Pain May Be in the Brain, But It's Still Real

If your doctor tells you that your chronic pain is in your head, don't be offended. You may be getting the latest in medical advice.

For too long, some doctors and psychiatrists say, the link between emotions and pain has been ignored or pooh-poohed by the medical profession. It has left some people with chronic pain to suffer, they claim, because the symptoms of their problems are being treated without the causes being addressed.

"Pain actually is an emotion, so clearly there is a connection," said Alex Zautra, a professor of psychology at Arizona State University, where he leads a research team whose work is centered on chronically ill patients with muscular-skeletal illnesses such as rheumatoid arthritis and fibromyalgia.

"Pain is the way the mind responds to trouble inside the body," he said. "Emotion is the same way. Whether you feel love or sadness is also a response to something you feel outside the body. With pain it is a closer-in response, to something inside the body, but it is a response in an attempt to learn about and motivate recovery."

A recent study in Europe found that more than 40 percent of people who suffer from depression also suffer from chronic pain, and a study conducted by the Stanford University School of Medicine in the United States, which has not yet been published, found similar results, said Dr. Alan Schatzberg.

Other studies have found even higher rates of co-morbidity between depression and chronic pain -- as high as 60 percent or 70 percent, depending on how chronic pain was defined, Schatzberg said.

"It is not a chance finding," he said. "I think it is a real finding."

In the Head, But Still Real

The reason for the connection may be that the neurochemical problems responsible for the depression may also be responsible for the patient's chronic pain.

Some doctors now prescribe certain antidepressants for people who suffer from chronic pain but apparently have no physical cause for the pain, even in people who do not suffer from depression. Duloxetine, for example, which is marketed as Cymbalta by Eli Lilly and Company, is the first drug to be approved by the FDA for treatment of diabetic peripheral neuropathic pain.

When discussing these findings, doctors and psychiatrists alike say it is important to understand that it is in no way a dismissal of the suffering endured by people who might not seem to have a physiological cause for their pain. Even when there is a clear physical cause, pain itself only occurs in the brain, they say.

"Pain is in fact all in our heads, but we have to be sure when we say that, we say it without the usual pejorative context, implying that pain is made up," said Dr. Sean Mackey, the co-director of the Stanford University Pain and Clinical Research Center. "An injury out in our arm is not pain, that is 'nociception.' The perception of pain occurs in the head."

'It Doesn't Mean You're Crazy'

People suffering from depression are not the only ones who suffer chronic pain without having any corresponding physical cause.

Some people who have had a stroke will experience fierce pain in an arm or leg without having any injury there. People who have had a limb amputated sometimes feel pain in the missing limb. And people with post-traumatic stress disorder or who have suffered emotional trauma or been the victims of early childhood abuse have all been found to be more susceptible to pain and more likely to suffer chronic problems such as lower back pain.

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