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Psychologic Factors That Contribute to Pain

By John Markman, MD, Sri Kamesh Narasimhan, PhD

Psychologic factors that commonly contribute to pain, particularly chronic pain, may include anxiety, depression, and insomnia.

Psychologic factors can strongly influence how people perceive pain—particularly chronic pain and sometimes pain-related disability. Almost all pain has some physical basis. But psychologic factors, including insomnia, anxiety, and depression, may make people feel less able to control their symptoms and thus less able to do their normal activities. For example, people with chronic pain know the pain will recur, and they may become fearful and anxious as they anticipate the pain's return. When people understand that worsening pain may not indicate damage to their body, they may have less anxiety (for example, about deteriorating physically or losing function) and thus have less pain.

Rarely, people have persistent pain with evidence of psychologic disturbances and without evidence of a disorder that could account for the pain or its severity. This pain may be described as psychogenic. However, psychophysiologic pain is a more accurate term because the pain results from interaction of physical and psychologic factors. For example, fear and anxiety can reduce the production of substances that reduce the sensitivity of nerve cells to pain. This change in sensitivity to pain partly accounts for pain that persists after its cause resolves and for pain that feels more severe than expected. Psychogenic pain is far less common than nociceptive or neuropathic pain.

The fact that pain is worsened by psychologic factors does not mean that it is not real. Most people who report pain are really experiencing it, even if a physical cause cannot be identified. Doctors always investigate whether a physical disorder is contributing to chronic pain but often do not find an adequate explanation for the pain.


  • Drugs to relieve pain

  • Nondrug treatments such as biofeedback

  • Often psychologic counseling

Pain that is heavily influenced by psychologic factors requires treatment, often by a team that includes a psychologist or psychiatrist. Treatment for this type of pain varies from person to person, and doctors try to match the treatment with the person’s needs.

For most people who have chronic psychogenic pain, the goals of treatment are to improve comfort and physical and psychologic function.

Doctors may make specific recommendations for gradually increasing physical and social activities.

Drugs and nondrug treatments—such as biofeedback, relaxation training, distraction techniques, hypnosis, transcutaneous electrical nerve stimulation (TENS), and physical therapy—may be used. Many drugs that help relieve pain also help relieve insomnia, anxiety, and depression.

Psychologic counseling is often needed.

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