From the Guidelines
Pain misinterpretation should be addressed through a multifaceted approach that includes pain neuroscience education, cognitive behavioral therapy, and medications such as low-dose tricyclic antidepressants or serotonin noradrenergic reuptake inhibitors, as these have been shown to modulate pain signals and improve patient outcomes. To address pain misinterpretation, it is essential to understand that pain doesn't always indicate tissue damage, especially in chronic conditions [ 1 ]. Patients should be educated on the concept of pain neuroscience, which explains that pain is perceived from sensory signals that are processed and modulated in the brain [ 1 ].
Key Components of Pain Management
- Pain neuroscience education to help patients understand that pain is not always a reliable indicator of tissue damage
- Cognitive behavioral therapy to identify and challenge catastrophic thoughts about pain
- Medications such as duloxetine (30-60mg daily) or amitriptyline (10-25mg at bedtime) to help modulate pain signals
- Physical therapy focusing on graded activity exposure rather than pain avoidance
Pain misinterpretation happens because the brain's pain processing system becomes sensitized over time, creating a disconnect between actual tissue status and perceived pain [ 1 ]. The nervous system essentially "learns" pain, making normal sensations feel threatening. This neuroplasticity can be reversed through consistent practice of the recommended techniques, helping recalibrate the pain processing system to respond more appropriately to sensory input.
Additional Considerations
- Providers should master patient-friendly language about the pathogenesis of pain, leveraging advances in neuroscience and behavioral science [ 1 ]
- Psychological inflexibility, or overfocusing on a cause or solution, is common in chronic pain syndromes and interferes with pain acceptance and response to treatment [ 1 ]
- Pain catastrophizing, the process of overestimating the seriousness of the pain coupled with feelings of helplessness, is associated with higher health care utilization and opioid misuse [ 1 ]
From the Research
Pain Misinterpretation
- Pain misinterpretation can occur due to various factors, including the complexity of pain itself and the subjective nature of the experience 2, 3.
- Effective pain management requires a structured assessment to identify the probable causes of pain and guide management, which can help reduce misinterpretation 2, 3.
- Barriers to effective pain assessment and management, such as the initial recognition of pain, can also contribute to pain misinterpretation 4.
- The use of tools and strategies, such as formal pain assessments and person-centred approaches, can help improve pain management and reduce misinterpretation 2, 4, 3.
- Studies have shown that patients with chronic pain conditions, such as fibromyalgia, often have multiple comorbidities and medication use patterns that can affect pain perception and management 5.
- The importance of a comprehensive understanding of pain physiology and classification is highlighted in the literature, which can help healthcare professionals better assess and manage pain 2, 3.