*2.2.2 Psychological effect on pain*

Psychological factors are the major players in how the patient perceive the pain. Factors such as initial awareness, emotional status, interpretation and processing of pain and coping strategy play an important role in the perception of the pain [15]. Research on the effect of psychology and mental state by S.J. Linton and W.S. Shaw defines that initial detection of pain plays a crucial role in building up the psychological effects of it [16]. It is noted that pain needs attention and it is mostly under our conscious control. If the pain is deemed a threat, the autonomous nervous system kicks in, and also for later stages the object is likely to be avoided. Emotional state and interpretation can play a major role in sensitization and interpretation of pain [16]. Pain behaviour can be linked to how the person interprets the pain while suffering from it like verbal or non-verbal action and also after suffering from pain like the patient may start avoiding the source of stimuli as it generates the fear response. Negative thoughts about life such as anxiety, depression and fear can negatively affect the perception of pain and this may consequence in not only increasing the intensity but also prolonging the pain. Studies such as in S.J. Linton and W.S. Shaw in 2011 have shown 52% of people suffer from such a negative emotional state during pain [16]. Patients with imminent fear of the future also fall in this category and this all consequences in poor rehabilitation of the patient [15]. The next stage comes to coping with the pain, it has been seen that painful stimuli trigger the flight response with epinephrine released that can greatly affect the sensation of pain [15, 16]. It can be inferred by this that in both cases, the sensation seems to be more tolerable as the person either avoids pain or confronts the source. The other method that seems to work is having a relaxed state of mind. Effects such as phantom limb pain are still considered to be a psychological phenomenon [17, 18]. Even though the limb does not exist, the pain is still perceived. In all, pain is greatly affected by the mental state of the person, but it has to be well understood and more studied.
