How Fear Can Influence Treatment for Chronic Pain

By Jane Farrell

A leading psychology professor at The University of Texas at Arlington has focused international attention on how a chronic pain patient’s irrational doubts about never getting better can influence both his reactions to pain and even treatment outcomes.

Chronic pain costs the U.S. up to $635 billion each year in medical treatment and lost productivity, and is considered a problem of epidemic proportions. The influence of these irrational beliefs on both patient behavior and chronic pain treatment success is of growing interest to the scientific community.

“We are seeing that patients who tend to have these irrational beliefs are at greater risk of misusing opioid medicines and take longer to return to work when experiencing work disability for acute lower back pain,” Robert J. Gatchel, UTA Distinguished Professor of Psychology and Nancy P. & John G. Penson Endowed Professor of Clinical Health Psychology, said in a news release from the university.

“A more complete treatment model around this problem would promote changes in lifestyle habits and attitudes, and strengthen social support systems, alongside medical treatments. We need to take into consideration a series of treatment components that people have not considered before,” he added.

The irrational or maladaptive beliefs that the pain will never get better are clinically known as pain catastrophizing. Gatchel has edited one of the first special issues dedicated to this subject for the Journal of Applied Biobehavioral Research, bringing together new studies from Asia, Europe and North America, as well as his recent review of the literature.

“We hope that this special issue will spark more interest in this significant construct and help guide further clinical research,” Gatchel said. “New research on brain imaging and the genetics of catastrophizing are highlighting the increased complexity of these beliefs and underline the need for a more complete model for pain treatment.”

Perry Fuchs, UTA’s chair of psychology, congratulated Gatchel on this achievement and his research program, which contributes to the University’s strategic theme of Health and the Human Condition within the Strategic Plan 2020: Bold Solutions|Global Impact.

“There is a long history of evaluating the cognitive appraisal of pain on therapeutic outcomes and Dr. Gatchel’s analysis of catastrophizing and comprehensive treatment approaches highlights certain aspects of why patients might feel less pain, why some patients recover faster, and how some better manage their conditions,” Fuchs said.

Additional work in the UTA research laboratories of Dr. Fuchs, Dr. Yuan Bo Peng, and Dr. Qing Lin is partially aimed at exploring the biological mechanisms that might help explain how cognition impacts pain processes.

Gatchel was recently awarded the American Psychological Foundation’s 2017 Gold Medal Award for Life Achievement in the Application of Psychology. He is also director of UTA’s Center for Excellence for the Study of Health and Chronic Illnesses.