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Using the Brain to Control Pain

dr. martin at his desk with a patientAndrew L. Martin, PsyD.

We’ve known for a long time that activity in the thought and emotion centers of the brain can dramatically affect how much pain we experience from injuries, disease, or normal aging. In fact, clinical psychologists treat chronic pain by teaching how to control brain activity, usually resulting in reduced pain intensity, fewer pain flare-ups, and fewer doctor visits and interventions.

A recent University of Colorado study re-confirmed these findings in a unique way. In the study, when referring patients to psychology for pain treatment, a physician spent an hour with the patient, explaining how the brain affects the amount of pain we experience. Physicians do not usually have that amount of time available to explain the brain-pain connection, or to advocate for psychological treatment. The research went on to confirm what we already know – that follow-on psychological treatment for chronic pain is quite effective at reducing pain levels, both at the time of treatment, and at least one year after treatment is completed.

What I find interesting about this study is that a physician spent time carefully explaining the brain-pain connection to patients before referring them for psychological treatment.  Usually, physicians have just a few moments to explain the connection and make a referral. In my experience, this often results in patients thinking, “the doctor said the pain is all in my head – that it’s not real.”  I would like to see additional research to show whether this additional time spent by the physician results in more patients getting help for pain through psychological treatment.

I am also curious if having a physician explain the brain-pain connection is more effective than a psychologist explaining the same connection. In other words, will more patients perceive this information as more reliable coming from a physician than from a psychologist, at least in the beginning?

If the answer to either is yes, it might be good practice to reimburse physicians for spending the necessary time to explain the brain-pain connection, and make referrals to psychologists for psychological treatment for chronic pain. It would probably save a lot of money and resources in the long run as well, because people with less pain require fewer doctor visits and fewer expensive interventions.

 

Ref: Ashar, Y. K., Lumley, M. A., Perlis, R. H., Liston, C., Gunning, F. M., & Wager, T. D. (2023). Reattribution to mind-brain processes and recovery from chronic back pain: a secondary analysis of a randomized clinical trial. JAMA Network Open6(9), e2333846-e2333846.

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