How to Manage Chronic Pain with Mental Wellness

As a Psychotherapist who regularly works with chronic muscular-skeletal pain, I am accustomed to hearing questions like, “I am in pain, so why is my doctor recommending psychotherapy?” or “How is talking going to help with pain management?” Others seek therapy feeling devastated after being told by their doctor that they are going to have to “learn to live with” their pain. This often comes at the end of a long and frustrating treatment course, which may have involved physical and occupational therapy, numerous drug treatments, nerve blocks, and surgery. Additionally, the biomedical model of pain assumes a biological abnormality, but even if you treat that abnormality and do everything to help reduce pain, that does not always equate to feeling or functioning better. I would like to take some time here to explain why it is important to include psychological and social aspects to treatment.

Being in constant pain can interfere with your ability to engage in regular daily activities. It can affect your confidence, relationships, and your ability to work. Simply put - it can erode your quality of life. This can be distressing and anxiety-provoking, making you feel trapped and out of control of your body and life. Additionally, the physical stress that chronic pain places on your body can result in the stress response system of your body experiencing wear and tear. This can contribute to numerous symptoms including, gastrointestinal difficulties, sleep disturbance, fatigue, headaches, poor concentration, shortness of breath, increased muscle tension, anxiety and depression (Caudill, 2009).

Pain is defined as an “unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” (International Association for the Study of Pain, 2020). As this definition points out, tissue damage can be an antecedent to feeling pain, but this is not always the case. The connection between the mind and body is so intimate that pain is always a personal experience. Therefore, biological, psychological, and social factors can influence pain trajectory and onset, and pain can influence those domains as well (Raia et al., 2020). So, if you are feeling pain, perhaps you are feeling anxious, sad, hopeless, or angry. It is not in your best interest to deny these influences on your pain or to act as if nothing is wrong. If you deny the pain, push yourself to your limits, and regularly do things that increase your pain, this not only can make your condition worse, but also result in endless frustration. On the other hand, completely avoiding your pain by decreasing activity levels can lead to physical deconditioning and negative impacts on mood. Understanding and managing the thoughts, emotions and behaviours that accompany the discomfort can not only help you cope more effectively with your pain, but also help improve your functioning and well-being.

The goal of psychotherapy is to help you learn to relate to pain with less fear and more acceptance, to maintain a self-efficacious perspective, and learn strategies that enable you to adapt your activity to better manage your pain and symptoms while remaining active. Treatment is individualized to meet your unique needs and goals. It may include, but is not limited to, Cognitive Behavioural Therapy (CBT) and mindfulness-based and acceptance-based therapy interventions, including:  psychoeducation on the biopsychosocial model of pain, psychoeducation about the reciprocal role of activity avoidance in pain maintenance, teaching stress reduction and relaxation strategies, body awareness exercises, mindful attendance to nociception versus suffering and distress, activity planning and pacing, cognitive restructuring around pain, development of imagery for pain coping, and addressing depression and anxiety that may accompany your pain.

Below is a poem one of my clients wrote during therapy as they moved through various stages of grief to come to acceptance of their pain condition and worked toward readjustments and gaining confidence. Changing their perspective away from fear and toward curiosity and acceptance not only allowed them to manage their pain more effectively, but also freed them to pursue their artistic/creative projects as their energy returned. I am including this piece with their permission, and for the purpose of helping other patients as they embark on their journey of healing and recovery. (Any use or distribution of this piece of writing is strictly prohibited.)

Hello Pain,

I’m reluctant to call you my friend Though I am no longer to view you as enemy I am to accept you, as you To welcome your existence To not aggravate you, so you’re bewildered But to ease you here, and to remind you that you’re safe here

Pain, you’re here Because our body’s alerted And once the first alert goes off Then the hundredth, thousandth, millionth time, We become so exhausted from this alarm “Why?” we ask, “Make it stop!” we plead, But it’s just our faulty nervous system Not knowing what else to do I welcome you here I make peace with you Everyday I live with you So I’m done fighting you I’m done arguing with you I will accept you as you are And make you as muted, As blurred as possible As I no longer try to push you out Because you are here to stay Why not make ourselves at home? Hello Pain, Welcome.

If chronic pain is impacting your quality of life and preventing you from living an active and enjoyable life, therapists are here to help. Being told you have to learn to live with pain does not have to be the end; it should be the beginning.

References

1. Caudill, M. (2009). Managing pain before it manages you (3rd ed.). The Guilford press.

2. International Association for the Study of Pain (2020, July 16). IASP Announces Revised Definition of Pain. https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/

3. Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X. J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939

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