RMTAO Blog
Factors that Influence Pain Experience
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You’ve likely seen two patients come into your practice with similar injuries, but with entirely different concerns and pain experiences. This is because an injury someone experiences or any other biological explanation for their pain is only one factor that might influence their pain experience. Some individuals will go on to develop chronic pain while others will not. The experience of musculoskeletal pain is biopsychosocial, meaning it is influenced by biological, psychological, and social factors. Biological factors could include the type and severity of the musculoskeletal condition, and psychosocial factors that might influence pain include catastrophized beliefs about pain, culture, fear of movement and mental health concerns.
In the article below we will be outlining how some of these psychosocial factors might influence a patient’s pain experience.
Catastrophizing
Catastrophizing can be defined as a tendency to magnify or exaggerate the threat value or seriousness of pain sensations. It can also be characterized by a tendency to feel helpless in the context of pain and being unable to stop pain related thoughts in anticipation of, during or after a painful encounter. Catastrophizing can lead to negative outcomes such as higher pain sensitivity, pain interrupting more activity, negative mood, depression, and increased disability.
People with chronic pain who engage with weekly physical activity appear to require additional support to address negative pain perceptions, which can include patient education about the nature of pain. This is likely due to the fact that catastrophizing often leads people to avoid exercise and other beneficial movement.
Culture and Beliefs
Differences in pain coping strategies, illness perceptions, self-efficacy (believing in yourself), fear avoidance beliefs and pain attitudes present in diverse cultures can lead to a distinct experience of pain. How someone communicates about pain is also influenced by their culture, and they might communicate differently about their pain to someone in their culture as opposed to with someone outside of their culture. What someone believes about the causes of their pain is also influenced by culture and can affect pain experience.
Pain beliefs are also influenced by a parent/guardian’s pain belief, which is of course influenced by culture. Unhelpful belief about pain such as the belief that means your body is damaged beyond repair is a significant factor in transitioning from acute to chronic pain and increasing pain-related disability. Cultural beliefs about the impacts of pain may impact treatment preferences, and expectations about pain, which can be culturally influenced, have an influence on pain experience.
Fear of Movement
Fear of certain movements because you believe they will result in pain is a significant factor influencing the development of persistent pain and pain-related disability. When people avoid certain movements due to fear of pain, they maintain or exacerbate pain and experience more depression. If, on the other hand, individuals progressively resume their physical activities, they’re testing and correcting their pain expectations and will likely experience a recovery.
People will often restrict regular daily activities and purposefully restrict their function in order to avoid pain. This might explain why people with chronic pain report in general lower levels of physical activity. There appears to be even more connection between fear of movement and lower levels of physical activity in older adults, perhaps due to a belief that they are frail or will face greater consequences from injuries. The fear or avoidance of certain movements to avoid pain is a significant factor in acute pain becoming chronic. This also leads to worse outcomes for patients.
Mental Health
Mental Health concerns like depression and anxiety can be another factor that leads to acute pain becoming chronic. Individuals with anxiety and depressive disorders also tend to have more severe symptoms of pain such as increased pain intensity. Anxiety in individuals with acute pain can also lead to decreased pain tolerance and more negative expectations of their pain experience, which can translate into worse outcomes. Anxiety can also lead to pain-related behaviors such as avoiding movements you perceive will cause pain, which can actually make pain worse.
Experiencing apprehension, nervousness, fear or anxiety about painful experiences can also lead to a worse pain experience. Any type of emotional distress can have a negative impact on pain. People with anxiety disorders typically have higher rates of persistent pain and depression significantly increases the risk of developing pain-related disability. People who have musculoskeletal pain and are depressed have also been found to take twice the sick leave as people who have musculoskeletal pain and are not depressed.
Massage therapy can help
Registered Massage Therapists (RMTs) can keep the factors that influence pain experience in mind when developing a treatment plan for their patients. RMTs can also educate their patients about how pain works and provide explanations for how the massage therapy treatment they’re providing and the exercises they’re recommending can help decrease pain and improve function. The language that RMTs use when discussing pain with their patients can also have an impact on pain experience. Calling a muscle weak or dysfunctional or using other negative language can increase a patient’s anxiety about their pain but using positive language like acknowledging the difficulties the patient’s pain experience has caused them and focus on the positive results you think the patient should expect after your treatment plan can help improve the outcomes for your patient. RMTs can help their patients understand their pain, which can make those patients more confident in their ability to complete their regular tasks, which can also contribute to positive patient outcomes.
References
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