One of the first questions I usually get when I meet with a patient suffering from chronic pain for the first time is, “Why am I here?”
Certainly, a fair question given the fact that most pain conditions can be treated medically with interventions meant to reduce pain and promote healing. Yes, you’ll experience some disruptions in your life, but the pain is meant to protect you from inflicting more damage to your injured body part. In short, your body sustains tissue damage, your brain registers it as pain, and then initiates the protective and healing process – sometimes with the help of modern medicine. But what happens when the pain doesn’t go away?
Before we answer that question, let’s set the stage by defining pain. Pain is defined as:
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (Gorczyca, Filip, & Walczak, 2013).
As you just read, the definition of pain includes the emotional experience that often accompanies pain. Chronic pain is recognized as pain that persists past the normal healing time, usually lasting or recurring for more than 3 to 6 months (Treede, 2015). While acute pain is adaptive in that it serves as an important warning signal, chronic pain does not serve the same function.
When pain persists beyond the expected healing time, treatment providers consider other factors that contribute to the experience of pain. A purely biomedical approach to treatment shifts to a biopsychosocial approach. Biopsychosocial is exactly what it sounds like (almost), psychological and social components are considered in addition to the biological aspects of pain, better known as identifiable tissue damage. The biopsychosocial approach views “pain as a dynamic interaction among and within the biological, psychological, and social factors unique to each individual” (Gatchel & Howard, 2021). Psychologically, pain can be experienced as suffering, through the experience of grief and fear of pain, for example. Socially, pain can be experienced as social withdrawal and lack of support. These psychosocial variables contribute to the overall experience of pain. While the equation varies from person to person, the experience of chronic pain can be influenced by a number of factors that can be explored, and possibly explained using the biopsychosocial model.
While a full overview of the biopsychosocial aspects of chronic pain is well beyond the scope of this blog post, there are several common concerns that I’ve heard from patients over years. These concerns typically come in the form of statements made by providers/family/friends or the beliefs and values that patients have. The primary objective of this blog post is to address these concerns to introduce transparency into the treatment options available. Below are just a few of these concerns.
“Your pain should have gone away by now.”
Yes, by all accounts, you shouldn’t be in pain anymore. You’ve undergone numerous treatments and have allowed enough time to pass but you’re still in pain. Perhaps the psychosocial variables described above have not been considered. As the pain persists, the more guarded your body becomes. This can result in muscle deconditioning, disability, negative thought patterns, and fear of pain or reinjury. These variables serve to maintain current behaviors and beliefs that amplify the pain—mood cycle.
“Your pain isn’t real.”
Your pain is real. Chronic pain is an extremely complex condition which elicits varied responses and experiences. Because of this, an approach that includes a combination of different treatments can address the differences in the ways that pain is experienced.
“Just push through the pain.”
Here’s the thing about pushing through the pain – it’s considered by most as admirable and praiseworthy. This belief that “no pain, no gain” is ingrained into society’s definition of hard work and anything less means that we’re not trying hard enough. This might be useful if you’re training for a marathon or trying to lose a few pounds so you don’t have to buy a new wardrobe (a little self-disclosure there), but chronic pain does not respond as well to this philosophy. Honoring your limits can be one of the most difficult aspects of pain, however, learning how to identify and accommodate for physical and emotional limitations can go a long way in expanding your limits. The more you stretch yourself beyond your limits, the more boxed in you’ll be.
“Accept your life in pain.”
In my experience, acceptance is considered a bad word in the chronic pain world. Trust me, I learned this the hard way in my younger years. When the topic of acceptance is broached, the general response is: “I do not accept that I will be in pain for the rest of my life.” Acceptance does not mean that pain and disability will be ever present, just present. Accepting that there are certain limitations right now can allow you to honor your limits and maintain a certain level of control over your pain.
“Medication is the only effective treatment available.”
Medication certainly has a valuable place your repertoire of pain management tools. The goal of psychological treatment of chronic pain is not to eliminate the use of medication, rather it is to provide additional tools in your tool bag. Ideally, you’ll be equipped with active and passive coping mechanisms. Active coping mechanisms are considered those that things that you can do for yourself to cope – solving problems, seeking information, seeking social support, changing the environment, and engaging in pain reduction activities (relaxation, meditation, etc.). Taking medication, getting massages or chiropractic adjustments are examples of passive coping mechanisms. Don’t let the word passive color your perception, passive coping mechanisms can be just as important as active coping mechanisms and the two can be used together.
Because pain is typically viewed as a purely physical sensation, referral to a psychologist without adequate explanation can leave the patient feeling confused, frustrated, and even insulted. The message that appears to be loud and clear is that the pain is somehow manufactured by the patient. Psychosocial factors certainly influence the ways in which we respond to and experience pain. Psychological treatment aims to increase the patient’s awareness and understanding of these factors while teaching methods of reducing their impact on pain and disability.
References:
Bruns, D. (n.d.). Managing Chronic Pain: How Psychologists Can Help With Pain Management. https://www.apa.org/topics/pain/management
Gatchel, R.J. & Howard, K.J. (2021, March 9). The Biopsychosocial Approach. Practical Pain Management. https://www.practicalpainmanagement.com/treatments/psychological/biopsychosocial-approach
Gorczyca R, Filip R, Walczak E. Psychological aspects of pain. Ann Agric Environ Med. 2013;Spec no. 1:23-7. PMID: 25000837.
Quintner, J.L., Cohen, M.L., Buchanan, D., Katz, J.D., Williamson, O.D. (2008). Pain Medicine and Its Models: Helping or Hindering? Pain Medicine, 9(7), 824-834.