What is Chronic Pain?
Acute pain usually occurs following an injury or illness, and is a normal sensation which prompts us to behave in ways that will promote healing (i.e., by avoiding behaviours that make the pain worse). In this case, pain signals to us that something is wrong. Chronic pain, on the other hand, is persistent and can continue even after recovery from the initial injury or illness. Here, the brain and nervous system continue to create pain, even when there is no clear damage - it’s like a fire alarm that keeps going off when there is no fire in the building.
Psychological Factors Involved in Chronic Pain
It takes a lot of energy to cope with chronic pain. Pain is unpleasant; therefore, our natural reaction is to try to do anything we can to reduce our pain. This may include avoiding potential triggers of pain, trying not to think about the pain, avoiding talking about the pain, or suppressing memories associated with the pain. Alternatively, we may think about it constantly in an attempt to “solve” it! Not surprisingly, pain is also associated with a range of unpleasant emotions, such as frustration, anger, anxiety, or sadness.
In the short-term, avoidance of pain and associated stimuli may have a positive effect in reducing pain and suffering. However, in the longer term, it may have undesirable effects such as reduced pain tolerance, reduced physical fitness, and increased pain severity, not to mention psychological effects such as social isolation, depressed mood, anxiety, and reduced overall quality of life. Understandably, sleep disruption is also common among individuals with chronic pain.
Psychological Management of Chronic Pain
During my Master of Psychology (Clinical) training, I completed a 6-month clinical placement at a multidisciplinary outpatient pain management program. This program was run by an outstanding team of physiotherapists, psychologists, and nurses, who provided comprehensive education about medical and psychological aspects of pain, as well as a tailored exercise program for each participant to improve their overall level of physical activity. The psychological components of the program were based on traditional Cognitive Behaviour Therapy (CBT), which involves identifying unhelpful patterns of thinking and behaviour that are contributing to vicious cycles of emotion, and using specific strategies to change them (e.g., by challenging unhelpful thoughts or beliefs).
Recent research developments suggest that Acceptance and Commitment Therapy (ACT) is also an effective psychological treatment for chronic pain. The goal of ACT for chronic pain is to reduce the “struggle” with pain by increasing psychological flexibility (i.e., the capacity to behave in ways that are consistent with your goals and values, despite the presence of discomfort). ACT uses metaphors, mental exercises, and experiments to help you to change your attitude towards pain and other associated symptoms (e.g., depression, anxiety).
Similarly, mindfulness-based interventions such as Mindfulness Based Stress Reduction (MBSR) are also effective in improving some of the psychological components of chronic pain, including the experience of pain itself. However, MBSR and mindfulness meditation may not be suitable for everyone (see https://moveforbetterhealth.com.au/exercise-options/courses/mindfulness-based-stress-reduction-courses/). This highlights the importance of setting up a treatment program that is tailored to the individual patient’s unique set of symptoms and difficulties.
How can we help?
Together with our physiotherapy colleagues at Move for Better Health, we are ideally placed to help individuals to manage chronic pain and may be able to help you to decide which treatment approach is best for you. Call 8373 5655 for more information or to book an appointment with any of our health professionals.
References
Feliu-Soler, A., Montesinos, F., Gutierrez-Martinez, O., Scott, W., McCracken, L.M., & Luciano, J.V. (2018). Current status of acceptance and commitment therapy for chronic pain: A narrative review. Journal of Pain Research, 11, 2145-2159.
Hilton, L., Hempel, S., Ewing, B.A., Apaydin, E., Xenakis, L., Newberry, S., et al. (2017). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 51, 199-213.