Psychological Risk Factors of Pain

Below are some psychological risk factors that can increase your pain.

Anxiety and depression

People in chronic pain are more likely to experience higher anxiety and depression. In turn, anxiety and depression in IBD can lead to lower quality of life, lower ability to perform daily activities, and higher disability related to pain. Anxiety and depression occur in IBD when the disease is active (60% to 80%), as well as during remission (30%).

Even for people with excellent health, pain creates anxiety and rightly so. After all, many times pain is a signal that something is ‘not right.’ However, in many chronic pain situations, the pain does not signal new damage. 

Depression can increase your perception of pain. In return, pain alone can cause more depression.

The prevalence of pain (i.e., how common pain is) in people who are depressed is greater than in those who are not depressed. Likewise, the prevalence of depression in people who have chronic pain is higher than in those who are not in pain. Also, the presence of pain can make it harder to recognize depression.

Early diagnosis and treatment of anxiety and depression are very important. If you are experiencing anxiety and/or depression, see your doctor right away. The treatment of anxiety and depression may include medication, psychotherapy, and education for you and the rest of your support system (family or significant others). 

Visit our section on Mental Health and Wellness for more information. 

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Negative thoughts about illness and pain catastrophizing

Pain catastrophizing and negative illness perceptions occur when you think negatively about your pain. An example might be if you constantly think about your pain in a negative overwhelming manner. You might tell yourself the situation is worse than it might be. This can lead you to think that you can’t do anything about your situation (i.e., helplessness). Examples of catastrophic thinking include thoughts like “It is never going to get better” and “I can’t stand this pain anymore.” 

Researchers have found that when people with chronic pain think negatively, they experience an increase in the occurrence, severity, or intensity of pain. The sensation of pain is affected by your emotions, thoughts, behaviour, and catastrophic thinking.

Psychological interventions are useful in reducing negative perceptions and pain catastrophizing thoughts. Learn more about these Psychological Stategies later in this section. 

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Fear of pain and avoidance

Pain-related fear is a fear of pain getting worse and, as a result, it can lead to the avoidance of physical activities. This process is known as pain-fear avoidance.

In general, if you are experiencing pain but do not fear it, and you can confront your pain in a healthy manner, you will be able to cope better with it. If on the other hand, your pain leads to catastrophizing and pain-related fear, you will be more likely to avoid activities you enjoy because of that pain. Avoidance of activity can, in turn, lead to depression, disability, and increased pain in a sort of vicious cycle.

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Childhood trauma and pain

In general, people who report abusive or neglectful childhood experiences are at increased risk of having chronic pain in adulthood. But, there are many people who have experienced early trauma that also do not report pain. 

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Additional resources

Video: Psychological and Cognitive Risk Factors of Pain

Watch the video below to learn more about the impact that anxiety, depression, thoughts about pain and other social actors can have on pain and quality of life in people living with Crohn's and colitis. 


Dr. Dean Tripp (C.Psych, PhD) is a recipient of research grants from Crohn's and Colitis Canada. He is a Professor in the Department of Psychology at Queens University and cross appointed to Anesthesiology and Urology at Queen's.

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