By Eric Larson, PMHNP-BC (Larson Mental Health)

The revolution of mental health awareness in recent years has made countless positive strides in bringing the wellbeing of our minds to the forefront of the cultural conversation. However, the focus on psychological wellbeing may also be widening the gulf many people perceive between the mind and the body. Too often we fail to view the mind as a part of our body, not a separate entity. Your mindset is directly impacted by your physical health, and your physical health can change with your mindset. The human brain is more powerful than we give it credit for, but other components of the human body can still impact the way our brains function. 

From changes to the gut microbiome to the effects of long-term oxygen deprivation from malformed air passageways, there are so many examples of our bodies changing brain works, and the way you feel. One of the most impactful physical conditions on a patient’s mental health is chronic pain. When comfort is always out of reach and feelings of powerlessness abound, it’s no wonder that suffering from chronic pain conditions will negatively impact your mental functioning. 

Exploring the Bi-Directional Relationship 

Not only can prolonged physical pain exacerbate mental health disorders, but also the state of one’s mental health can influence the intensity and experience of physical pain. This back-and-forth is sometimes referred to as the “bi-directional relationship” between the mind and body. Some of the factors of chronic pain that influence one’s mental health include: 

• Interrupted Sleep: Chronic pain can disrupt sleep patterns, escalating symptoms of anxiety and depression. 

• Reduced Physical Activity: Persistent pain often limits engagement in physical activities, which can be crucial for mental health maintenance. 

• Social Isolation: Due to the added difficulty of performing daily activities, individuals with chronic pain conditions may withdraw socially, leading to feelings of loneliness and increased mental health challenges. 

Mental Health and Pain Perception 

Negative emotional states can alter the body’s pain response mechanisms, meaning when you feel worse, you experience more pain, and when you experience more pain, the cycle only continues. Emotional distress can lead to an amplification of pain signals in the brain, which can cause patients to perceive pain as being even more intense than it already is. Ongoing stress may also contribute to inflammation, which only exacerbates inflammation-based chronic pain conditions. 

Behavioral therapy and other psychological interventions have been shown to improve pain outcomes. Therapy can help develop healthier thought patterns and behaviors related to pain and improve stress levels, providing relief from both physical and emotional pain points. 

Mental Health Conditions in Chronic Pain Sufferers 

The incidence of depression and anxiety is significantly higher in individuals with chronic pain than the general population. Depression occurs in approximately 30% to 50% of patients with chronic pain. Care providers must be vigilant in their assessment of chronic pain patients, not just for the management of physical pain but also for the identification and treatment of potential co-occurring mental health symptom; our approach should be multifaceted and collaborative. Including the disability for mental health in these discussions is important, as recognizing the connection between physical and mental health can yield improved support and outcomes for patients.

The Three Prongs of Pain Management 

Well-adapted coping strategies can profoundly influence how pain interferes with daily life and a patient’s capacity to maintain physical activity. There are three main approaches to focus on with patients suffering from chronic pain: 

• Clinical medicine: Works to craft a diagnosis and treatment plan for diseases and disorders. 

• Behavioral therapy: Aims to modify pain behavior and reactions by addressing psychological factors. 

• Physical therapy: Focuses on enhancing mobility and reducing physical symptoms. 

Note that each form of therapy targets a different aspect of the pain experience. When these therapies are integrated together, this three-pronged approach can be far more effective than solely treating physical or mental symptoms and causes.  

While there are pain management practices that allow patients access to multiple disciplines under the same roof for effective treatment, not all patients have access to these facilities. That’s why it becomes key for open, clear communication between all the care providers in a patient’s treatment program and an understanding of the role each professional must play. 

Improvement Through Integration 

The main thrust of this article is simply to stress the importance of working together for our shared patients. Mental healthcare providers can be seen as a separate entity from other healthcare providers, despite the direct and undeniable link between mental and physical health. Thinking of the mind and body in two different categories only increases the number of obstacles to desired patient outcomes. Through an emphasis on integrated care approaches, we believe we can improve the quality of life for individuals with chronic pain far more than any of us could on our own. 

Erik Larson, PMHNP-BC, a dedicated mental health professional, has been serving in healthcare since 2005, beginning his career as a Registered Nurse after graduating from Regis University. With extensive experience in treating traumatic brain injuries and psychiatric conditions, Erik has worked at Craig Hospital, served as a Nurse Practitioner in the U.S. Army, and now leads Larson Mental Health in Denver. He specializes in a broad range of conditions, including PTSD, depression, and substance abuse, and is committed to providing effective and compassionate care. Larson Mental Health offers expert medication management services across Colorado.

• Patient Safety