AOCPMR 2024 Mid-Year Meeting-So, You're Saying It's All in My Head?! Demystifying the Connection Between Emotional and Physical Pain

So, You're Saying It's All in My Head?! Demystifying the Connection Between Emotional and Physical Pain - Mark Paidin, DO

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Video Transcription

Video Summary

The lecture explores the complex relationship between chronic pain, emotional distress, and trauma, emphasizing the mind-body connection. It highlights that chronic pain often coexists with anxiety and depression, and trauma—especially adverse childhood experiences and military sexual trauma—can increase pain sensitivity and conditions like fibromyalgia. The presenter explains how pain is both a sensory and emotional experience, processed through brain regions such as the brainstem, limbic system (including the amygdala and hippocampus), insula, and anterior cingulate cortex, which together influence threat response and emotional regulation. Polyvagal theory is introduced to describe different autonomic nervous system states, including social engagement, fight-or-flight, and freeze responses, illustrating how trauma affects nervous system function and pain experience. Nociplastic pain, where pain outlasts or exceeds tissue damage, is discussed alongside central sensitization mechanisms in the nervous system. The talk stresses the importance of compassionate patient care—reassuring, validating, educating, motivating, and activating patients—and multidisciplinary treatments including cognitive behavioral therapy, somatic approaches, medications, and emerging interventions like stellate ganglion blocks. The lecture also touches on placebo/nocebo effects, the potential of psychedelics for PTSD (primarily MDMA), and future directions involving neuromodulation and brain imaging. Overall, it advocates for nuanced understanding and integrated treatment of chronic pain as an intertwined emotional and physiological condition.

Keywords

shoulder pain diagnosis

physical examination

imaging techniques

ultrasound imaging

differential diagnosis

Dr. Sherman and Dr. Tu

chronic pain

emotional distress

trauma

mind-body connection

polyvagal theory

nociplastic pain

central sensitization

multidisciplinary treatment

psychedelics for PTSD