The Surprising Connections Between Emotions and Pain 

When it comes to arthritis pain, you know it’s your body that’s hurting: it’s your knees, your hands, your shoulder or a dozen other joints. But there are definite—and sometimes unexpected—emotional and psychological links to experiencing pain too. Understanding the role emotional and mental health can play in your arthritis care plan gives you more tools for your self-management toolbox.  

Researchers recognize that pain is affected by five interconnected factors:

  1. physical problems caused by injury, surgery or disease;
  2. tense muscles;
  3. fatigue;
  4. mental stress: and
  5. depression or other negative emotions.
 

These factors affect each other in a process known as the pain cycle: pain can lead to anger or worry which leads to stress which leads to fatigue which leads to more pain.  

A number of recent studies have examined the relationship between pain and our emotional state in more detail. For example, a 2018 study in the International Journal of Geriatric Psychiatry looked at 4,792 people with depression and self-reported arthritis diagnosed by a doctor. Arthritis prevalence rates were higher in those with minor (55%), moderate (62.9%) and severe (67.8%) depression. Depression doesn’t cause arthritis, of course, but the two conditions often occur together, leading to worsening of physical and mental health outcomes. If you’re feeling that your mood is not quite right, talk to your primary care provider or rheumatologist about getting screened for depression.  

Another 2018 study, published in the Annals of Behavioral Medicine, asked two groups—one for people living with osteoarthritis, the other for people living with type 2 diabetes—to keep diaries about their mood, how severe their symptoms were, and if their interactions with their spouse were negative or positive. Their spouses kept diaries too. The results were pretty telling. For both groups, participants were in a worse mood on days they felt more tension than usual with their partner, and also reported more pain. For the osteoarthritis group in particular, when people were in more pain, they were grumpier and had more tension with their spouse the next day as well. So if you apply insights from the pain cycle here, when you’re upset, you may notice pain more and tend to focus on the negative, so that the pain feels more significant. As well, if you’re in pain, you’re more likely to be short-tempered with the people around you, and be hard on yourself as well.  

What’s the bottom line? Recognizing that there is a cycle means that you can take steps to break the cycle and feel better. Medication to treat pain and depression can be important pieces of the puzzle in many situations, but they’re not the only pieces available. Our brains respond well to retraining or reframing the way we look at things. Some ideas to consider:  

Mindfulness activities  

Yoga, tai chi and meditation, with their emphasis on breathing and staying present in the moment, can help settle your mind and direct it away from focussing on pain. 

Exercise 

Studies have found that making a workout a regular part of your routine helps to quell anxiety and depression as effectively as many prescription antidepressants. Staying active as best you can also helps to prevent pain and stiffness in a number of forms of arthritis.  

Cognitive-behavioural therapy (CBT) 

This may sound a little intimidating, but really it’s just about training your brain to stay away from negative thought patterns, which in turn affects both how you see the world and how you cope with challenges. Research has shown that regular use of CBT helps improve pain, fatigue and depression in people with rheumatoid arthritis, for example, especially when they use CBT early on in their diagnosis. CBT techniques include learning how to pace yourself and set goals, assertiveness training, problem solving and relaxation. Ask your health care provider for more information about CBT. 

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