By Jennifer Johnston, PhD, DNM, NMD
Research is well established on the influence of emotions on perception of pain, pain treatment, catastrophizing, and speed of healing. The Institute of Medicine reports, “people’s experience of pain can be influenced by genes, cultural attitudes toward hardships, stress, depression, ability to understand health information, and other behavioral, cultural, and emotional factors. Successful treatment, management, and prevention of pain require an integrated approach that responds to all the factors that influence pain” (1).
Emotions of stress, joy, sadness, or even anxiety are all a natural part of life and are often felt physically. When preparing to step on the stage to give an important speech we may feel our anxiety as a physical sensation of knocking knees or even butterflies in the stomach. When meeting to go on a first date we may experience anxious feelings as a flutter in the chest, swirling feeling in the head, or nervous smile. Each of us may describe how we experience a situation differently, but most agree on how basic feelings are experienced in the body.
When emotions become excessive, suppressed, or turned inward they may begin to influence our overall physical function and how and where we perceive pain. Studies have established that emotions have distinct biological expressions that influence overall health. Additionally, emotions are responsible for prompting the body to prepare us to react to environmental challenges by communicating with the cardiovascular, skeletomuscular, neuroendocrine, and autonomic nervous system. For example, stress can both be the cause and influencing factor for a variety of physiological responses that can enhance health or promote disease (2). When we sense fear our flight or fight responses are activated and we feel that fear in the body. By taking a deeper look at how emotions correlate with the location of pain we may find a deeper understanding on why and how patients experience pain.
In 2014 researchers were able to identify locations of body sensations related to emotions using a topographical body mapping method. Results reveal consistent and distinct maps associated with basic emotions. Physical sensory information is known to trigger conscious emotional experiences. This study showed that different emotional states are associated with distinct and culturally universal body regions. These regions could aid in our understanding of how emotions correspond with pain locations in the body (See figure 1, below) (3).
Researchers ran five studies with a total of 701 participants and identified that different emotions were reliably associated with statistically identifiable bodily sensation. These maps were equal among both West European and East Asian samples. They propose that emotions are represented in the somatosensory system as culturally universal categorical somatotopic maps (3).
TCM: Emotions and Meridians
Traditional Chinese Medicine (TCM) views the body as a whole, with mind, body, and emotions as correlated factors influencing overall health and happiness. A TCM fundamental principle states that everything experienced on the outside of the body reflects the quality of health on the inside (4). Certain areas of the body are more vulnerable to injury due to potential underlying emotion, energy, or organ imbalance. Many individuals experience a physical event, such as a slip or fall, so why do some experience injury and others do not? Why do some individuals experience injuries to their knee, ankle, hip, low back, or wrist? Why is there so much variation in the potential for injury and the location of the injury?
Sports Medicine Journal reported that 1.5 million young men participate in football and an estimated 1.2 million football-related injuries are reported annually. Overall, 50% of all injuries were lower extremity injuries (with knee injuries accounting for up to 36%). Thirty percent of injuries occurred in the upper extremities. Overall, sprains and strains accounted for 40% of injuries, contusions 25%, fractures 10%, concussions 5%, and dislocations 15% (5).
Pain can result from an external source, such as an auto or sports injury that damages the meridians and physical structure, as well as from an internal condition, such as an organ or energy imbalance. It is often easier for the practitioner to identify and treat the cause when it is related to external visible factors. Pain related to internal or emotional conditions has a tendency to be more complex, and effective treatment requires a closer look to determine the root cause.
All emotions can influence the body’s response to external factors such as injuries and accidents. It is when emotions become out-of-balance, excessive, or repressed that overall health and pain responses are influenced. Excessive or repressed emotions are understood to contribute to organ imbalance thereby leaving the body more susceptible to physical damage, pain, and injury.
The reverse is also true. Individual organ health can similarly influence the experience of emotions and pain. The theory is that balancing the organ that is associated with the emotion results in a balancing of the associated emotion. Sometimes the organ is out of balance and produces the emotional imbalance or potential physical vulnerability for injury. The difference is important to the practitioner in identifying and reducing future recurrence of the symptom.
Meridians are a three-dimensional energy network in the body that make pathways that connect to each other and to every bone, tendon, tissue, organ, and skin cell. These intercommunication networks function within the entire physical and emotional framework. There are 12 major meridians that run through the body (4). The left and right sides of the body mirror each other, while the back and front are different. Each meridian corresponds to an internal organ along with the associated emotions and other similar energy frequencies. (See Figure 2, below).
Liver and Gallbladder. An individual experiencing feelings of anger, frustration, irritability, and stress may be suffering from a liver imbalance. Liver and gallbladder meridians are correlated with migraine headache, tendon and ligament problems, ankle and hip pain, menstrual cramps, and arthritis. When the liver becomes healthier, the associated physical pain and emotion will reduce or disappear. However, a persistent lifestyle situation that increases or continues feelings of stress and anger will cause the liver imbalance to continue, along with the associated pain (4).
Spleen and Stomach. The spleen and stomach are associated with feelings of worry and over-thinking. Imbalances in these meridians can result in excessive or easy bruising, muscle injuries, or pain conditions related to the torso, front of the legs, and feet. Pain felt in the big toe can be linked to digestive imbalances involving the liver and spleen, as both meridians end in the big toe (4).
Kidney and Bladder. The kidney and bladder are associated with the emotions of fear and anxiety and their meridians are further related to pain associated with the knee, heel, neck, low back, feet, and bones. In a case study involving kidney function and meridian location, a female reported sore knees after skiing season and a subsequent right knee injury resulting from skiing (6). In this case, the sore and injured knees are related to the activity of skiing but, why the knees and not the hips or ankles? TCM theory links the state of the individual’s kidney energy and function to the health and resilience of the knee area (4).
Lung and Large Intestine. The lung and large intestine are associated with the emotions of sadness, depression, and grief. Pain conditions correlated with these organs and their meridian locations include painful skin conditions and shoulder, elbow, and hand injuries (4).
Heart and Small Intestine. The heart and the small intestine are related to the emotions of joy and happiness and are further associated with pain experienced in the upper body, chest, shoulders, and hands.
For instance, a broken heart from a problematic relationship will eventually cause an organ function disorder if the emotion is not addressed and resolved. Joy is the heart’s corresponding emotion. When an individual loses the capacity to experience joy, the heart’s health can be negatively affected resulting in both physical and emotional pain (4).
Due to the complexity of pain and emotions, the diagnostic process should include many questions related to lifestyle, emotional wellbeing, and physical health to aid in identifying the root cause of the pain. Our job as practitioners is to help patients evaluate all contributing factors related to their pain condition, not just the physical. Once the key underlying cause is identified, then the imbalance can be addressed and the environment that created that imbalance can be changed.
Additionally, when considering emotional correlates to pain it is important to remember that cause and effect are not linear but circular. For example, after an auto accident we can say that the accident caused a neck injury, but why the neck location for that individual? The sore neck is the symptom of the effect of the auto accident which is the cause. But what set the stage for the injury in the first place?
Pain can be a complex symptom and the cause may not be so straightforward, which is especially true when dealing with emotional factors. Which preexisting emotional patterns or organ imbalances have contributed to the individual’s specific pain symptoms and locations? We have the opportunity as practitioners to identify underlying factors that contribute to pain in order to help patients relieve and/or reduce the manifestation of pain.
Finding the time to help our patients identify emotional and lifestyle factors related to pain symptoms can be challenging. It is also important to take the time to examine and identify how our own personal choices influence our physical and emotional experiences. Finding time to relax, take a nap, or have some much needed fun is always a good first step toward improved health and happiness.
Jennifer Johnston, PhD, NMD, MS, is a board-certified practitioner at Holistic Health Solutions, Inc. with more than 13 years’ experience in naturopathic and Traditional Chinese medicines. She has a master’s of science with studies in psychoneuroendocrinology and a doctorate in clinical nutrition. Dr. Johnston is part of TCM World Foundation’s advanced studies program and is certified to practice LifeForce: Tao of Medical Qigong, Dragon’s Way®, Menopause and Breast Health programs.
- Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011.
- Institute of Medicine (US) Committee on Health and Behavior: Research, Practice, and Policy. Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences. Washington, DC: National Academies Press (US); 2001.
- Nummenmaa L, Glerean E, Hari R, Hietanen JK. Proc Natl Acad Sci USA. 2014;111(2):646–651.
- Nan L, Schaplowsky E. Traditional Chinese Medicine: A Natural Guide to Weight Loss That Lasts. New York, NY; TCM World Foundation; 2000: 139-142, 159-161, 180, 200-203, 218-223.
- Saal JA. Common American football injuries. Sports Med. 1991;12(2):132-147.
- Nan L. Ask Dr. Lu: Volume One. New York, NY: TCM World Foundation; 2011: 97-99 & 121-122.
From The Pain Practitioner, Fall 2015 issue. Join the Academy to receive The Pain Practitioner.