body systems, the brain, and a variety of chemical and emotional factors. Pain receptors, found in muscles, internal organs, and skin, serve as sensors for harmful stimuli. When activated by damaging signals, these receptors trigger neurotransmitters that send pain signals to the spinal cord, which then relays them to the brain for processing and interpretation.
In response, the brain releases endorphins that function as natural painkillers or neurotransmitters that amplify the pain or stimulate the immune system. Chemicals in the brain influence how far the pain signal travels, with physical and emotional factors affecting the process. Pain is experienced once a specific threshold is reached.
PAIN SCALES
Doctors, nurses, physician assistants, and today, even parents and coaches, utilize pain scales to assess care needs. The McGill Pain Questionnaire, developed by Dr. Melzack and Dr. Torgerson in 1975 at McGill University, employs numbers and descriptive words for patients to articulate their pain. The Wong-Baker Faces Pain Rating Scale, created in 1983, uses facial expressions and numbers to help children rate their pain. The Pain Assessment Scale for Critically Ill Children aids intubated and nonverbal kids, while the RPH/FPS scale uses numbers and words to clarify how pain impacts sleep, concentration, and daily activities. The most widely used scale among doctors, and familiar to the public, is The American Pain Society’s Numeric Pain Rating Scale, which ranges from 0 to 10.
Doctors, clinicians, psychiatrists, and therapists often use pain scales to assess a patient’s needs. However, these scales are not precise medical tools, and 59% of surveyed individuals found that using a numerical system was ineffective in measuring their pain. Many in the medical community believe pain scales are too simplistic and fail to consider several crucial factors:
- Subjectivity: People experience, interpret, and express pain differently.
- Cultural Differences: In some cultures, expressing pain is discouraged or even considered taboo.
- Communication Barriers: Patients with cognitive impairments, disabilities, and the elderly may inaccurately report their pain levels.
- Response Bias: Patients may report what they think their doctor wants to hear or under-report their pain to avoid seeming like complainers.
- Emotional Factors: Anxiety or nervousness around doctors can affect how patients report their pain.
- Varied Pain Types: Pain can be acute, chronic, emotional, or physical, and not all forms are easily captured by a simple scale.
Despite these limitations, pain scales remain widely used in the medical community, particularly in emergency rooms, where they may not fully reflect the complexities of pain experience.
TYPES OF PAIN
When people are in pain, they have little concern about what type of pain it is. Their primary concern is what’s causing it, how it will affect them long term, how it will affect their lives on a daily basis, and what it’s going to take to control it, or make it go away. Pain affects the body and the mind, and lingering untreated pain can lead to anguish, chronic anxiety, behavior disorders, and substance abuse. Ongoing untreated pain can lead to emotional distress and suicide.
Acute Pain
Acute pain usually comes on suddenly and lasts only for a limited time. It is usually the result of damage to muscles, bones, or organs. It can be caused by injury, surgery, illness, trauma, or medical procedures. “Acute pain can be overwhelming, affecting one’s state of mind.” According to Psychology Today, acute pain is a warning sign that the body is in trouble and is an essential part of survival and evolution.
Chronic Pain
Chronic pain is long-lasting pain that persists for months or years, often beyond the typical recovery time. It can come and go or seem never-ending. Chronic pain affects all areas of life, often limiting one’s ability to work, enjoy relationships, participate in physical activity, or effect self-care – bathing, eating, dressing, and toileting. Back pain, headaches, neuropathies, arthritis, foot and ankle pain, fibromyalgia, and brain and spinal cord injuries can cause chronic pain. Even psychogenic pain can fall into this category.
Nociceptive Pain
Resulting from damage to body tissue, nociceptive pain is sharp, aching, burning, cramping, or throbbing pain. Usually localized, it can be acute or chronic. Arising from tissue damage, often caused by trauma, surgery, or chemical agents, nociceptive pain is most common in people with skeletal conditions – often leading to immobility. Patients diagnosed with rheumatic diseases, neuropathy, or damage to sensory nerves can experience nociceptive pain.
Neuropathic Pain
Neuropathic pain is caused by damage to the nervous system. Symptoms include tingling, burning, bruising, and shooting spark-like sensations. “Neuropathic pain can be mild or severe. It might come and go, or it might linger. Diseases like diabetes, shingles and central nervous system disorders can cause it. People with neuropathic pain might need a combination of different treatments, including medication, physical therapy, psychological counseling, and surgery.” Sciatica, diabetic neuropathy, and postherpetic neuralgia can cause neuropathic pain.
Visceral Pain
Visceral pain is pain that originates from the internal organs. Originating in the middle of the body, It can be a deep gripping, dull pain of the chest, pelvis, belly, muscles, skin, or joints. Visceral pain can be acute or chronic and difficult to locate. Varying from person to person, most common causes are inflammation, menstrual cramps, tumors, trauma, urinary track infections, IBS, and nerve damage. Visceral pain has frequently been linked to anxiety, chronic stress, and depression.
Other Types of Pain
Somatic Pain comes from the skin, muscles, and joints; phantom pain is felt in an amputated part of the body; psychogenic pain is influenced by emotional, psychological, and behavioral disorders, and referred pain is felt in a part of the body not related to the original disease. Breakthrough pain is a sudden recurrence of pain currently controlled by medication.
PHYSICAL EFFECTS OF PAIN
Pain of any type can interrupt sleep, affect personalities, cause verbal outbursts, and affect bodily processes. Other effects include, increased heart rate, elevated blood pressure, weakening of the immune system, inflammation, difficulty breathing, poor circulation, eating disorder, immobility, fatigue, low energy, and blood clots. Because the body uses energy to cope with discomfort, which can wear individuals down over time, managing pain can be exhausting leading to chronic fatigue.
PSYCHOLOGICAL EFFECTS OF PAIN
Pain, whether from a stubbed toe, jammed finger, stomachache, headache, or sore muscles, impacts the emotional, cognitive, and behavioral state of mind. It often triggers fear, “What’s causing this, will it be temporary or recurring,” anxiety, “Should I take medication, call a doctor, or go to the emergency room,” and feelings of depression, anger, and frustration, “Why is this happening, why is my body failing me?
Cognitive Effects
Pain can impair cognitive functions making it difficult to concentrate, recall simple facts, or perform routine tasks. This is because pain consumes mental energy, leaving less capacity for other activities. Cognitive distortions, such as catastrophizing, involve anticipating the worst, believing the pain is severe or deadly, which increases anxiety. Persistent pain often leads to rumination—obsessive thoughts about the pain, heightening emotions, and stress.
Pain is more than just a physical sensation; it has psychological, emotional, and biological components. These factors influence how intensely individuals experience pain, how debilitating it is, and how effective treatments are likely to be. There is significant variability in how people regulate their emotions, including their emotional responses to pain. Pain can lower self-esteem, lead to a loss of identity (where the pain feels all-encompassing), and diminish the ability to engage with oneself. It can contribute to PTSD and pain-induced anxiety disorders.
PAIN MANAGEMENT
Pain management aims to alleviate or control pain from various causes, significantly improving quality of life. Key approaches include over the counter and prescription medications; however, chronic pain, PTSD, long-term pain, and visceral pain often require more targeted strategies. Many people use relaxation techniques, mindfulness, and positive thinking, while others find relief through massage, acupuncture, reflexology, or even hypnotism.
Commonly used over the counter and prescription medications include non-opioid medications, anti-seizure medications, nonsteroidal anti-inflammatory drugs, muscle relaxants, and topical medications. While there are risks associated with these medications, NSAIDs are particularly effective for managing mild to moderate pain accompanied by swelling and inflammation.
Support Systems and Intervention
Gaining popularity in the 1970s, support groups have become a refuge for those suffering from chronic pain, offering compassion and understanding. Individuals with similar diagnoses meet weekly, either in person or online, to provide empathy, support, and valuable coping strategies. Typically led by a counselor, therapist, or doctor, these sessions allow participants to share experiences and resources, navigating life changes without fear of judgment. This supportive environment serves as a powerful coping mechanism.
Opioids – Non-opioids
Opioids such as morphine, oxycodone, hydrocodone, and fentanyl are effective for sudden pain but carry physiological and psychological risks, including the potential for addiction, and if not properly managed an increased desire for stronger medications.
Cannabis
Medical cannabis is now approved for sale in most states and for casual use in twenty – four. It is prescribed for chronic pain, cancer pain, and neuropathic pain. Cannabis products, including creams, lotions, oils, flowers, and edibles, have provided relief for many.
Psychedelics
Two dissociative psychedelics are currently FDA-approved: ketamine, used as an anesthetic, and, esketamine, approved for treatment resistant depression. Scientists are investigating whether other psychedelics such as psilocybin, MDMA, LSD, and mescaline, may be effective treatments for chronic pain, substance abuse, and other mental disorders.
PAIN – MEDICAL MYTHS
Often, people of color report higher pain levels but receive less effective treatment, due to disparities in healthcare. “As recent as 2016, a study published in the Proceedings of the National Academies of Science found 50% of white medical trainees believe black people experience less pain, than white people. Trainees who believed this myth were less likely to treat black people’s pain appropriately.” Though research shows experiences of pain can vary among different racial and ethnic groups, it’s essential to consider social, cultural, and economic factors influencing pain perception and treatment. Medical News Today list inherent biases, gaps in education, and underrepresentation keeps the myth alive.”
SUMMARY
Pain signals that something is wrong—it’s not always chronic or acute, nor is it necessarily never-ending. People experience pain differently, and treatment plans can vary widely. To support your physical health and mental well-being it’s important to know your body, be sensitive to bodily changes due to age, diet, and lifestyle, and have annual physical and regular mental-health check-ups.
Using cognitive behavioral therapy, mindfulness and relaxation techniques, group therapy, and pain management programs, the diverse team of counselors, therapists, and clinicians of Improving Lives Counseling Services will shift your perspective on pain, help you manage the stressors associated with pain, help you make needed lifestyle changes, and provide the essentials needed for developing and maintaining effective coping strategies. The psychological effects of pain, of all types, can be controlled. Call us to learn more.
PAIN MANAGEMENT
