The consequences of pain: The social and physical pain overlap on psychological responses

Current theories suggest that social and physical pain overlap in their neurological and physiological outcomes. We investigated how social and physical pain overlap in their psychological responses by testing the hypothesis that both social and physical pain would thwart satisfaction on four human needs, worsen mood, and increase desire to aggress. In Experiment 1, recalling an experience of social or physical pain produced overlapping effects in the form of thwarted self‐esteem and control needs and increased negative affect and desire to aggress. In Experiment 2, we induced social (Cyberball ostracism) or physical pain (cold pressor) within the laboratory session, and found that both pain types produced feelings of being ignored and excluded, and thwarted belonging, self‐esteem, control, and meaningful existence. Our results provide further support to pain overlap theories and indicate that social and physical pain cause common psychological consequences, resulting in new ways to understand and manage pain. Copyright © 2011 John Wiley & Sons, Ltd.     

Social Support and Money as Pain Management Mechanisms

Social exclusion and monetary loss are perceived as painful. The pain produced by these two kinds of events shares similar psychological and physiological systems with physical pain. Thus, physical pain, social pain, and monetary-loss pain were generally regarded as overlapping pain systems in previous theories. In this article, we propose that social exclusion is painful because it is a threat to a primary psychological buffer against pain—social support—whereas monetary loss is painful because money is a secondary pain buffer. Here both social support and money are conceptualized as pain buffers. We review a growing body of empirical data that support this contention. On the basis of a comprehensive analysis of the sociocultural and personal functions of social support and money, we formulate two basic hypotheses that have received empirical support. First, anticipation of pain heightens the desire for social support as well as the desire for money. Second, both social support and money reminders alleviate pain, whereas social exclusion and monetary loss result in an upsurge of pain awareness. In our view, social support is the primary defense against pain and the reliance on money may result from the failure of social support to accomplish its pain-buffering goal.     

Integrating Pain Management in Clinical Practice

There is much evidence to suggest that psychological and social issues are predictive of pain severity, emotional distress, work disability, and response to medical treatments among persons with chronic pain. Psychologists can play an important role in the identification of psychological and social dysfunction and in matching personal characteristics to effective interventions as part of a multidisciplinary approach to pain management, leading to a greater likelihood of treatment success. The assessment of different domains using semi-structured clinical interviews and standardized self-report measures permits identification of somatosensory, emotional, cognitive, behavioral and social issues in order to facilitate treatment planning. In this paper, we briefly describe measures to assess constructs related to pain and intervention strategies for the behavioral treatment of chronic pain and discuss related psychiatric and substance abuse issues. Finally, we offer a future look at the role of integrating pain management in clinical practice in the psychological assessment and treatment for persons with chronic pain.     

A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, “Mindful Living and Relating,” aimed at alleviating pain and suffering by promoting couples’ psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners’ health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one’s partner, fully attending to the present moment, and responding empathically in a way that serves one’s own and one’s partner’s values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.     

Pain reduces discrimination in helping

Because of their shared neurobiological underpinnings, factors increasing physical pain can also increase feelings of social disconnection (“social pain”). Feelings of connection with a social group are reflected in the term social identification, and social identity is commonly associated with intergroup discrimination. In two experiments, we examined the notion that physical pain would reduce social identification and subsequently inhibit intergroup discrimination in helping. By using a pain memory manipulation and a support measure of helping in Study 1 (N = 173), and an actual pain manipulation combined with a behavioural measure of helping in Study 2 (N = 72), results from both studies confirmed the predictions. As expected, physical pain eliminated ingroup favouritism in helping, and identification mediated this effect in the ingroup condition but not in the outgroup condition. We discuss these findings in light of the apparently paradoxical relationship between social support and pain. Copyright © 2014 John Wiley & Sons, Ltd.     

团队合作对4838例居家癌痛患者疼痛管理的效果与思考

通过对大连医科大学附属第一医院宁养院2001年3月～2013年11月收治的4838例癌痛患者进行调查,总结归纳居家癌痛患者的疼痛控制情况,探索癌痛患者的疼痛管理方法,结果提示依靠团队合作在居家条件下免费向癌痛患者及其家属提供身体、心理、社会和精神全方位的照顾和支持,即理想的疼痛管理是“整体性疼痛”与“整体性痛苦”的治疗,不仅针对临床疼痛症状,还必须处理相关因素。     

Quality of Life,Personality and Use of Pain Medication in Patients with Chronic Back Pain

The aim of the study was to assess whether the functional disability and the quality of life in patients with chronic back pain was associated with some personality traits and whether the use of pain medication in patients with chronic back pain can be predisposed with some personality traits. The study sample comprised 262 older patients with chronic back pain of non-inflammatory origin. The level of disability related to chronic back pain was assessed by Roland-Morris Questionnaire, health-related quality of life was assessed by Short Form 36 and personality traits by Eysenck Personality Questionnaire. Among analyzed personality traits (psychoticism, extraversion, neuroticism, lie tendencies), only neuroticism significantly predicted self-reported disability caused by back pain. Patients on pain medication had significantly worse quality of life and disability caused by back pain, but they did not differ significantly in personality traits compared to patients without pain medication. There were no differences in disability due to back pain and in level of neuroticism between patients who had jobs with higher or lower physical demand. People with higher scores on neuroticism inclined more to report a lower functional disability and the quality of life caused by chronic back pain. Patients on pain medication reported more inferior physical than psychological concept of quality of life. Use of pain medication was not associated with personality traits assessed by Eysenck Personality Questionnaire. In our elderly patients with chronic back pain, lower quality of life was associated with elevated neuroticism score and more frequent use of pain medication.     

Pain: Biopsychosocial Mechanisms and Management

Traditionally, pain has been viewed as a sensory event warning of tissue damage or illness. This explanation fails to account for many of the experiences of people suffering from clinically painful conditions. Over the past two decades, a new biopsychosocial perspective on pain has emerged. This perspective emphasizes that pain is a dynamic process that not only is influenced by biological, psychological, and social mechanisms of pain, but also produces biological, psychological, and social changes that can affect future responses to pain. This review presents findings from recent studies of the biological, psychological, and social mechanisms of pain and discusses the implications of these findings for pain research, assessment, prevention, and treatment, as well as for health care policy.     

Learning from Physical Pain to Help with the Management of Emotional Pain

There may be important similarities between chronic emotional pain and chronic physical pain. Both forms of chronic pain may promote negative beliefs about the self and the future. Chronic emotional pain and chronic physical pain both serve to disrupt patients’ focus from their actions and goals. Techniques used for the treatment of physical pain may be translated into the treatment of emotional pain. Four core strategies are reviewed including: (1) reducing catastrophic interpretations, (2) increasing tolerance by promoting acceptance, (3) cultivating positive expectations, and (4) remaining flexible in movements and attitudes. Patients can learn to tolerate limitations while pursuing their goals. Clinicians can help patients to reduce emotional pain by making a series of small changes in their thoughts and behavior.     

慢性疼痛与心理障碍

疼痛是一种复杂的心理生物学过程。疼痛的感知和情绪活动密不可分,疼痛是一种包括感觉、情绪和认知的多维性体验,人与人之间差异很大,甚至同一个体也随疼痛的背景、意义以及心理状态而异。认知因素和情感因素对疼痛感知具有非常重要的影响。本文回顾疼痛认知和情感状态调节（身心治疗的重要组成部分）潜在的神经学机制。回顾慢性疼痛本身会改变大脑环路、包括参与内源性疼痛调节的循证证据,这些证据表明随着疼痛转为慢性,控制疼痛越来越困难。     

The push of social pain: Does rejection’s sting motivate subsequent social reconnection?

Physical pain motivates the healing of somatic injuries, yet it remains unknown whether social pain serves a similarly reparative function toward social injuries. Given the substantial overlap between physical and social pain, we predicted that social pain would mediate the effect of rejection on greater motivation for social reconnection and affiliative behavior toward rejecters. In Study 1, the effect of rejection on an increased need to belong was mediated by reports of more intense social pain. In Study 2, three neural signatures of social pain (i.e., activity in the dorsal anterior cingulate cortex, left and right anterior insula during social rejection), each predicted greater behavioral proximity to rejecters. Our findings reify the overlap between social and physical pain. Furthermore, these results are some of the first to demonstrate the reparative nature of social pain and lend insight into how this process may be harnessed to promote postrejection reconnection.     

A Unified,Transdiagnostic Treatment for Adolescents With Chronic Pain and Comorbid Anxiety and Depression

Chronic pain disorders represent a significant public health concern, particularly for children and adolescents. High rates of comorbid anxiety and unipolar mood disorders often complicate psychological interventions for chronic pain. Unified treatment approaches, based on emotion regulation skills, are applicable to a broad range of emotional disorders and suggest the possibility of extending these interventions to chronic pain and pain-related dysfunction. This case report describes the use of a unified protocol for treatment of an adolescent boy with chronic daily headache and social anxiety and an adolescent girl with whole body pain and depression. Following weekly, 50-minute individual treatment sessions, the boy demonstrated notable improvement in emotional symptoms, emotion regulation skills, somatization, and functional disability. The girl showed some improvement on measures of anxiety and depression, although there appeared to be a worsening of pain symptoms and somatization. However, both patients demonstrated improvement over follow-up. This case study illustrates the potential utility of a unified treatment approach targeting pain and emotional symptoms from an emotion regulation perspective in an adolescent population.     

Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis

Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients’ quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.     

The Symbolic Power of Money: Reminders of Money Alter Social Distress and Physical Pain

ABSTRACT— People often get what they want from the social system, and that process is aided by social popularity or by having money. Money can thus possibly substitute for social acceptance in conferring the ability to obtain benefits from the social system. Moreover, past work has suggested that responses to physical pain and social distress share common underlying mechanisms. Six studies tested relationships among reminders of money, social exclusion, and physical pain. Interpersonal rejection and physical pain caused desire for money to increase. Handling money (compared with handling paper) reduced distress over social exclusion and diminished the physical pain of immersion in hot water. Being reminded of having spent money, however, intensified both social distress and physical pain.     

疼痛的心理学研究

心理学对疼痛的研究已经进行了几十年,成果颇丰。众多的研究已经证实了疼痛与基本心理过程之间的相互关系,包括注意、情绪、动机和记忆。除了基本心理过程外,社会因素也能够调节疼痛,如社会排斥、信仰、音乐、虚拟情境、金钱和权利等。已有疼痛研究中的疼痛测量方法过于主观,并且疼痛调节因素在临床中缺乏实践价值。当前疼痛研究呈现与具身思潮相结合的趋势,未来应更加重视发掘调节疼痛的社会因素。     

Illegitimate Pain: Dimensions,Dynamics, and Implications

In this paper, we outline a model of emotional and physical pain that is misunderstood, neglected or stigmatized, conceptualized along dimensions of relative legitimation and physicality. Drawing upon extensive qualitative data from former residents, staff, and faculty of a controversial religious boarding school, we analyze institutional practices that officially delegitimize the pain of individuals or groups, along with the interpersonal and power dynamics that emerge. After discussing modifications to the model rooted in these data, we outline the utility of attending to the concept of illegitimate pain in the study of cults, social problems, social movements, conflict, victimology and deviance.     

Sex Differences in the Presentation of Chronic Low Back Pain

Sex differences in 351 patients with chronic low back pain were examined. Biological, psychological, and psychosocial factors were considered. Sex differences in adaptive functioning were consistent with traditional gender roles. Significant interactions were found for sex and employment status, and sex and marital status. Retired women reported more pain and less activity than retired men. Retired men reported the least pain of any group. Outdoor work and social activities show opposite within–group patterns for men and women when stratified by employment status. Marriage was associated with more household work for women and less for men. The financial and social contexts of employment status and marriage are different for men and women. Results suggest the treatment of women with chronic low back pain requires attention to work in the home and the financial and social context of work outside the home.     

The Family Environment in Chronic Pain Patients: Comparison to Controls and Relationship to Patient Functioning

Operant and cognitive-behavioral models of chronic pain have called attention to the importance of examining the marital and family environments of chronic pain patients. In this study, 50 chronic pain patients and their spouses and 33 control participants and their spouses completed measures of the family environment, marital satisfaction, and patient physical and psychological functioning. Patients' overt pain behaviors were coded from videotapes of patient–spouse interactions. Compared to controls, pain patients and their spouses rated their family environments as lower in cohesion and higher in control, and there was a trend for spouses to report more marital dissatisfaction. Chronic pain patient depression was associated negatively with patient-rated family cohesion and expressiveness and spouse-rated family organization and positively with patient-rated family conflict. Overt patient pain behaviors and spouse-rated patient disability were related negatively to spouse-rated family cohesion. Spouse marital satisfaction was associated negatively with patient depression and with spouse ratings of patient disability and pain behaviors.     

The Accuracy of the DSM-IV Pain Disorder and the ICD-10 Persistent Somatoform Pain Disorder in Chronic Pain Patients

Objectives. In this investigation we studied the relationships between different psychological relevant subgroups and the presence of different psychosomatic symptoms in a sample of chronic pain patients, testing the accuracy of the DSM- and ICD classification systems.Results. We found no evidence for a “pure” pain syndrome according to the DSM- and ICD systems. On the contrary, we found highly significant evidence of a mixed psychosomatic condition.Conclusion. The results suggest a broad somatoform classification, with subgroups based on personality characteristics taking a stress—coping model into account, including interpersonal attachment behaviour. An alternative model of a diagnostic approach is presented.     

Chronic Pain,Chronic Demoralization,and the Role of Psychotherapy

This article discusses demoralization in patients with chronic pain and the role of psychotherapy at combating chronic demoralization associated with chronic pain. The advantages of the biopsychosocial conceptual framework for the understanding of chronic pain are highlighted. Demoralization may be viewed as a combination of distress and subjective incompetence. While the distress experienced by the patient may be understandable and commensurate to the predicament, the co-occurrence of subjective incompetence (the polar opposite of resilience) and its escalation to helplessness, and hopelessness may result in suicidal attempts, demands for euthanasia, or death by suicide. The complexity of chronic pain and its relationship to demoralization may be examined from multiple perspectives. Biological, psychological, social and cultural variables play varying roles depending on the observer’s perspective and the context of the observation. The role of psychotherapy in chronic pain may be viewed in terms of multiple pathways through which language, cognitive style, behavior, relationships, attitude towards pain, and awareness of the body modify the relative influences of top-down and bottom-up processing of information within the pain neuromatrix. Various psychotherapeutic interventions developed for patients with chronic pain are reviewed and recommendations are made for future research.