Pain Psychology: Treatment For Chronic Pain
Chronic pain can significantly impact the daily lives and well-being of people worldwide. This complex symptom can persist for months to years, pushing far beyond the typical course of an acute illness or injury. Exploring the intricacies of chronic pain and how pain psychology can offer relief and improve quality of life may help you or a loved one move forward and have hope alongside chronic pain.
What is pain psychology?
Pain psychology is a psychological approach that helps people cope with the thoughts, feelings, and behaviors associated with chronic pain, recognizing that everyone experiences pain differently and that a person's perspective is an important part of their pain experience.
Healthcare professionals can treat chronic pain effectively with care rooted in pain psychology. Research suggests that by reducing rumination, people with chronic pain can reduce pain intensity, as well as symptoms of depression and anxiety.
How chronic pain affects the body and mind
Chronic pain is not only a physical experience. This symptom may take a toll on mental and emotional health. Persistent pain can lead to feelings of anger, frustration, and helplessness, affecting the individual and their loved ones.
The physical stress response and pain
Physical pain activates the body's sympathetic nervous system (SNS), otherwise known as the fight-or-flight response. This affects how the body functions, temporarily increasing heart rate, blood pressure, and other physiological responses. Since chronic pain affects how the body functions, it may be associated with high blood pressure and other health issues over time.
Muscle tension, spasms, and pain flares
When the sympathetic nervous system is activated, by stressful situations or perceived danger, it can trigger muscle tension, muscle spasms, and pain flares. Understanding this connection helps explain why relaxation techniques are used in pain treatment and management.
Emotional and psychological factors in chronic pain
Chronic pain, by definition, lasts longer than six months and significantly impacts daily life. While doctors can address the physical aspects of chronic pain, psychologists are uniquely equipped to help individuals manage the mental and emotional challenges associated with this condition.
How emotions influence pain intensity
Pain can be seen as a subjective experience, so your emotional state may influence your pain experience. Positive emotions may reduce the perception of pain, while negative emotions may heighten it. A perceived stressful event, such as moving to a new city, may therefore make you more susceptible to pain. Since pain and emotions are closely connected, ongoing pain may lead to emotional factors like fear, stress, and sadness, which in turn can make pain feel more intense.
Chronic pain and mental health problems
People with chronic pain may be more likely to develop mental health conditions such as depression and anxiety, as well as physical health problems like heart disease. For those experiencing depression, symptoms such as fatigue and poor sleep may also increase pain sensitivity.
Pain is a common reason people visit doctors, yet alleviating it is not always easy. According to a Centers for Disease Control (CDC) report from a 2021 National Health Interview Survey, over 51 million adults are living with chronic pain. This significant figure represents 20.9% of the US population, amounting to more than one in five Americans.
Chronic pain serves as a complex signal that involves biological, psychological, and emotional components. Unlike acute pain, which alerts individuals to immediate harm, chronic pain often leads to feelings of anger, hopelessness, sadness, and anxiety. Effective treatment often aims to address both the physical and psychological dimensions of pain.
Cognitive patterns that shape the pain experience
From your emotional state to your core beliefs or your current environment, various factors affect your current pain experience. The way you think about pain can directly affect how intense or manageable it feels.
Changing unhelpful beliefs to reduce the pain experience
Cognitive patterns are shaped by various things, from your core values to the environment you’re currently in. Cognitive patterns like attention, expectations, and beliefs may directly influence your pain experience. If, for example, you are playing a contact sport, you may direct your attention on the activity, rather than the pain. This highlights the brain's ability to prioritize certain sensations at a given time. For this reason, pain psychologists help people identify areas where thoughts amplify pain and practice skills for changing unhelpful beliefs to manage the pain experience.
What to expect from pain psychology treatment
Psychological treatment plans are personalized, often including relaxation techniques, changing negative beliefs about pain, building new coping skills, and addressing any anxiety or depression linked to the pain. Pain psychologists can teach you to challenge unhelpful thoughts about pain and develop new perspectives.
The length of treatment
The length of treatment depends on various factors, such as your level of pain and whether you are experiencing other mental health issues. Most patients attend 3-12 short, focused sessions in the initial weeks to learn relaxation techniques and life-related coping strategies. Within just a few sessions, patients find ways to cope with pain, but longer course plans can provide additional benefit and reinforce progress over time.
Long-term benefit and patient outcomes
Studies have shown that some psychological treatments can be as effective as surgery in altering how the brain processes pain sensations. Additionally, psychologists may help you make lifestyle changes to stay active in work and recreational activities and address sleep issues that often accompany chronic pain.
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Types of pain psychology therapies for pain relief
Just as chronic pain can affect each individual differently, there are different psychological treatment methods available. Exploring different types of pain psychology may help you find a method that suits your unique needs. Below are a few types of pain psychology therapy methods.
Cognitive-behavioral therapy (CBT)
CBT focuses on changing thought patterns that contribute to emotional distress and chronic pain. CBT may guide clients in understanding how their perceptions influence their feelings and behaviors. By altering these thought patterns, individuals may reduce depression and anxiety symptoms often associated with chronic pain. Research indicates CBT can improve mood and functional status and decrease pain levels.
Acceptance and commitment therapy (ACT)
ACT teaches individuals to accept aspects of their pain that they cannot change while committing to actions that align with their values. This dual approach may help people live meaningful lives despite chronic pain. Studies have shown that ACT can lead to greater acceptance of pain, improved physical functioning, and lower levels of depression and anxiety.
Chronic pain self-management
Pain management involves a combination of methods proven to help individuals manage pain more effectively. Approaches might include CBT, ACT, relaxation training, stress management, and activity pacing. These techniques may empower individuals to take control of their pain and improve their quality of life.
Group therapy for managing health and chronic pain
Group therapy offers a supportive environment where individuals can learn and discuss effective pain management strategies. Programs like the PRISM (Pain Rehabilitation through Improved Self-Management) program at Missouri Baptist Medical Center provide weekly sessions led by pain psychologists, yoga therapists, and mindfulness training providers. Group discussions may also provide a sense of community and common understanding. Topics covered can include
- Theories of chronic pain
- Relaxation strategies
- Stress management
- Activity pacing
- Cognitive behavioral therapy (CBT)
- Acceptance and commitment therapy (ACT)
Clinical hypnosis for pain relief
Hypnosis uses techniques to induce a natural, altered state of consciousness called a “trance.” In this state, the conscious mind is relaxed, allowing the subconscious mind to reach hidden resources and abilities. This process enhances suggestibility, heightens senses, increases mental absorption, and activates controlled imagination for insight and solution-focused skills.
Hypnosis may only be effective when the participant is willing, requiring collaboration between therapist and client. The process does not induce sleep or unconsciousness but a state of relaxation. Individuals in trance remain aware of their surroundings and can recall the session. Some professionals may view all types of hypnosis as self-hypnosis, meaning the individual controls the trance state and can end it at any time.
Skills learned in pain psychology treatment
Pain can be an unavoidable part of everyday life, but in pain psychology sessions you can learn strategies to cope in real-life situations. Some skills you may learn include:
- Deep breathing exercises: Focusing on the breathing can help with acute pain, slow the heart rate, and reduce body tension.
- Acceptance: Learning to accept pain without fighting it can reduce extra pain caused by resistance and rumination.
- Behavioral activation: Engaging in activities that promote joy, such as a sport you love, rather than avoiding activities because you’re in pain.
- Progressive muscle relaxation: Moving your attention down the body, gently relaxing each area, and improving overall body-awareness.
- Activity pacing: Balancing activity with rest to avoid flare ups and enjoy activities without overdoing it.
Coping strategies for daily life with pain
The American Psychological Association (APA) offers additional tips and information on coping with the effects of chronic pain, including the following.
Manage your stress
Emotional and physical pain are closely linked, and chronic pain can increase stress levels. Managing stress through healthy practices like nutritious eating, adequate sleep, and approved physical activity may improve your ability to cope with chronic pain.
Talk to yourself constructively
Positive thinking can be a powerful tool in pain management. Focus on your progress, no matter how “small” it may seem. Remind yourself that you are working toward managing your pain and living a productive life.
Become active and engaged
Distracting yourself from pain by participating in enjoyable activities may highlight the positive aspects of your life. Engaging in hobbies or pastimes may help you combat feelings of isolation and foster a positive outlook.
Accommodate yourself
If aspects of your life worsen your chronic pain, consider seeking accommodations for daily life that reduce the pain. For example, you might try using a cane when you go out, sorting your laundry in buckets instead of folding it, working in a soft-backed chair with a TV tray, keeping healthy snacks in a cart near your bed, and using tools like pain patches, joint braces, and cooling packs.
Alongside treating chronic pain with a doctor’s support and guidance, find out what works for you and advocate for yourself, even if others do not understand why you are acting differently or unable to do activities in the same way you may have been able to in the past.
Working with a multidisciplinary pain team
A multidisciplinary approach to pain management involves a team of healthcare professionals who work together to help you manage pain in different ways. A physical therapist may help you build strength and move more comfortably, while a therapist may help you change thought patterns that can make pain feel harder to manage. A multidisciplinary team may consist of:
- Surgeons
- Physical therapists
- Dieticians
- Therapists
- Social workers
- Pharmacists
- Neurologists
- Nurses and case managers
Find support for pain management and side effects of chronic pain
Dealing with chronic pain can be challenging, especially if you have a sense that you’re alone. Seek support groups online or in your community to connect with others who understand your experiences. Discussing your highs and lows with others may reduce the emotional burden of chronic pain.
Getting support through BetterHelp for chronic pain
If chronic pain continues to overwhelm you and disrupts your daily routine, you might consider talking to a mental health professional. Psychologists may help you address the physical and psychological effects of chronic pain, providing strategies and support to improve your quality of life.
How online therapy supports people living with pain
Mobility issues and challenging symptoms can make it difficult to attend in-person therapy sessions. Online therapy through a platform like BetterHelp may be more available for individuals with chronic pain, as it offers flexibility and the ability to attend therapy from home. Being able to schedule sessions around pain flares, low-energy days, and life-related challenges can make relieving chronic pain easier on a long-term basis.
Additionally, online therapy offers a broader range of providers, allowing you to find a therapist that meets your specific needs more efficiently. Someone living with chronic pain may find it easier to connect with a provider who is familiar with their symptoms. Studies show that the ability to stay home for therapy makes it easier for clients to receive consistent support.
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Takeaway
By incorporating relaxation training, cognitive-behavioral therapy with a therapist, acceptance and commitment therapy, and other psychological approaches, individuals may find effective ways to manage their pain and lead fulfilling lives. If you want support coping with the mental impacts of pain, consider reaching out to a therapist online or in your area for support.
What kind of pain management plan is best for chronic pain?
An individual’s plan for pain management will vary based on their condition, comorbidities, symptoms, and external circumstances. However, many plans include:
- Physical therapy, often in short courses that patients continue at home
- Occupational therapy
- Over-the-counter and prescription medications
- Medical procedures
- Strategies to reduce stress, one of the most frequent aggravators of pain
The field of pain medicine also offers the opportunity to meet with pain management specialists who can provide additional guidance on which treatment options could be best given your specific life variables.
Why is chronic pain management important?
Research shows that long-term pain can rewire the central nervous system that causes a hypersensitivity to pain in a process called central sensitization. When pain goes undertreated or untreated, there is a greater risk of sensitization, which makes the body react more frequently and strongly to potential pain. Other sensations can become painful, too. Over time, this can become a self-perpetuating cycle that makes pain worse overall. Central sensitization can occur in a variety of pain disorders, including:
- Chronic musculoskeletal pain, such as that related to an old injury
- Migraines
- Chronic back pain related to sciatica or biomechanical imbalances
- Diabetic neuropathy
- Rheumatoid arthritis and other inflammatory disorders that cause joint pain
Undertreated chronic pain can also get in the way of one’s ability to live and enjoy life the way they want to. Someone with lower back pain, for instance, may struggle to work, care for dependents, participate in hobbies, or socialize. Improving quality of life is one of the primary goals of chronic pain management.
How do people cope with chronic pain?
In conjunction with medical management, people can address chronic pain in a variety of ways. Introducing or gradually increasing exercise—which releases natural pain-killing neurotransmitters called endorphins—can improve both pain levels and other symptoms, such as trouble sleeping or paying attention. Some forms of alternative medicine, such as acupuncture, also show promise. Some individuals try to find meaning or purpose in their experiences—such individuals might enroll in clinical trials to test new treatments or start campaigns to raise awareness and resources for treating their condition.
What does psychology say about pain?
Psychology recognizes pain as a subjective experience that is influenced by social, psychological, and biological factors, such as lack of sleep (can make you more sensitive to pain), age, or beliefs about pain expression and tolerance.
Can pain be caused or worsened by psychological factors?
Yes, pain can feel more intense if you’re experiencing depression or anxiety, are having trouble sleeping, going through a stressful period, or ruminating on pain or worst case scenarios. These factors can make the nervous system more sensitive to pain.
How do emotions and stress affect chronic pain?
Emotions such as stress activate the body's sympathetic nervous system – the fight-or-flight response – leading to nervous system sensitization, muscle tension, and inflammation.
What are the 4 pillars of chronic pain management?
The four pillars of chronic pain management are pain (recognizing pain and its impact), purpose (finding meaning despite pain), pacing (balancing activity with rest), and positivity (fostering resilience).
How do I mentally cope with chronic pain day to day?
Some skills and coping strategies you can use to cope with pain include mindfulness and relaxation techniques, talking to yourself constructively, balancing activity with rest, engaging in activities you enjoy, and working with a multidisciplinary pain team.
How long does pain psychology treatment usually take?
Pain treatment can take anywhere from weeks to years, depending on how intense your pain is, your age, any underlying mental and physical health conditions. However, people may see improvements and learn effective coping strategies within 3 - 12 therapy sessions.
How do I know if pain psychology could help me?
Pain psychology may be beneficial if your pain is affecting your mood, daily routines, relationships, sleep, or overall quality of life. If you’re avoiding activities that bring you joy and over-the-counter medications are not helping enough, professional support may be worthwhile.
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