Experts at the National Institutes of Health estimate that 25.3 million adults in the U.S. are living with chronic pain. Although the Centers for Disease Control and Prevention recommends against opioids as a first-line or routine treatment for chronic pain, the rate of opioid prescriptions has increased dramatically in recent years, contributing significantly to the U.S. epidemic of opioid addiction, overdose and overdose death. The rise in opioid prescriptions is driven by a number of factors that include patient demand and insurance reimbursements tied to patient satisfaction scores.
People living with chronic pain often experience depression and negative emotion, magnifying both the severity and ongoing nature of the pain. Although that may come as no surprise to someone who has lived with pain or other significant life stress, in fact, people also experience positive emotions in the midst of chronic pain—an idea researchers have been slow to realize. Positive emotion—feelings such as happiness, excitement and calmness—can lower perceptions of pain intensity, may break the vicious cycle of pain and negative emotion, and thereby reduce pain-related suffering.
As a professor of medical social sciences and director of research at the Northwestern University Osher Center for Integrative Medicine, my research confirms that positive emotions commonly surface and can easily co-exist during times of intense grief or pain. For example, although caregivers we studied reported high levels of depression and stress, they also reported experiencing frequent positive emotions as well, often in response to a fairly mundane event such as the sight of a beautiful sunset or a kind word from a stranger. These positive emotions gave them a momentary break from the burden of caregiving and helped them cope better with the stress.
Scientists are working hard to find non-addictive substitutes for opioids to treat chronic pain and the NIH has laid out a detailed plan to address the growing opioid crisis through targeted research. But these efforts are unlikely to result in immediate, widely available interventions that could slow the epidemic of opioid-related deaths.
In my lab we study a program that teaches a set of skills for noticing, extending and creating more positive emotion, even in the midst of chronic stress, and we are testing whether people who learn these skills are less stressed and depressed.
The eight tools or skills in the program—noticing positive events, savoring them, gratitude, mindfulness, positive reappraisal, noting personal strengths, attainable goal setting and acts of kindness—improve psychological well-being in people with chronically stressful conditions including diabetes, HIV and cancer. In addition, secondary analyses from a study in people without chronic pain suggest that these positive emotion skills may weaken the powerful link between physical pain and psychological distress that often spirals into chronic pain and may even reduce opioid use.
The idea that positive emotion can be helpful in coping with pain is counterintuitive and may seem to place the burden on the individual to simply “think positively” to fix their chronic pain. To be sure, positive emotion is not a cure-all that will magically make the pain disappear. But consciously focusing on ways to bring more positive emotion into your life, even in the face of ongoing stress and pain, is one modest step toward coping better with pain.
The experience of positive emotion may lessen pain through several pathways.
Positive moments can serve as a break from the stress of chronic pain and help to sustain coping efforts and may foster better adherence in pain treatments that require sustained practice to have an effect such as physical therapy. Positive emotions curtail the physiological stress response and evidence is accumulating that sustained activation of brain areas associated with positive emotion is associated with lowered physical stress response.
Unrelenting pain is demoralizing and can lead to hopelessness when it seems that nothing can be done to stop it. Intentionally cultivating positive emotional experiences through practice of activities such as gratitude or savoring small positive events in daily life thus offers one small way to stay engaged and actively cope with chronic pain. It is possible to experience moments of positive emotion even in the face of negative life experiences and these positive moments can provide a respite, and help to build resilience to continue coping in the face of the stress of living in constant pain.
The science supporting positive emotion interventions for chronic pain is nascent and there is much work to be done before we can definitively say that simply increasing positive emotion makes a difference. And a focus on positive emotion is by no means minimizing the significant suffering of people living in chronic pain or, perhaps even worse, arguing that pain should be ignored, suppressed or denied. Instead the data show that it is possible to experience positive emotions alongside negative emotions and pain, thereby interrupting the downward spiral of pain and suffering, allowing space for healing to begin.