It might surprise you (or not!) to know that I was the only nutritionist/naturopath at the recent Australian Pain Society conference. The attendees were largely made up of pain researchers, physiotherapists and psychologists with some GPs thrown in to the mix. The attendees were representative of the biopsychosocial approach to chronic pain and accordingly within the conference presentations there was a focus on the significant psychological influences on chronic pain.
One conference presentation examined how negative expectations and learning processes can have physiological effects and impact on central pain processing i.e. negative expectations and associated behaviours can amplify pain responses. Negative expectations about chronic pain can be formed through verbal suggestions of heightened pain (a concerned family member, ‘Don’t do that, you will hurt yourself’), prior painful experiences (see example below), and observation of pain in others. An example of this is someone with irritable bowel syndrome (IBS) who feels anxious about going out with friends because last time they ate something that triggered their IBS symptoms. The anxiety then leads to worsening symptoms regardless of food triggers in that situation. Subsequently the IBS sufferer starts to avoid social situations, creating a situation where the symptoms and pain related to IBS start to control the individual’s life and lead to a degree of social isolation. This might seem like an extreme end point however it is not uncommon for people in chronic pain withdraw socially due to anxiety or fear of heightened pain.
In situations where negative expectations play a part in creating or heightening pain responses mindfulness, cognitive behavioural therapy and hypnosis can be helpful. I also add into the mix time in nature, with animals, friends that understand what you are going through and a supportive nutritionist/naturopath who can help you de-tangle when and where negative expectations are impacting and identify what resources might assist.