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Feeling the Pain of Pain

News from the Department of Psychiatry and Behavioral Sciences

“It’s awful; I can’t stand it, and it’s never going away.”

Dr. Haythornthwaite

Dr. Jennifer Haythornthwaite

An irony marks the way certain people respond to pain, especially in chronic illnesses like arthritis, fibromyalgia and chronic low back pain. “The irony,” explains Jennifer Haythornthwaite, Ph.D., “is that these people are extremely sensitive to pain, struggle in living with it and could benefit from others’ help. But their response to pain is so negative, so pessimistic that it makes things worse and can push away the very support they need.” 

Psychologist Haythornthwaite and colleagues with the Behavioral Medicine Research Laboratory that she directs study psychological issues that touch the optimal treatment of pain. “Huge differences exist in how people perceive pain,” Haythornthwaite explains, “and understanding what they are is crucial to treating them safely and well.” The work is particularly meaningful now, a time of concern over medications like Vioxx and OxyContin, she says. “We need to sort out who does best on these, and who can do better with alternatives.”

So Haythornthwaite’s group investigates specific diseases, noting, for example, what’s unique or what’s common psychologically to patients with arthritic, dental, pelvic or neuropathic pain. And they test therapies: A current trial of patients suffering from temporomandibular joint disorder (TMD), for example, compares the antidepressant pain drug nortriptyline with stress management or teaching about TMD.

Some of their work, though, looks more generally at human pain responses. Lately, they’ve focused on a behavior called catastrophizing. Some patients home in on their pain with unusual intensity. Those feelings get magnified, along with a sense of helplessness and overall pessimism. It’s not uncommon, this “great converging of negative thought and emotions,” as Haythornthwaite calls it. And though it overlaps depression, the syndrome is still distinct. “Think of it as an emotional response to pain.”

Not only are high “catastrophizers” more sensitive to pain, but they’re more likely to be disabled by it.

Haythornthwaite is quick to assure, however, that, like pain, catastrophizing is in the brain,  not “in your head.” In imaging studies, more pain areas light up in patients’ brains. “Our work suggests that, in some people, the central nervous system is sensitized to pain—a negative sort of plasticity in which pain begets pain. Our goal? Find treatments to change that.”

For information, call 410-614-3366.

Find other Hopkins Newsletter articles from past issues.