Chronic Pain, its complexity and the benefits of psychotherapy
Are you offended if your doctor or health care practitioner suggests seeing a mental health counsellor to help you with your chronic pain? In our Western culture, we first turn to a doctor for our physical problems. However, more often than not, they are unable to find a cause to effectively fix the problem and remove the pain. From your perspective, as a chronic pain sufferer, this can leave you confused, frustrated and disempowered.
In our Western culture, we first turn to a doctor for our physical problems. However, more often than not, they are unable to find a cause to effectively fix the problem and remove the pain. From your perspective, as a chronic pain sufferer, this can leave you confused, frustrated and disempowered.
Not feeling believed
A recent study found that health care providers did not always believe their patients’ chronic pain complaints, which they “considered imaginary” and the providers’ responses “indicated speculation, underrating and denial of pain” (Ojala et al, 2015). Your scepticism about psychotherapy as a viable treatment method is completely understandable when the idea comes from someone who made you feel like they didn’t believe you. I can also see why it wouldn’t make sense to you to receive a suggestion to work on your mental or emotional health when you very clearly are experiencing a physical health problem. Chronic pain is a complex problem, whether you feel it in your lower back or anywhere else. So why should chronic pain be any more complex than acute pain?
How is chronic pain different?
Acute pain is temporary, not lasting longer than three to six months, which is the normal amount of time for tissue damage to heal. This kind of pain generally serves an important function of signalling damage to the body, as a warning to prevent further injury and to give the body time to heal. Also, the intensity of the pain experienced usually corresponds to the extent of the tissue damage. Chronic pain is persistent, does not usually match pain intensity to tissue damage, and serves no useful biological function. Even though chronic pain is not a signal of tissue damage the pain is still experienced biologically through the nervous system. Brain regions associated with pain may be activated even when there is no indicated tissue damage or observable cause. Whether there is an observable cause or not, all pain is physically perceived and experienced through the brain’s nervous system and the neurochemistry of pain is extremely complex. All that is to say, just because there is no observable cause, doesn’t mean that the pain you are experiencing isn’t real, in fact, it is the opposite – your pain is very real!
Even more complex…
Chronic pain is a complex and multifaceted problem that includes biological, psychological and social dimensions. For those of you who suffer from chronic pain, you know how difficult the experience is and how it can affect so many aspects of your lives.
Many people suffering from chronic pain often face other challenges like trouble sleeping, depression or other mood disorders, weight issues and relationship distress. When a doctor focuses on any of the above, especially psychological factors, you, as a chronic pain sufferer, may understandably feel like your pain experience is being invalidated and that you are being treated as if the pain is “just in your head.”
There are some really valid reasons for a health care practitioner to ask about these issues because these often are legitimate contributing factors to your pain experience. A well-informed pain practitioner should take into account your physical state, your emotions, your thoughts and your relationships. They will know that chronic pain is both a physical issue and a psychological issue.
The multi-dimensionality of chronic pain makes it a condition worth being treated by psychotherapy, not only by a body expert like a doctor, chiropractor, osteopath or massage therapist.
Psychological processes of pain
Researchers going back to the 1960s have studied how experiences in the brain, such as thoughts and emotions affect pain perception. In their ground-breaking study in 1965, Canadian psychologist Ronald Melzack along with Patrick Wall first introduced the gate control theory of pain, where they proposed that the perception of pain is not only from a specific place in the body to the brain but that what happens in the brain (thoughts and feelings) also influences the pain experience (Melzack & Wall, 1965).
Psychological and social aspects such as your environmental stressors, emotions and interpersonal issues play a role in affecting pain. Neurobiological research has verified that chronic pain includes biological, psychological and social dimensions; and therefore psychotherapy is a beneficial treatment method.
How a counsellor/psychotherapist can help
Counsellors or psychotherapist working with sufferers of chronic pain understand how the emotional, mental and physical components all interact together to produce and exacerbate the client’s experience of pain. As mentioned above, many people suffering from chronic pain usually report multiple and overlapping problems such as sleep disorders, mood disorders, disability, weight issues, and relationship distress, which are all issues that psychotherapy can help with. Numerous studies over the years have shown that 40 to 50 percent of those with chronic pain suffer from depression and these two conditions, unfortunately mutually reinforce each other.
As your counsellor, I will pay attention to your emotional state, which for many chronic pain sufferers is usually primarily negative emotions such as helplessness, fear, and anger. Living day after day with pain that interferes with your desired activities along with feeling little to no control over the pain, it is completely understandable you would be experiencing these difficult emotions. I also work with a client’s experience of stress, underlying beliefs and expectations, identity issues, family dynamics, problem-solving styles, formative experiences and behaviour patterns that may all be contributing to the pain experience.
Chronic pain is a complex and multifaceted problem that includes biological, psychological and social dimensions. While it may seem like a suggestion to see a mental health counsellor to help with your chronic pain is not what you need, over fifty years of ongoing research continues to demonstrate the ways that psychotherapy can help. If you are a chronic pain sufferer, please consider setting up a free meet and greet session with me so we can talk more specifically about how psychotherapy and counselling could help.
Ojala, T., Häkkinen, A., Karppinen, J., Sipilä, K., Suutama, T., & Piirainen, A. (2015). Although unseen, chronic pain is real—A phenomenological study. Scandinavian Journal of Pain, 6, 33-40. doi: 10.1016/j.sjpain.2014.04.004 Melzack, R. & Wall, P.D. (1965). Pain mechanisms: A new theory. Science, 50, 971-979.