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Chronic Pain

Jeannie Minchin

Clinical Psychologist, Psychotherapist
Perth, Western Australia

PAIN: "highly unpleasant physical sensation caused by illness or injury"1

Pain is subjective, is adaptive, and serves the function of telling us that we are injured or have an illness so that we can take notice and attend to it.

Chronic pain is pain that continues after the normal expected recovery time for that specific injury or illness. It is pain that has persisted for more than three months and is experienced on a daily basis.

Most people who injury themselves expect to experience some level of pain. So why do some people experience more pain than others with similar injuries or illnesses? Why do some people go on to develop chronic pain whilst others do not?

Studies have shown that there are a number of predictive psychosocial factors associated with chronic pain2&3 such as:

  • Individual's beliefs about their pain
  • Attribution of pain onset
  • Fear and harm avoidance
  • Self-efficacy
  • Psychological distress and depressive mood
  • Catastrophic thinking patterns
  • Somatisation (psychological distress manifesting in bodily symptoms)

How can psychology help people who experience chronic pain?

Experiencing chronic pain can affect individuals across many domains such as:

  • Physiological
    • Where the pain is felt as a highly unpleasant physical sensation in the body
  • Social
    • It may reduce your ability to participate physically in your regular activities such as employment, exercise and social engagements
  • Psychological
    • Depression
    • Anxiety
    • Anger
    • Sleep problems
    • Alcohol/drug dependency (including dependency on prescribed pain killers)
    • Self worth /self esteem
    • Motivation
    • Grief and loss. Grief for the person you were before and losses across many domains of functioning. Such losses include:
      • Employment - complete change of work or inability to work again
      • Career - expectations of a planned career path not realized
      • Financial instability
      • Housing and accommodation - loss of finances may affect your ability to pay your mortgage or rent, child support payments, car loan
      • Interpersonal relationships
      • Family and children
      • Intimacy
      • Social contacts / isolation

Seeing a psychologist may help you through the initial grief and loss period while you adjust to your new situation. You may feel that there is nothing you can do to stop the pain and just need to put up with it. You may feel helpless, resentful, angry, guilty, depressed, or fearful of doing things that may make your pain worse. By talking this through with a psychologist, they may be able to help you to identify unhelpful thought patterns and behaviours that maintain these feelings, and give you strategies to manage better in challenging situations.

Thoughts and Beliefs

Think of pain as messages that get sent up to the brain through a gate - the pain gate. Factors that can keep this gate open to receive these messages include catastrophic thinking (my life has fallen apart since my accident... this pain is never going to stop...I can't control it...this will never end...), helplessness (there's nothing I can do...), fear of the pain (I know this will hurt /make it worse /won't make it any better...) which leads to avoidance of physical activities, and potential social isolation.

Psychology can help you to take control over the pain gate and shut it. Learning strategies for coping with the pain, increasing motivation and self-efficacy, and acceptance. For example:

Unhelpful thoughts and beliefs
(keep the pain-gate open)
Helpful thoughts and beliefs
(shut the pain-gate)
"I can't cope with this pain" "I can cope, I know how to manage it"
"I can't walk it will make the pain worse" "Just because it hurts a bit, does not mean I'm doing more damage to it"
(hurt does not equal harm)
"This pain will never end" "I know that the pain comes and goes, I just need to use my strategies until the pain decreases again"

Understanding chronic pain, learning how to grade and pace your activity, and relaxation are all strategies that you may find useful.

Behaviours

Identification of "pain behaviours" such as grimacing in anticipation of pain, or favouring a limb because of anticipation of having it hurt, serve to maintain your pain narrative. Also, having a "helpful" friend who does your shopping for you, or comes over each day to bring your post in from the mailbox may seem like a helpful thing for them to do, but they could be enabling you to avoid everyday manageable activities that will increase mobilisation and encourage you to engage in your environment in a positive manner using behaviours that move you towards wellness.

So, in summary, psychology may help you to change the way you interact with and manage your pain so that you can move forward rather than feeling trapped.

If you would like to learn more, please contact Jeannie on 0406 033 644 or email jeannie@jeannieminchin.com.au

Jeannie Minchin
Clinical Psychologist, Psychotherapist

Mt Lawley Counselling Centre
13 Alvan Street
Mount Lawley, WA 6050

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References

  • Oxford University Press, 2015.
  • Pincus, T., Burton, K. & Field, A.P. (2002). A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. SPINE, 27(5) E109-E120.
  • Turk, D.C., & Okifuji, A. (2002). Psychological factors in chronic pain: evolution and revolution. Journal of Consulting and Clinical Psychology, 70(3), 678-690.


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