Pain is the most frequent reason people seek medical help and take medications. You should consult with your family physician if you develop any new pain problem, if you have had an ongoing pain problem, or if you experience any change with respect to the quality or intensity of the pain.

However, most people with a pain problem think only about medical consultation and medications. Most of us have become accustomed to look for external help only. We do not usually look inward to use our own resources to cope better and promote healing. Psychological treatments for pain educate people and empower them so that they can take control of their pain, whatever the cause, and help themselves cope better. This approach complements whatever medical approach their physician may have recommended. Psychological strategies can be especially helpful in dealing with chronic pain.

Acute vs. Chronic Pain

We are all familiar with acute pain. For example, the pain of a sprained ankle may be quite severe but over time, it fades and eventually disappears. Chronic pain, on the other hand, is a pain that persists. It may be due to a diagnosed illness such as arthritis or cancer. It may follow an injury, for example, chronic shoulder and neck pain after a whiplash injury or fall. Or it may occur without any clear cause.

Chronic pain can be divided into three categories:
(1) Periodic – pain that is intermittent, such as migraine headaches or arthritic flare-ups

(2) Intractable and benign – pain that is present most of the time although the intensity might vary, and which is not associated with cancer

(3) Progressive – pain that is associated with malignancies.

Subtypes of Pain

Pain is sometimes categorized as follows:

(1) Somatic Pain – this is pain believed to originate from the skin or deeper soft tissues including muscles and ligaments; for example, are soft-tissue injuries after a car accident resulting in back or neck pain

(2) Visceral Pain – this is pain believed to originate in internal areas of the body that are in a cavity, for example, cancer-related pain or pain due to a fracture

(3) Neuropathic Pain – this is pain believed to originate from damaged or irritated nerves, for example, diabetic-related leg pain or sciatica due to a herniated disc

For all of these types of pain, psychological treatment can be very helpful.

All Pain is Real

Every sensation, every thought, every feeling, and every experience occurs because of neurological and chemical activity in our brains and every reaction to those experiences changes the activity in our brains. Furthermore, everything going on in the brain affects the body and everything going on in the body affects the brain. The mind-body connection is a complex two-way street. This means that any pain we experience reflects activity in the brain and the body interacting. One cannot be separated from the other. This fact has now been accepted by most researchers in the field of pain.

It used to be thought that pain could be categorized as physical or psychological. Health care professionals used to label pain as “organic” or “functional”. Some still do. This approach implies a mind-body split that reflects a misunderstanding of the mind-body interaction that underlies all of our experiences.

Our medical tests, however sophisticated, are still imprecise and far from comprehensive. We cannot measure everything that occurs in the human body. A good example involves migraine headaches. If a person who has a full-blown migraine, undergoes medical tests including such as X-ray, CT scan and blood work, it is likely that the test results would all be negative. However, obviously the person suffering the migraine is experiencing real pain. Further, there must be physical factors which are causing the pain even though our medical tests are not yet sophisticated enough to detect and measure those factors. Negative medical tests can rule out serious illness or damage that might be causing the pain. As a result, it is important to consult with your family physician to investigate any new pain problem, or any change in an existing pain problem to rule out illness or damage. However, negative medical tests do not mean that the pain is “all in the head” or not real. It does not mean that the pain is purely psychological as no experience is purely psychological.

Psychological Treatment Can Help

The fact that psychological factors are always involved in our experiences means that we can change our experiences by altering our thoughts, emotions, and behaviour. For example, imagine that you stub your toe while you are on the way to the dentist for a root canal procedure. Now, imagine that you stub your toe in exactly the same way, but this time you are on your way to collect your lottery winnings. The injury is the same in both cases. However, your experience of pain will likely be dramatically different. In the first case, you would likely feel anxious and upset about having to go to the dentist for the root canal. You might be anticipating pain. When you stub your toe, you might feel angry and think, “Why does this have to happen now?” or perhaps you think self-critical thoughts such as “Why wasn’t I more careful? How could I be so clumsy?” In the second case, you would likely be feeling happy and anticipate the joy of receiving your winnings. You might be thinking happy thoughts about what you are planning to do with your winnings. When you stub your toe, you might feel irritated but you think, “Oh well. This isn’t important. I’m going to pick up my winnings!” Your thoughts about the lottery ticket would likely distract you from the pain of your stubbed toe.

In the same way, altering your thoughts, emotions, and behaviours can make a dramatic difference in the quality and intensity of the pain you experience, no matter what the underlying cause. People with pain due to illness, injury, or no known cause all benefit from learning to react to the pain in more constructive ways.

Types of Psychological Treatments for Pain Management

People are all different. The goal of all psychological treatment is to find the strategies and approaches that are most effective for you, as a unique individual. Many people with pain problems benefit from a combination of psychological treatment techniques. These include:

(1) Cognitive-Behavioural Interventions – help people identify and change negative self-statements, thoughts and interpretations about their pain
(2) Relaxation Procedures – help people learn to calm themselves physically and emotionally especially when the pain becomes challenging to manage
(3) Hypnosis – helps people alter their habitual often self-destructive thoughts and reactions to their pain, relax more emotionally and physically, and focus their attention elsewhere so that the pain fades more into the background of awareness
(4) Psychodynamic Interventions – help people become more aware of their emotional reactions and thoughts about themselves, their health and others and move toward accepting their feelings about their pain problem so that they can work with themselves to cope better rather than working against themselves
(5) Mindfulness Meditation Interventions – help people focus more on the here and now and establish a more gentle and compassionate way of viewing themselves and their pain problem

Many people with chronic pain unknowingly adopt self-destructive habits in response to their pain, which aggravate the problem. These habits may include becoming focused a lot of the time on the pain and on the body; worrying a lot and appraising the pain as extremely threatening and as catastrophic; avoiding activity and interactions with others due to the anticipation of pain; depressed thoughts and feelings about themselves and their pain; angry feelings and thoughts about their pain; self-criticism; poor sleep habits; changes in diet; abuse of medications and other drugs; and withdrawing from others. When people adopt such self-destructive habits, their pain problems may not respond effectively to other forms of treatment. This is the reason psychological treatment often becomes a priority. We do not automatically know how to cope with a chronic pain problem. Psychological treatment is educational and teaches people effective strategies that they can use to help themselves. By coping better, the quality, intensity, and frequency of a pain problem can often be reduced regardless of the cause.

Other Treatments

Most people with pain problems benefit from a multidisciplinary approach which involves medical treatment, including medications, psychological treatment and rehabilitative treatments including physiotherapy, occupational therapy, and kinesiological or other exercise-related interventions.

Call for a free telephone consultation or to arrange an appointment.

For further information:

1. Chronic Pain Association of Canada: www.chronicpaincanada.com
2. Canadian Pain Coalition: www.canadianpaincoalition.ca
3. The Canadian Pain Society: www.canadianpainsociety.ca
4. Chronic Pain Information Page: National Institute of Neurological Disorders and Stroke:
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm
5. American Chronic Pain Association: www.theacpa.org
6. American Pain Society: www.ampainsoc.org

Thoughts? Questions? Do you have experiences with pain that you wish to share with others? Please respond below.