Psychology of Pain

Adjustment to Chronic Pain

One of the most difficult aspects of chronic pain is how it can impact on people’s sense of identity. It interferes with their work, leisure, domestic life and aspirations. It affects people the way a bereavement does in that the person they were before the pain is in some way gone. Like with any bereavement, people with chronic pain need to have a period of adjustment where they accept that the pain is there to stay. Many people can find this difficult, as they want to return to how they were before and accepting the pain can feel like “giving up”.

However, trying to get back to the person they were before can make it more difficult for people to manage their pain and they get caught in negative cycles. One example of this is where people try to maintain a high level of activity that they used to be able to do and so push too hard until they have a flare-up. The result of this is that rather than feeling better about themselves, they end up feeling worse and even further away from the person they were before the pain.

Like with all adjustment, how long and difficult it is will be different for each person. It can help if people feel that everything that can reasonably be done medically has been tried and they are satisfied with their diagnosis. Sometimes people can feel they need help to adjust, and may see a Psychologist or Counsellor to support them in this. One thing that often worries people is that if the pain is not going to go away, how can they live their lives. This is where pain management strategies can be helpful. These are ways of helping minimise the pain’s impact on someone’s life, rather than taking the pain away.

Pain Management

There are a lot of different strategies that can help manage pain in addition to medication, and below is an overview of some of them. Though they are presented as different strategies, the most effective approach combines elements of all of them.

1. Psychological approaches

It can often be helpful to explore patterns of behaviour and thinking that make it difficult to manage pain, and try and identify how to break these cycles. These unhelpful patterns often stem from people’s beliefs and sense of identity from before the change that pain has brought about, and by understanding and changing these patterns can help in the process of adjustment.

Another approach involves the link between pain and stress (or anxiety/fear). Because greater stress tends to mean people can experience more pain, often they can get locked in a cycle of increasing stress, that increases pain, that then increases stress and so on. Therefore learning ways of managing and reducing stress, people can help reduce the amount of pain they experience. This often involves using a range of relaxation techniques – and importantly building in the time to use them.

2. Physical conditioning

Because people with chronic pain can often begin to avoid doing exercise, they can become deconditioned and progressively find it harder to do physical activities. Therefore, a graded, structured exercise programme that gradually improves physical activity levels and helps people overcome fear of movement can greatly benefit people with chronic pain. They may not be able to return to the same activity levels as before (or in the same way) but will still be able to do more physically.

3. Pacing

One common feature of chronic pain is falling into a boom and bust cycle. This is where people can have a good day and push themselves to do a lot (hoping to get it in before the pain starts), but this then brings on a flare-up which means this is followed by a period of low activity.

Pacing aims to balance out these extremes, and has several components. The first involves focussing on breaking up activities (for example by either taking a rest or doing something else for a bit) in a planned way to avoid pushing too far. The second main component is reducing the highs and lows of activity, typically trying to do less on a good day, and a bit more on a bad day.

There are many other components that people can look at when trying to manage their pain – for example setting goals in a structured way, being more assertive and looking at how they are trying to balance their life. If you are interested in these techniques, it might be worth speaking to your G.P. about whether there are Pain Management teams near you. These can either be run on an individual one to one basis or through groups (often called Pain Management Programmes).

Dr Christopher Cutler, Clinical Psychologist
Michelle Morgan, Occupational Therapist