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Psychology and Pain

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Managing Pain

Psychology and Pain

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All the following points are psychological factors which can make the pain seem much worse.  A psychologist can help with all these aspects which can help bring the pain under control.

This does not mean that your pain is all in the mind.

Cognitions – thoughts, not only about pain, but our ability to cope with it are important

Distraction – can be helpful in some instances

Coping – ways of dealing with day to day life. Some coping strategies can be helpful, others less so. What’s important is finding out what works best for you.

Fear and distress

Social factors, how others respond to your pain

Catastrophising is a common response to pain and can lead to a vicious cycle:

Catastrophising

There are three aspects of catastrophising:

Rumination – thinking about the pain, worrying about it, followed by helplessness – what to do about it, ending in magnification – whereby the pain ends up feeling so much worse – so you ruminate and feel more helpless, and so on.

This leads to a double vicious circle:

The first is physical – something hurts, so there is a fear of more pain or damage, which leads to an avoidance of that activity.  Consequently, it takes less activity to cause pain, leading to further avoidance, leading to more pain.  There is evidence to suggest that exercise can have a positive influence on pain.

The second is psychological – pain may lead to low mood, which in turn can lead to or inflate anxiety, distress and anger, leading onto depressive feelings – which can make the pain feel much worse.

Chronic pain can disrupt the patient’s life in many different ways - disrupted marital, social, employment and recreational activity; Disrupted daily activity; Disturbed sleep; Increased anxiety, distress – are all commonly reported.

Going onto the management aspects of pain, there are often a number of barriers to successful pain management:

From the patient’s point of view:

Language and Culture can sometimes be a problem

Fear – of what might be causing this pain

Fear of judgement – being taken as a sign of weakness

Children, elderly, cognitive impairment – difficulty in expressing the problems clearly

Mood

Individual differences

And from the medical professional’s point of view:

No ‘objective’ measures, so it’s very difficult to assess what is “real” pain

Lack of time to listen

Access to other services can be a problem in some areas.

Knowledge/training in all the manifestations of pain.

Regulations, forms, litigation, prosecution

There is a very clear formula for approaching health professionals about pain:

1. Tell them
2. Tell them again
3. Tell them again – firmly this time
4. Tell them again – even more firmly, with some authority
5. Shout!
6. Shout louder

It does help, however, if you ensure you can talk to them about the following:

Describe the pain as thoroughly as you can – eg. Is it burning, shooting, throbbing, sharp

Describe how much it interferes with your day to day life

When does it happens, how often during the day

Anything that makes it better / worse?

Does it stop you doing anything?

Pain Management based on psychological principles can be broken down into various core components which can help control chronic pain.

Identify and alter unhelpful thoughts and get out of the catastrophising cycle

Coping skills training (self management, relaxation)

Alter environmental contingencies – change what can be changed around the home and general environment to make life easier.

Relaxation is a vital skill for gaining control of pain

Core skill – fosters feelings of self control. Often used in combination with other treatments

How it can help? – reduce anxiety, tension…pain

How to do it? – biofeedback can facilitate learning

Different types

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