Learning to live with chronic pain

There are currently 3.6 million Australians living with chronic pain. A statistic that is sobering. Pain is unpleasant and difficult to live with. During my early clinical experience in rehabilitation settings across Victoria, I discovered that most of my clients living with persistent pain had different experiences of pain.

By the time these people see a psychologist, they have often explored and exhausted many types of medical, surgical, and alternative interventions.

Commonly reported symptoms included frustration, fatigue, depression, anxiety, stress, sleep disturbance, difficulty in coping with daily life, relationships, work and doing the things they enjoy. These factors may not only be exacerbating pain, but can also interfere with pain treatment outcomes and recovery.

What is chronic pain?

Physical pain is usually protective. Danger detectors send information from our body to our brain to avert us from significant tissue damage. Many of us experience pain that is acute. This pain usually resolves within a normal period of healing. However, chronic pain can persist beyond the normal period of healing (for more than 3 months, or past the normal tissue healing time). Psychological factors are now recognised as risk factors for persistent pain. Stress, anxiety, and depression can make chronic pain worse.

How does chronic pain impact a person's life?

Most people who see a psychologist for pain management have developed chronic pain from an injury such as a workplace or sporting injury, a car accident or medical illness e.g., cancer pain, multiple sclerosis. Regardless of the origin of pain, for many people, chronic pain has long term negative impacts on a person's quality and enjoyment of life if left untreated.
People often report difficulties with substance use, opioid dependence, sleep problems and insomnia, social isolation, depressed mood, high anxiety/stress, loss of libido, relationship issues, occupational and performance issues, loss of enjoyment in meaningful activities. This list is certainly not exhaustive.

What is the role of a psychologist?

Health and clinical psychologists have training in the assessment and treatment of chronic pain and other medical illness. An assessment explores the biological, psychological, and social factors into why some people develop chronic pain and others do not.

Psychologists provide education about pain, formulate and communicate to affected people what psychological factors are contributing to pain, and subsequently treat these factors utilising evidence-based interventions. For example, psychologists identify maladaptive sleep habits, attitudes and beliefs about pain, stressors and poor environments that influence pain. We assist people to develop adaptive psychological and self-management skills to improve their pain and overall well-being.

Psychological treatment of pain

When it comes to treating chronic pain, cognitive behaviour therapy (CBT) is the most well-established and utilised psychological intervention in peer reviewed journals. Whilst it is considered the first line of treatment, Acceptance and Commitment Therapy (ACT) approaches are also considered effective in alleviating symptoms of pain and improving quality of life. ACT allows a willingness to have difficult experiences, particularly those of an emotional nature, and develop persistent flexibility in efforts toward behaviour change (Dahl & Lundgren, 2004).

ACT considered 4 psychological elements that contributes to pain:

1. Fusion with thoughts

What memories, worries, fears, self-criticisms or other unhelpful thoughts do you dwell on or get ‘caught up’ in that related to pain? What thoughts do you allow to hold you back or push you around or bring you down?

2. Struggling with Feelings

What emotions, feelings, urges, impulses, or sensations associated with pain do you fight with, avoid, suppress, try to get rid of, or otherwise struggle with?

3. Avoiding Challenging Situations

What situations, activities, people or places are you avoiding or staying away from because of pain? What have you quit, withdrawn from, dropped out of? What do you keep ‘putting off’ until later?

4. Life-draining Actions

What are you currently doing that makes your life worse in the long run; keeps you stuck; wastes your time or money; drains your energy; restricts your life; impacts negatively on your health, work or relationships; maintains or worsens the problems you are dealing with?

Two primary aspects of intervention are important:

1. Willingness to experience pain

As soon as danger messages have been perceived by the brain, the mind starts producing cognitions or “scripts” about the pain. These mindscripts include thoughts regarding the causes of pain and rules aimed at protection from further pain e.g., “A person with my pain cannot work” or “Any physical exertion might cause more pain”.

ACT techniques teach clients to defuse (unhook) from thoughts e.g., "It will hurt too much”, accept and be willing to face feelings, like fear about the pain, and incorporate mindfulness exercises such as formal meditation and informal practices.

2. Engaging in valued life activities even in the face of pain

Values illness develops when a person puts valued activities on hold in the service of reducing symptoms, in this case pain (Dahl & Lundgren, 2004). As pain occupies more and more of a person's time, other valued activities are neglected.

When this happens, a person suffering from chronic pain risks losing touch with what is meaningful to them, which can have an impact on their mood. Psychologists assist people to identify, establish value-directed goals, and encourage ways to reconnect with meaningful activities in the face of pain.

How can Myndful help you?

Our psychologists have expertise in pain management. We work with you and your healthcare team to provide high quality psychological assessment and treatment.