From the Guidelines
Pain misinterpretation is a complex process where the brain amplifies pain signals, and addressing it requires a comprehensive approach that includes patient education, cognitive behavioral therapy, and mindfulness practices. According to the 2021 clinical practice update on management of chronic gastrointestinal pain in disorders of gut-brain interaction 1, providers should master patient-friendly language about the pathogenesis of pain, leveraging advances in neuroscience and behavioral science. This involves explaining to patients that chronic gastrointestinal pain is real, perceived from sensory signals processed and modulated in the brain, and modifiable.
Key factors that contribute to pain misinterpretation include:
- Catastrophizing, which involves overestimating the seriousness of pain and feeling helpless
- Hypervigilance, characterized by excessive focus on bodily sensations
- Fear-avoidance behaviors, where patients avoid activities due to fear of symptoms
- Psychological inflexibility, or overfocusing on a cause or solution
- Pain solicitation from support systems and presence of psychological comorbidity
To address these factors, providers should adopt a patient-centered approach that emphasizes pain education, cognitive behavioral therapy, and mindfulness practices. This approach can help patients understand that pain doesn't always indicate tissue damage and promote present-moment awareness, reducing pain catastrophizing and hypervigilance. By rewiring neural pathways that process pain, reducing the brain's threat assessment, and activating descending pain inhibitory systems, patients can experience significant improvements in their pain experiences. As noted in the 2021 clinical practice update 1, explaining the Fear-Avoidance model of pain to patients can help them understand why they may have more pain than others despite a similar diagnosis and instill hope for improvement.
From the Research
Pain Misinterpretation Process
The pain misinterpretation process is a complex phenomenon that involves the interaction between patients' subjective experience of pain and clinicians' objective assessment of pain.
- Clinicians often face challenges in reconciling patients' self-reported experience with their own clinical assessment and personal biases 2.
- Patients' subjective experience of pain may not be adequately captured by simple numeric scales, and conflict can exist between patients' reported experience and clinicians' observations and expectations of pain 2.
- Clinicians may attempt to recalibrate patients' reported experience to reflect their own understanding of pain, which can lead to misinterpretation of patients' pain 2.
Factors Contributing to Pain Misinterpretation
Several factors can contribute to pain misinterpretation, including:
- Patients' individualized and subjective experience of pain 2
- Clinicians' personal biases and expectations of pain 2
- Limited understanding of pain physiology and classification 3, 4
- Inadequate assessment and management of pain 3, 4
Implications for Pain Management
The pain misinterpretation process can have significant implications for pain management, including: