Chronic Pain

Pain makes us human. Because of pain, we can receive warnings that trigger the reflexes to escape potential danger. But what happens when pain is continuous? How do we respond to a signal when it interferes with the other elements that make us human?

Pain that lasts longer than six months is considered chronic, and it may not go away. With chronic pain, the ongoing pain signal gets your nervous system wound up and increases its reactivity to incoming pain messages. This is distressing and anxiety-provoking. Additionally, the feelings of frustration or sadness when pain doesn’t go away can make pain worse.

What’s the link between emotion and my perception of pain?

Pain, depression, and anxiety travel through similar pathways along your nervous system and share many of the same biological mechanisms. One of the areas in the brain that receives pain signals — specifically, the limbic region — shares many of the same messengers as the mood signals. Research studies using neuroimaging show that the parts of the brain controlling emotion and sensory features of pain are altered in people with chronic pain.

The connection between pain and emotion can also be seen with certain classes of medications. For example, some medications used to treat pain can cause side effects like euphoria, and medications originally developed for psychiatric conditions can be effective treatments for certain types of pain.

The medical community has come to appreciate a direct correlation between improvement in one’s emotional well-being and their experience of pain (and vice versa). Chronic pain increases the risk of depression and anxiety, and depression and anxiety strongly predict the development of chronic pain. This association is seen in conditions like fibromyalgia and irritable bowel syndrome, where behavioural and psychological treatment strategies have shown benefit in reducing symptoms.

What can a psychologist help me address?

• Pain catastrophising: This is when you magnify the negative effects of pain and focus on feelings of helplessness while ruminating about the presence of pain in your life. Negative thoughts and beliefs about pain often lead to worsened emotional and social functioning and a decreased response to medical interventions for pain.
• Fear of pain: Concern or worry about an injury drives avoidant or protective behaviours. The anticipation of an increased sensation of pain may limit you from engaging in physical activity or attending social outings. Pain-avoidant behaviours can lead to physical deconditioning and further decreased quality of life.
• Pain acceptance: This is a challenging, but highly effective technique focused on developing an accepting attitude towards the pain. It involves doing your best to nonjudgmentally acknowledge the presence of pain and minimise unhelpful thoughts and behaviours that won’t make pain better.
• Trauma: The link between prior trauma and chronic pain is becoming better understood. Psychological therapies can address ongoing physical and emotional stress responses linked to traumatic experiences.

What type of psychological therapies help with chronic pain?

There are multiple psychotherapeutic treatment options commonly used to help people manage chronic pain. Practicing meditation and becoming as active as possible have been shown to be effective methods that can be done on your own. In my practice, I use CBT and EMDR, which have been shown to be effective in treating chronic pain. 

Cognitive Behavioural Therapy- (CBT) 

CBT helps to change your thoughts and behaviours related to pain and improve coping strategies. Chronic pain is a rare condition with the ability to disrupt ALL levels of functioning. Beyond the unpleasant experience of pain itself, consider some of the ways that chronic pain affects our human needs:

• Pain limits our ability to maintain our family roles as breadwinners, parents, and spouses. Guilt is a common experience among patients with chronic pain when they feel inadequate as parents or romantic partners.
• Pain increases our dependence on others. Over time, many patients with chronic pain come to feel like burdens.
• Pain creates uncertainty about the future, upsetting financial stability and future goals. Anxiety and fear are the most common emotional responses to chronic pain.
• Pain harms relationships with family, friends, and work. Patients with chronic pain frequently become isolated and disconnected from others.
• Pain often steals sources of happiness, contribution, and achievement as a patient’s ability to engage in hobbies, work, and recreational activities is reduced.

The result is that chronic pain adds many sources of stress—while simultaneously subtracting many of our sources of reward and meaning.

Because chronic pain includes a medical side and a psychological side, you can benefit from including a psychologist as part of your treatment. This is absolutely not because the pain is “in your head.” Psychology treatments are potentially useful for every patient with chronic pain. This is because pain psychology aims to help each individual address the ways in which their pain condition is interfering with their ability to fulfil their human needs, using many different treatment approaches to restore relationships and improve function, meaning, contribution, and sources of personal growth.

For clients coping with chronic pain, treatment plans are designed are very much tailored to the individual. The plan often involves relaxation techniques, changing old beliefs about pain, building new coping skills and addressing any anxiety or depression that may accompany your pain.

Eye Movement Desensitisation and Reprocessing (EMDR)

EMDR has proven to be an effective form of treatment for patients with post-traumatic stress disorder. It was discovered that many patients who also had chronic pain complaints along side trauma had fewer complaints following EMDR. 

Normally, pain is a signal that something is going wrong in the body. Sometimes the cause of the pain is gone, but the pain remains, or the pain is worse than the nature of the injury would lead you to expect. We experience pain with our brains, where several brain areas work together in a network. It has been shown that intense, threatening and chronic pain cause changes in the nervous system. In chronic pain patients, some brain areas become hypersensitive or overly active, while activity in other areas decreases. Scientific research has shown that EMDR normalises brain activity in post-traumatic stress disorder. EMDR also influences brain patterns in certain types of chronic pain. EMDR can be particularly effective if the pain is a result of a traumatic incident but can also be helpful in allowing clients to find ways to control pain resulting from non traumatic causes. 

How can I help?

As a practitioner of both CBT and EMDR we can work together to ascertain which approach (possibly both) may be most beneficial for your condition and your type of pain. I can help you develop new ways to cope with, think about your pain and even in some cases come to terms with it. This can lead to a reduction in individuals reported pain. The goal is to help you develop skills to cope with your pain and live a full life.