Beyond the News: Professor studies link between pain and emotions

November 7, 2017

Wayne State distinguished Professor of Psychology Mark Lumley recently completed a study to determine how emotional experiences affect the amount of pain fibromyalgia patients experience.

Fibromyalgia is a chronic pain disorder that causes widespread discomfort over the entire body. Common symptoms include muscle stiffness, difficulty sleeping and fatigue. It can affect men, women and children. An estimated 10 million Americans are afflicted with fibromyalgia and there is no known cure.

Lumley completed the research with a team from the University of Michigan. The study consisted of randomized clinical trial in which 230 adults with fibromyalgia were given one of three treatments. The team used Emotional Awareness and Expression Therapy (EAET) to help patients see that pain can be influenced by their emotions, and compared it to both cognitive-behavioral therapy and an education control condition. The results of the study were recently published in the journal PAIN.

We asked Lumley to tell us more about this study.

What inspired you to pursue this research study?

I have long had an interest in emotions, especially those healthy emotions and experiences — like memories and secrets — that people suppress or hide. I’ve been driven by the question of the costs of such avoidance — how does it harm the person’s mental and physical health? I have also long been interested in the mind-body connection and how mental experience can shape bodily experience, especially symptoms such as pain that are linked with stress. Finally, I see an epidemic of people in chronic pain, and our psychological tools are rather weak as we attempt to help people manage their pain. Trauma, conflict, relationship problems and struggles often underlie and drive people’s pain. Knowing that we might be able to help reduce pain by addressing these issues has been very exciting and motivates me to pursue this work.

What is the relationship between emotional experiences and chronic pain?

Chronic pain undoubtedly leads to depression, anxiety and anger. However, people who have these emotional difficulties in the first place are also more likely to develop chronic pain later. Furthermore, the real culprit may not be the experience of emotion, but the “work” of suppressing or avoiding the experience of important emotions such as anger, sadness, love and self-compassion that are appropriate for the person’s circumstances but are too difficult to experience and express. Such emotional avoidance appears to drive chronic pain, and helping people reverse this pattern can reduce chronic pain. This is particularly true with some forms of chronic pain that are centralized or based largely in the brain and central nervous system.

What was the outcome of the research?

We developed an emotion-focused therapy, which we call Emotional Awareness and Expression Therapy (EAET), and compared it to an active education-based control condition and the leading psychological intervention for fibromyalgia, cognitive-behavior therapy (CBT). The EAET condition was substantially better on multiple outcomes that the control condition six months after treatment. EAET was superior to CBT on reducing widespread pain. This is the first large-scale study to show that directly addressing the emotionally difficult issues in patients’ lives improves their fibromyalgia symptoms. This is the first study to show superiority of one psychological intervention for fibromyalgia pain over another legitimate psychological intervention — in this case, the leading intervention in the field.

What does this research mean for the future of fibromyalgia patients and treatments?

We hope that our work will show people with fibromyalgia and their medical providers that the primary organ of their pain is the brain and that the brain is changeable through powerful new, healthy experiences. Engaging in such experiences will, for many patients, substantially reduce their symptoms, occasionally eliminating them. Many patients with fibromyalgia do not need to be as hopeless or limited as they are often led to believe.

Neuroscience research is now demonstrating that much chronic pain is constructed by the brain as a warning and protective mechanism. Emotional experiences have been found to activate the same brain mechanisms as physical injuries, thus suggesting emotional experiences can cause physical pain. Individuals who have early life adversity are more likely to have chronic pain as adults. This suggests that the brain’s alarm mechanism is sensitized in childhood and then can be triggered later in life by stressful life events. Many people with fibromyalgia have experienced adverse childhood events or have other internal conflicts, and we have an approach to address these problems, which can lead to substantial reductions in pain.