Emotional Awareness: Key To Chronic Pain Management

Recognising and expressing emotions plays a crucial role in managing chronic pain, as difficulties in these areas can lead to increased psychological distress and worsened pain outcomes.

People who struggle with identifying and describing emotions could experience more disruption to their daily activities from pain due to increased psychological distress, a new study has found.

Researchers, led by those at the US' Johns Hopkins Medicine, looked at how alexithymia, or the difficulty in recognising and expressing emotions, can affect pain outcomes.

The link between chronic pain and emotional response

Chronic pain, in which pain persists beyond the immediate recovery period of three months, is often a result of psychosocial factors, including one's emotional response to pain and cognitive processes such as coping mechanisms.

'Alexithymia had a significant indirect effect on pain interference through psychological distress,' the authors wrote in the study published in the journal, Health Psychology.

The researchers related elevated levels of alexithymia in patients with chronic pain with a worse pain severity, physical interference, depression and anxiety.

Evidence suggests that alexithymia can be targeted and reduced in chronic pain treatment, they added.

Understanding alexithymia and pain

'Prior studies have shown that alexithymia tends to be higher in people who have chronic pain.

'However, we did not know whether alexithymia leads to worse pain or whether worse pain leads to alexithymia.

'We also have not had a good understanding of why these two distinct processes were related,' senior author Rachel Aaron, associate professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine, said.

More than 1,450 patients with mixed chronic pain conditions across the US were surveyed and monitored.

Patients having a higher alexithymia at the study's start were found to develop greater psychological distress a year later.

An increased distress predicted a greater pain interference after two years, which meant that pain had a larger impact on daily functioning and quality of life.

Key findings about emotional processing and pain

Results also showed that alexithymia and distress did not significantly increase how intense pain felt for the participants.

Pain interference also did not predict a later alexithymia, which supported evidence that difficulties in emotional processing are a risk factor, not a consequence, of worsening pain outcomes, the researchers said.

'Greater difficulties identifying one's own feelings can lead to greater symptoms of psychological distress, including symptoms of depression and anxiety,' Aaron said. 'This in turn can lead to greater difficulties managing chronic pain.

'These findings highlight the role of considering alexithymia in psychological treatment for chronic pain, and how it might lead to psychological distress, to improve pain outcomes.'

The researchers said the study highlights psychological distress -- especially anxiety and depression -- as a key intervention target, particularly for people who have difficulty identifying and expressing emotions.

Further, the study provides new evidence that how people experience and process emotions plays a crucial role in how chronic pain shapes their lives over time. Addressing psychological distress, they added, may be one of the most effective ways to improve long-term outcomes.