Pain and Attitude

Is Mind Over Matter More Than A Cliché?

No pain, no gain. If you don’t mind, it doesn’t matter. It’s all in your mind. We’re all familiar with these sayings about pain and the mind. We’ve used them – or similar sayings – to push ourselves one way or the other in a variety of circumstances, whether it’s doing one more mile on a run, doing one more rep in the gym, or trying to overcome a bothersome headache or other physical pain. But is there any truth behind these sayings? Does the mind really have an impact on how we deal with pain? More studies seem to reveal that there is at least some truth to that notion.

When it comes to on-the-job injuries, the decision not to return to work may be made long before an employee suffers an injury on the job, according to a one study. At the outset of the study, patients experiencing chronic pain answered a list of yes/no questions and completed a set of rating scales. These all related to their impressions of and feelings toward their job, including one questioning their “intent” to return to the same type of job after treatment for their injury. Results showed a direct correlation between the number of positive versus negative answers and the likelihood of a patient returning to work after treatment for pain caused by injury. ⁱ

In findings that researchers hope will change the way arthritis of the knee is battled, one study found that arthritis sufferers with a high level of self-confidence and support from friends and family are less likely to become disabled than are those who are more socially isolated and less self-confident. The study was conducted over a three-year period and looked at 236 people who suffered from osteoarthritis of the knee. The average age of the mostly female group was about 68 years old. At the start of the study the patients filled out questionnaires that measured their belief in their own ability to walk 100 feet on flat ground in 20 seconds, walk 10 steps downstairs in 7 seconds, and get out of an armless chair without using hands for support. They also gave details of their own social support structure.

Those who scored high in the study for levels of self-confidence, or self-efficacy, or strong social support were far less debilitated by their arthritis after three years, Dr. Leena Sharma, the lead researcher on the Northwestern University medical school study said. The results even held up when researchers adjusted the data based on other measures of disability, including the level of pain each person suffered. Dr. Sharma hopes the study, which has been published in the journal Arthritis and Rheumatology, will inspire a deeper look into how treatment can be improved. ⁱⁱ

Additionally, a study published in the Mayo Clinic Proceedings of August 2002 reported that people who expect misfortune and only see the darker side of life experience more pain and don’t live as long as those with a more optimistic view. Researchers evaluated results from a personality test taken by participants over 30 years ago and compared them to later mortality rates. The study revealed that those who scored high on optimism had a 50 percent lower risk of premature death than those who scored more pessimistic. Besides a lowered risk of early death, researchers found other health benefits related to positive attitude. The study also revealed that those who scored high on optimism had:
• Fewer problems with work or other daily activities because of physical or emotional health
• Less pain and fewer limitations due to pain
• Less interference from physical or emotional problems when engaging in social activities
• Increased energy
• More peaceful, happier and calmer feelings

The results could lead to ways to help pessimistic people change their perceptions and behaviors and thereby improve their health and perhaps lengthen their lives, says Toshihiko Maruta, M.D., a psychiatrist at Mayo Clinic, Rochester, Minn., and lead author of the study. ⁱⁱⁱ

“It confirmed our common-sense belief,” says Dr. Maruta. “It tells us that mind and body are linked and that attitude has an impact on the final outcome — death.” The researchers said they couldn’t definitively explain how a pessimistic outlook acts as a risk factor for decreased longevity. Dr. Maruta says optimists may be less likely to develop depression or “learned helplessness,” a condition that occurs when someone is exposed to repeated punishment or negative conditions and perceives no chance of getting away. Optimists also might be more likely to seek and receive medical help, seeing bad events as specific, temporary and controllable.

Pessimists, however, see life events in a negative light and expect the worst possible results. When bad things happen, they often blame themselves and see problems as all-encompassing and everlasting. “It would help if they interpreted their negative experiences in such a way that they didn’t blame themselves when things went wrong,” Dr. Maruta says. “It also would help if they didn’t think bad situations or experiences were going to last and realized that such circumstances often are temporary.” ^iv

Will having a good attitude always enable you to overcome pain, speed-up recovery, and enhance your quality of life? Not always. On the other hand, being pessimistic seems to rarely – if ever – result in the kinds of benefits that a positive attitude can bring. Despite all the things that remain beyond our control, attitude remains solely within our power. It’s up to us what we do with it.

ⁱ Patients’ work status was assessed periodically from one month to 30 months after therapy. Results showed that patients’ negative vs. positive attitudes toward their jobs correlated with whether or not they returned to work after treatment for pain caused by injury. (Fishbain DA, Cutler RB, Rosomoff HL, Khalil T, Steele-Rosomoff R. Clin J Pain. 1997; 13:197-206)

ⁱⁱ “Good attitude helps cope with arthritis,” by Shamus Toomey, Chicago Sun Times. Dec. 15, 2003.

ⁱⁱⁱ The researchers surveyed individuals in 1994 who previously had taken the Minnesota Multiphasic Personality Inventory (MMPI) at Mayo Clinic between 1962 and 1965. The 500-question personality test has an optimism-pessimism scale that grades the “explanatory style” of the participants — how people explain the causes of life's events — and categorizes them as optimists, pessimists or mixed based on their answers to certain questions.

^iv CNN Health Library, Sept. 12, 2002.