Interpretation of pain determines pain perception

When people interpret their pain complaints in an extremely negative fashion, this has a negative effect on their pain perception, while a more accepting attitude can have a positive effect. This is the result of research conducted by psychologist Maaike de Boer of the University Medical Center Groningen. She also concluded that cognitive-behavioural treatment of chronic pain via the internet is effective and in some regards works even better than face-to-face group treatment. In addition, internet treatment costs less than face-to-face treatment. De Boer will be awarded a PhD for her research by the University of Groningen on 30 October.

Maaike de Boer focused in her research on the psychological mechanisms and treatment of chronic pain. Learning to live with chronic pain is a major problem for those who have to deal with it. Chronic pain has a negative effect on various aspects of life and can often not be alleviated through medical treatment. It is extremely prevalent and the costs to society of chronic pain are tremendous. It is now acknowledged that psychological factors can play a major role in chronic pain.

De Boer's research showed that chronic pain is a problem that occurs very often, not only in patients, but in the population in general. Over a third of the population has pain complaints, with a quarter of these indicating that the pain has existed for over six months.

De Boer established that the degree to which people catastrophize about pain determines their pain perception. Catastrophizing entails interpreting pain or expected pain in an exaggeratedly negative fashion. The degree to which people interpret and approach their pain as very negative influences the way they perceive it. This can lead to an increase in the number of visits to doctors and in the use of pain medication. Greater acceptance of negative experiences can have a positive effect on how pain is experienced. De Boer advocates specifically surveying the degree to which people catastrophize about pain. She feels that decreasing the degree of catastrophizing should be the goal of chronic pain treatment.

Psychological treatment of chronic pain can very well take place in primary care and need not be given in hospital. The goal of the treatment is not primarily alleviating pain but decreasing the specific psychological burden. De Boer studied the effect of cognitive-behavioural group treatment focused on learning to deal better with pain and came to the conclusion that participants were prone to fewer catastrophic thoughts regarding their pain and pain perception.

However, treatment can currently also be given via the internet. She compared the internet treatment with cognitive-behavioural group treatment and found that internet treatment was at least as effective as group treatment and in some respects even more effective.

De Boer: 'Treatment via the internet appears to be a useful and cost-effective supplement to existing treatments for chronic pain. It has the advantages of easy accessibility, flexibility and a clear focus on self-management. Internet can make the treatment of chronic pain more accessible.'

Maaike J. de Boer (Harlingen, 1977) studied Psychology at the University of Groningen. She conducted her research at the Pain Centre of the UMCG department of Anaesthesiology and at the UMCG's GUIDE research school. Her thesis is entitled ‘Living with chronic pain. Mechanisms and interventions.’ After the thesis defence, she will continue working at the UMCG as a postdoc.