Is chronic pain “all in your head?”

The one thing that frustrates a sufferer of chronic pain more than the pain she experiences is hearing that the pain is “all in [her] head.”  A new study, recently published in the Journal of Pain and reported upon in the LA Times, noted that there really are clear and demonstrable differences in the brains of chronic pain patients and non-pain-suffering controls.

Now this does not mean that chronic pain is “made up” or “just in your head” but it may help identify who is more prone to develop chronic pain post-injury and who is not.  It is critically important to note that chronic pain is real.  Surely the sufferer’s mental state, personality, supports and other factors affect his response to and ability to function with the pain, but this does not mean that chronic pain is not real pain.

The study demonstrated that there is an observable difference in the white matter of the brain when comparing chronic pain patients to “normal” controls (i.e., people without pain).  However we do not yet know what to do with this information.  The article in the Times noted that employers or insurance companies might want to have this information for money saving reasons (treating chronic pain can be very expensive, especially when sufferers are dismissed by health practitioners and they then have to shop around from doctor to doctor).  It also mentioned that people with such a predisposition to chronic pain may want to make behavioral or other life choices that may minimize risk of injury.  Hopefully this sort of research will eventually lead to effective treatments of chronic pain beyond standard narcotic medication.  It already has been well established that psychotherapy can benefit sufferers in many ways: even if the psychotherapy does not directly address the actual pain, the interventions can focus on improving other aspects of the patient’s life, attempting to minimize interpersonal conflict secondary to the emotional irritability that often accompanies pain, develop a different perspective on the meaning and role of pain in the person’s life, and simply “coping” with the pain differently.