It’s all in your head
In other words, the hypochondriac’s worst nightmare. It’s a phrase that carries an air of disbelief and condescension. Recent studies are showing that this phrase appears to have merit—although not in the derisive connotation with which it’s normally associated.
Advances in neurological science have shown that the source and machinations of physical pain are indeed all in your head… or, to be more accurate, they are experienced (or not experienced) via the complicated neural structures in your brain.
We've all experienced both types of pain: physical and emotional.
The experience feels very different but neuroscientists found—strangely enough—that both forms of pain engage the same neural mechanisms.
The number 1 factor leading to opioid addiction risk is the presence of a mental disorder and to make matters worse, depression and anxiety are on the rise.
The experience of pain clues us into why mental disorders lead to addiction.
The function of opioids is to alleviate physical pain but these drugs inadvertently also provide emotional relief—because painkillers are hitting the same neural paths that affect physical and emotional pain.
Physical therapy doesn’t fix emotional pain so the emotional distress lingers even after physical pain subsides. Unfortunately, opioids help with emotional pain that remains, and those individuals will naturally seek relief with what’s worked for them lately—opioids.
If these individuals seek relief via opioids for even 10–20% longer duration, or utilize a 10–20% higher dose, the increase can push the patient over the tipping point and into an addiction.
Individuals suffering from depression or anxiety are more prone to increased, longer-term opioid use and, ultimately, increased risk of addiction.
It would be wise to thoroughly screen for mental illness even when treating strictly musculoskeletal ailments, especially when prescription pain pills are part of the treatment protocol.
If it indeed is all in your head, then we can do a better job of approaching patient care by diving in head-first.