Fear, Distress and Pain Perception in Osteoarthritis

by John A. Speyrer

A study which appeared in the April, 2007 issue of the journal Arthritis and Rheumatism Treatment Implications examined how the brain processes arthritic pain. It was found that there are two different but parallel areas where pain is processed. They are named the "lateral" system and the "medial" system. It was found that the medial system is much involved in the processing of "emotional aspects of pain, such as fear and stress."

The brain imaging study, reported by Salynn Boyles in the WebMD medical news, quotes neuro-rheumatologist Anthony Jones, M.D. It's the way that people regard their pain which influences their perception of it, Jones explained. "That may sound obvious, but a lot of people with pain think they have no control over what they are feeling."

A study of knee osteoarthritics confirmed this theory during the application of heat induced pain to their knees compared to when the subjects were experiencing arthritis pain.

Their findings suggested that "arthritis pain was more strongly associated with fear and distress than other types of pain."

The study had a number of conclusions, but I will restrict my observations to only one of the study's findings:

"Expectations of decreased pain powerfully reduced both the subjective experience of pain and activation of pain-related brain regions."


Osteoarthritics often have a number of somatic health problems of psychophysiological origin. Those with osteoarthritic complaints reported fair to poor health about three times more than those without OA. They also suffered from insomnia, fibromyalgia, hypertension, and other comorbidites. Many experts in this field report no correlation between neurosis and osteoarthritis. "One searches the literature in vain for reports on on psychological aspects of this localized, degenerative form of joint disease" writes physician, W. Donald Ross in Psychosomatic Medicine, (p. 301). However, the cited case, probably of repetitive strain was one of localized OA and not the generalized form of the disease, which by definition would be more systemic.

There is, however, a more or less agreement that rheumatic forms of arthritis have a psychosomatic origin. See on this website, a Denver Primal Journal article, Marie: An Interview which recounts a cure of arthritis, possibly of the rheumatoid type.

Many who were in vehicular crashes with resultant moderate to severe injury, in later life, often suffer from severe forms of generalized OA. One wonders if both specific and generalized severe birth injuries can also predispose one to osteoarthritic changes in later life.

Indeed, expectations of decreased and of increased pain are all important as to the degree of suffering as well as even to the perception of pain itself, but what is the source of this expectation? Is it from the preceding painful arthritic episodes or from the unconscious memory of one's severely traumatic birth injuries. It is well known that, in some individuals, even with severe osteoarthritis ("bone on bone") can be relatively pain free while others may experience excruciating pain even though their x-rays reveal minimal pathology.

The difference may be because the fetally traumatized brain has a larger number of pain receptors than is typical. Those who had a relatively pain free birth and intrauterine experience may later have a relatively pain free osteoarthritic experience. However, it is possible that osteoarthritis, later in life, can be so painful, because, earlier in life, birth pain was so severe.

It is logical for the mind to associate arthritis pain with fear and distress than with other types of pain because we had been conditioned by fear and distress during our birth process or other severe illnesses in infancy or early childhood where much suffering was involved. The global response to the fear and dread of intrauterine and birth pain can become a predominant and prototypic imprint over any other response to a trauma of lesser severity.

The perception of pain when we were very young, especially inutero and at birth can lock us in a perceptive and interpretative mode which stays with us for the rest of our lives. At the time of the trauma there was a feeling of intense fear and distress which was part and parcel of that original suffering. Will a partial resolution of the prototypic traumas of our very beginnings alleviate the present day distress and sufferings of osteoarthritis?

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