Psychological pain - help from a psychologist

It happens that psychological pain, the experiences that we experience in connection with traumatic events that happened to us in life, can be much stronger in intensity and duration than physical pain. In this article we will consider pain, which has a different nature, but is experienced by us as psychological suffering. How can you live with this, how can you survive it, and what can a psychologist do when accompanying these processes?

What is pain from the perspective of the body and psyche?

Pain can be thought of as a signal to the body of an unpleasant experience, which indicates that something is wrong. Security is also compromised, both in terms of physical and mental health. At the physiological level, these signals are identified by the human body as threatening life or health.

There may be a lot of pain, and at the same time there are not enough resources to survive it, then a psychological defense mechanism is activated, for example, as a way to avoid, not to feel what is happening now. Physical pain cannot be ignored without special medical means, but psychological pain is possible through the mechanisms of stopping, devaluing, protecting, suppressing, rationalizing and others.

People who don't feel pain

The people found by scientists are not carriers of any neurological disorders; they also have absolutely all the senses characteristic of an ordinary person. All three families live in Pakistan and belong to the same clan. Over the years, scientists studied 6 representatives of these families (children and adolescents).

The children did not understand at all what pain was. One of the teenagers (a 14-year-old boy who soon died after jumping from a roof) earned his living by performing dangerous stunts: he pierced his hands with daggers and walked on hot coals. All the children studied had very severely damaged tongues and lips, as they bit them at an early age, when they did not yet understand that this was harmful. Two of them even bit off a third of their tongues. Everyone has a huge number of scars, bruises and cuts, sometimes children did not even notice that they had broken something, the fractures somehow healed and they were found after the fact.

They distinguish hot from cold well, but do not feel pain if they get burned. They have a well-developed sense of touch, they feel everything perfectly, for example, how a needle enters their finger, but for them this is not an unpleasant sensation.

How to survive pain?

As long as a person allows the pain to flow, he can withstand it without catastrophic, destructive consequences for him. And when you stop the experiences, they can come. The fact is that a person “squeezes” his pain through the body. Stopping breathing, freezing, etc. is a marker of stopping feelings, a reaction of the body, the psyche, so as not to face pain.

If a person constantly experiences this, then there is a high probability of developing psychosomatic diseases. That is why the help of a psychologist in recognizing these signals will be very important.

Processes occurring at the bodily level are associated with experiences and are emotionally colored. And any way to stop is to stop your feelings. For example, a child is told: “Don’t be afraid!” He learns to stop his experiences, not to express them. A person may prohibit himself from even thinking about a painful situation, not allowing himself to talk about it with someone.

Talk about your pain

There are also standard protocols for the use of analgesics for various diseases.

For headaches, paracetamol and NSAIDs are recommended.

For migraine , first-line drugs are also paracetamol and NSAIDs, but if they do not help, it is suggested to use triptans.

For minor injuries (bruises, scrapes, sprains), it is recommended to use paracetamol and NSAIDs without resorting to opioids.

In case of severe injury (wound, burn, fracture, very severe sprain), opioids should be used for up to 2 weeks.

For postoperative pain, it is recommended to use paracetamol and NSAIDs if the operation was not severe and, accordingly, the postoperative pain is not very severe; otherwise, opioids.

Renal colic - depending on the severity - paracetamol and NSAIDs or opioids.

Heartburn and gastroenteral reflux - antacids, H2 antagonists, proton pump inhibitors; Aspirin and NSAIDs should be avoided.

Chronic back pain - paracetamol and NSAIDs, in especially severe cases - opioids.

Fibromyalgia – antidepressants, anticonvulsants.

One of the important principles of pain management is to encourage the patient to constantly give feedback, talk openly about his pain sensations, and express his opinion about treatment, even if he does not agree with the doctor's opinion.

“Don't listen to those who question your pain,” says Dr. Michael Ferrante, director of the Los Angeles Center for Pain Management. – Don’t give in to their negativism. Believe in yourself and strive to get the right treatment."

Is it possible to avoid facing pain?

Of course, it is clear that any organism strives to avoid painful experiences. But at the same time, it is important to understand that then life will become limited, “gray”.

During the session, the psychologist asks about painful experiences. Experiencing pain is an essential part of life. Why did the client come to the psychologist’s office? To make him feel better! What's going on? At some stage, on the contrary, it may become more difficult for him, harder in the emotional aspect. But this is necessary to ensure in the future an adequate perception of reality and the construction of contact in the “here and now” mode, without references to “there and then”.

Avoiding pain can be like anesthetizing the psyche. At the same time, other feelings, for example, joy, cannot be fully experienced. There is a price to pay for avoiding heartache. For example, when experiencing a breakup with a loved one, one can observe a lack of desire in a client to enter into a new relationship. This happens in order not to experience the state that was in that relationship. This may explain wariness when making new acquaintances and a long-term lack of trust. A traumatic situation is a reaction to that situation, and not to the current one.

People who don't feel pain

As a result of the analysis of genetic markers, it was discovered that all children had a mutated SCN9A gene, but each family had its own mutation in it. What is known about this gene is that it is active precisely in those regions of the peripheral nervous system that are responsible for pain.

After conducting a series of experiments, scientists came to the conclusion that the mutations they found completely turn off the gene. As a result, stopping the work of a single gene is a sufficient and necessary condition for losing sensitivity to pain.

This discovery has given scientists the opportunity to develop new effective painkillers, and, probably, in the near future, achieve complete victory over pain. After all, choosing an inhibitor that can suppress the activity of a certain protein is routine work in modern pharmacology.

The study authors add that they had previously discovered a hereditary anomaly associated with this gene. It was called primary erythromelalgia. But it has completely opposite characteristics.

In people with this gene mutation, sensitivity to pain goes off scale to possible and impossible limits. Even the smallest stimuli (for example, light physical activity or heat) can cause severe pain attacks. This disorder is associated with other mutations in the SCN9A gene that alter the sensory threshold.

Mutations with changes in sensitivity in this gene protein have not previously been found in humans, but this phenomenon has been actively studied in mice. Mice in which the gene had partial loss of sensitivity had a low pain threshold, but if the gene was completely out of order (which happened in 6 Pakistani children studied), then the mice died soon after birth. Most likely, their gene performs some other important functions.

What if you freeze sensitivity (sensations)?

If sensitivity is blocked, the ability to adapt to the environment sharply decreases. Because in order to react to the world around you, you need to at least feel it.

If a person is faced with strong, unexperienced pain “there and then,” then it is important to note that the less he is in the “here and now.” This means that the ability to satisfy current needs is reduced.

A frozen experience requires effort to maintain. The point is that in order to freeze some feelings and states, strength is required. And our resources are finite.

Children are a special case

Pain management standards for children differ from adult standards. In this case, the system is not three-, but two-stage, excluding the adult second stage. This is explained as follows. The opioid codeine is metabolized into morphine in adults by the enzyme CYP2D6, the amount of which in the body varies depending on ethnic group and age.

In children under 5 years of age, the activity of this enzyme is only 25% of that in adults, and therefore codeine is ineffective for them. As for another weak narcotic drug, tramadol, which is widely used for pain management in adult patients, it has not been well studied for use in pediatric practice and is not currently licensed for use in pediatric patients.

WHO recommendations for pain management in children are based on three principles:

Administering a dose of pain medication at regular intervals;
Using the least invasive method of drug administration;
Individual approach.

As in the recommendations for pain management in adult patients, WHO experts suggest administering drugs “on an hourly basis” rather than “as needed,” but emphasize that if breakthrough pain occurs, a remedy should be available to relieve it.

For a child, the oral method of taking drugs (in the form of tablets) is preferable, and if for some reason this is not possible, then rectal (in the form of suppositories) or transdermal (patch). If possible, you should avoid injections, which are an additional source of pain and stress for a small child.

An individual approach is, first of all, a careful selection of the dose suitable for a particular child and the drug itself, taking into account side effects.

At the first stage of pain relief, experts recommend paracetamol and ibuprofen (the only one of all NSAIDs), and at the second stage - morphine. An important recommendation from experts is the availability of both long-acting forms of morphine (to be taken at regular intervals) and fast-acting forms in case of breakthrough pain. At the same time, the recommendations specifically stipulate the fact that there is no upper threshold dose of morphine, and if the standard dosage does not provide relief, it must be increased.

How does a psychologist help you overcome a painful condition?

You can end your experience of pain in a psychologist’s office. This leads to liberation. This is followed by other feelings, and sensitivity returns. In society, not all feelings are pleasant to experience or talk about. This may be seen as a sign of weakness, for example.

But when the experiencing processes begin, it is difficult to slow them down, the client may say: “I feel worse!” This is a normal and inevitable process during a psychological session. It is important to live and move on.

The idea that pain can be worked through forever is utopian. "How can?!" clients can speak. At some point, the client may react to the trigger event and make a note of it.

For example, when working with a psychologist on the topic of breaking up with a loved one, after some time, similar emotional states may again be observed in the client. With less force and intensity, but it is difficult to completely get rid of these experiences.

If these states transform into the status of learned experience, then the very attitude of the individual to this changes, the personality becomes more stable. The point is that a very strong emotional event, after a while, also causes feelings, it’s just that the person perceives it completely differently. The psychologist’s task is to bring the client to a position where he can say that he is now ready for something similar in life. A psychologist helps to find the meaning of a traumatic experience and stop concentrating on it. This allows you to begin to interact with the environment “here and now.”

Emotional background

No less important is a person’s mood, the emotional background that accompanies pain. This position can be confirmed by the research of the doctor G. K. Becher, who observed the perception of pain of wounded soldiers during World War II.

The doctor noticed that wounded soldiers needed less morphine to relieve pain than people in peacetime after surgery. Becher associated this with the emotional state of a person: soldiers were happy to be alive, while people after surgery tend to be pessimistic and easily depressed.

Thus, a positive attitude makes a huge difference in the perception of pain—another reason to become an optimist .

Is pain also a new experience in life?

Situations that force us to experience pain make us more difficult. The psyche acquires multifaceted experience. And a person who grew up in “sterile” conditions, when nothing overshadowed his condition, most likely will not be able to survive in a changing world.

An important conclusion that clients often make after a series of psychological sessions is that the pain they have experienced can be turned into a resource. But what is important is that if you do not deliberately drag the client into experiencing pain, and this process happens naturally, then the client is able to endure it, gradually becoming stronger. The dosage of the degree of residence will make it possible to work harmoniously with these conditions.

Are pain caused by emotions, or is pain caused by emotions?

At the emotional level, we first of all evaluate our state. We put a label on it, and these labels look like this - “bad”, “something happened”, “this could end in death”, “I can’t stand it”, “all plans collapsed”, etc.

Emotions, of course, influence the course of the pain process and, most often, in the direction of intensification. Let's say you have a stomach ache. Well, I got sick - maybe it’s not scary at all. You ate something stale, the body recognized it as a chemical invasion, the corresponding receptors turned on and sent a signal to the brain.

Perhaps all you have to do is drink more/eat something else/go to the toilet/just lie down and relax - and most likely everything will pass. What does pain mean? – the body is fighting a chemical invasion, which it notified you about.

It may not take much time for your body to overcome the situation. As a last resort, you can take a pain reliever to reduce smooth muscle spasm.

In most cases, your pain has every chance of not developing into anything serious. But many often begin to “increase” the pain: get scared of it, draw pictures like “what if it’s appendicitis and I’ll die from peritonitis?”, “what if I have a dangerous infection?”, in the easiest case – “I won’t get caught.” for an appointed meeting, this will ruin all my plans, oh, what an unbearable pity,” etc.

What happens to the body – I think it’s clear. The fear of pain or unpleasant events in connection with it triggers a new surge of adrenaline, the spasm becomes stronger, the heartbeat becomes faster, the horror becomes even deeper, the adrenaline becomes even more, and so on in a circle. As a result, either you will be able to stop all this pandemonium with an effort of will, or you will faint.

I described all these mechanisms in an article about a panic attack, if you want to understand them in more detail with examples, read it. Here it is important for us to pay attention to something else - physical pain can develop into mental pain and vice versa, and with your direct participation.

You can, for example, upon learning unpleasant news or hearing hurtful words, go deeper into “chewing” the offense and ultimately create a chemical cocktail in your body that will lead not only to real tachycardia, but even to a heart attack, if there is any associated it is a physiological disposition.

In other words, when we begin to “increase” emotions, we generate approximately the same set of chemical changes, but they can affect different systems of the body. Most often, the weakest genetically or simply overloaded systems of your body are the first to suffer.

What if you convince yourself that nothing is happening?

The other extreme is the “pain mask,” when the client himself, or those around him, pretend that nothing bad happened or rationalize the event. For example, after doctors have diagnosed a serious illness, a person may try not to come into contact with it, avoid talking about it, not think about it, pretend that nothing happened. This is a blocking of experience. Tension within can have a negative impact on your health.

It is important to understand that the client who came with a request for severe pain experienced has already encountered this. The psychologist’s task is to restore his sensitivity. It is important to support other poles of experience - the environment can not only destroy and cause pain, but also give something that brings positive emotions.

Three stages of pain relief

The pain management standards used in most developed countries were developed by the World Health Organization for cancer patients, but they are used by pain specialists in other cases: injuries, renal colic, neuralgia, migraines and other acute and chronic diseases.

For adults, this is a three-stage pain relief system.

At the first stage, that is, with mild pain , the patient receives a non-narcotic analgesic (paracetamol, aspirin, nonsteroidal anti-inflammatory drugs (hereinafter referred to as NSAIDs)) plus an adjuvant. An adjuvant is a drug that does not have an analgesic effect, but relieves the patient’s fear or anxiety and calms him down.

The second stage is for mild to moderate pain . For pain relief, either a combination of two drugs is used, paracetamol (acetaminophen) or a non-steroidal anti-inflammatory drug (ibuprofen, diclofenac, etc.) plus a weak narcotic drug (codeine, tramadol), or one drug of two ingredients, for example, Percocet (opioid oxycodone plus acetaminophen), Vicodin (hydrocodone plus acetaminophen). As in the previous case, the patient is shown an additional remedy to relieve anxiety.

At the third stage, for severe pain , a strong opioid of the morphine group plus a non-narcotic analgesic plus an adjuvant is used.

The gold standard for pain relief is the drug morphine. Fentanyl has fewer side effects and is also good because it can be used in patch form, which is very convenient for chronic pain. A number of fast-acting pharmaceutical fentanyl products have been approved in the United States for the treatment of breakthrough pain.

Breakthrough pain is an attack of pain that occurs between regular doses of analgesics. According to WHO standards, analgesics are administered to the patient every 3-6 hours, regardless of whether he is currently experiencing pain or it has not yet begun. In case of breakthrough pain, he receives an additional dose. At the same time, a patient at home must have a remedy on hand that allows him to relieve pain quickly and independently, without the help of medical personnel.

How to face pain head on?

Appropriating your own feelings is one of the tasks during a psychological session. The point is that, having experienced something in your life, it is important to translate it into experience. For example, an unsuccessful date gave experience in similar situations.

The more painful the client has experienced from the past, the longer it will take to live through it. And clients want “rescue”, practically, in one session - this is impossible.

A psychological session will allow the individual to build his future life after a strong experience in such a way that this will allow him to paint it with new bright colors that were previously not available.

Why is depression (in almost every way) the same as chronic pain?

The similarity in the symptoms of chronic pain and depression is explained very simply - the brain produces a chemical substance (neurotransmitter) that passes through nerve cells. And these diseases have common nerve cells.

Chronic pain has a very strong impact on a person's life processes. People suffering from chronic pain lose a lot in their lives: they cannot sleep normally, they have to change jobs, family relationships often deteriorate, sexual activity is no longer what it was before, and social life changes. Such changes and losses cannot pass without a trace for a person: some patients find the strength to fight it, but many simply go into depression.

If we make a comparison between patients with chronic pain and depression and those with only pain syndrome without depression, we will notice the following: the first group of people suffers the most severe pain, they cannot manage their lives, and often try to cope with the disease in unhealthy ways .

Since chronic pain and depression have a close relationship, complex treatment is used for them. There are even medications that treat both pain and depression at the same time.

Can antidepressants relieve pain and depression?

As we said above, pain and depression have a common source, namely the same neurotransmitters and nerve endings. Therefore, both in the case of chronic pain and in the case of depression, antidepressants help well. The main goal of antidepressants is to change the way the brain works so that the body's pain threshold decreases. Tricyclic antidepressants (Doxepin, Evalin) have long proven their effectiveness. But they have a lot of side effects that have made their use limited. But medicine does not stand still. And today there are already new generation antidepressants such as Effexor and Cymbalta, which are very successful in treating chronic pain and depression, and their side effects are very minor.

What is the best way to treat chronic pain and depression?

Every person suffering from chronic pain wants to know: how to alleviate their condition and how to achieve a positive effect from treatment? There is only one answer - first, contact a good and competent specialist, especially if chronic pain is accompanied by depression. Do not try to cope with your condition on your own and alone - only a doctor can develop an ideal treatment plan. After all, effective treatment and regaining control over your life can only be obtained by using comprehensive treatment that affects all aspects of your illness - both chronic pain and depression.

Primary appointment with a neurologist: 1850 RUR.