I catch myself worrying about pain at times – especially when having a pain flare.
“What if this flare never ends?… What if it stays as bad as this?… What if…”
Rationally, I know that the pain flare will end at some point in the near future and the pain will eventually settle back to its normal level.
I try to be aware of the thoughts and reappraise them, which helps lessen my feelings of worry.
Pain can make people feel worried. But can worry make pain worse?
Excessive worry and rumination about the worst possible outcome of a situation, are key aspects of ‘pain catastrophizing’, associated with increased pain intensity and severity, higher levels of disability, and worse outcomes post-surgery.
In this post, I’ll go into more detail about how worry can affect your experience of pain, look at why people worry about pain, and what you can do about it.
How worry can affect pain
Worry is an emotion that arises when we have thoughts about possible future events that we find threatening.
Much of the research around the influence of worry on pain has been focused around something called ‘catastrophizing’.
‘Pain catastrophizing’ means excessively worrying.
Rumination (repeated negative thoughts) and worry are important aspects of pain catastrophizing in pain research. It happens when we imagine the worst possible outcome of a situation and dwell on it.
Physiological, psychological and social factors interact with each other to influence a person’s experience of pain.
Excessive worry is part of the psychological influence on pain, and pain researchers have been interested to find out the connection between catastrophizing and pain.
This 2020 review of all the relevant research found that,
“High levels of catastrophizing are associated with heightened pain intensity [and] increased pain severity… higher levels of pain and suffering… greater health-care utilization, increased disability, and worse outcome after surgery.” (Petrini & Arendt-Nielsen, 2020)
They also looked at the studies on rumination (going over and over thoughts in your mind), which is closely related to worry. Rumination was associated with poor clinical outcomes for people with pain.
It was related to people’s ratings of their pain severity, and their level of physical disability.
- 60% of people with chronic pain who took part in a 2011 study said they ruminated almost always or very often.
- Everyone said that they ruminated about their pain when they were experiencing pain.
- 35% of people reported that rumination made their pain worse. as it kept their focus on the experience of pain and the negative emotions associated with it.
Why do people worry about pain?
We can often worry when we perceive a future situation to be threatening – we’re preparing for the worst, and to trying avoid it if possible.
Pain is often perceived as a sign of something threatening, and so people can ruminate over ways to avoid or solve the situation. The problem with chronic pain is that there is no immediate solution or escape.
This could lead to being stuck in a cycle of worrying, attempting to solve the situation around the pain, failing, worrying more, etc. When we’re worrying about the pain, we are on the lookout for it, keeping careful watch for it.
This research team in 2001 analyzed how and why people with chronic pain worry. They discovered,
“In comparison with non-pain related worry, worry about chronic pain is experienced as more difficult to dismiss, more distracting, more attention grabbing, more intrusive, [and] more distressing.”
(Eccleston et al., 2001)
Medical uncertainty and physical limitations were the most common worries that people had in relation to the pain.
The researchers explain that people’s worries about chronic pain did not happen because they were generally predisposed to worry or anxiety, but were related to their awareness of bodily sensations.
The 2011 rumination study found that pain triggers people with chronic pain to ruminate over:
“How to relieve the pain, what had triggered the episode of the pain, how much longer it would last, how the pain was stopping them doing certain activities and how the pain will affect them in future.”
(Edwards et al. 2011)
- 45% of people said that they ruminated about pain when they were feeling low
- 85% said that it made them feel unhappier, frustrated with their situation and irritable
Despite this, three quarters of people believed that rumination was useful to them, as they think about things over and over to try to find solutions to problems.
But the majority say they aren’t able to find solutions to their problems. They’re,
“Motivated to worry in an attempt to problem-solve, but failure to resolve the pain fuels their worry.”
(Edwards et al. 2011)
What can help reduce worry for people with chronic pain?
Excessive worry and rumination can have an effect on a person’s experience of pain.
The ‘what if’ kind of thoughts that I can have at the onset of a pain flare used to be much worse than they are now. In my mind, the severe pain could seem hugely threatening in that moment.
I now catch myself slipping into worry and recognise the thoughts for what they are – just thoughts. I can then step back and reappraise the situation.
I can think it through logically and realise I’m just reacting. I know from past experiences that although the pain flare is very unpleasant to say the least, the severity of the pain will not stay at that level.
At other times, I might just notice the thoughts. I can choose to just be aware of them, and then let them be.
Oftentimes people find the thoughts that make them worry to be quite persistent. It can take a bit of time to bring worrying thoughts into focus and re-appraise them, or just notice them.
Some people find it helps to find a distraction to occupy their mind when they start to have worried thoughts about the pain, especially at night.
Other time people find that taking actions towards solutions can help stop going over and over thoughts in their mind.
But sometimes it can also help to focus your attention on the present movement. Using all of your senses can help to keep your mind in the here-and-now.
Worry is focused on the future, and rumination could be about things that have passed. The present moment can be a slice of peace.
Note: If you have worries about any aspect of your health, discuss them with your doctor in the first instance.
You may also like my post on anger and chronic pain.
References
Eccleston, C., Crombez, G., Aldrich, S. and Stannard, C., (2001). Worry and chronic pain patients: A description and analysis of individual differences. European Journal of Pain, 5: 309-318.
Edwards, M.J., Tang, N. K. Y., Wright, A. M., Salkovskis, P. M., & Timberlake, C. M., (2011). Thinking about thinking about pain: a qualitative investigation of rumination in chronic pain. Pain Management, 1:4, 311-323.
Petrini, L., & Arendt-Nielsen, L. (2020). Understanding Pain Catastrophizing: Putting Pieces Together. Frontiers in Psychology, Volume 11.