Chronic pain hurts, its tiring, and over time it wears you down mentally and physically. The reasons for chronic pain are not well understood. Pain is protective and helps us to understand our world, however if it becomes chronic it can cause significant problems in your life. Treatments generally focus on managing symptoms rather than curing the pain. At least one in five people in Australian experience chronic pain and this number is rising. For people aged over 65 years this number increases to one in three. Chronic pain is the most common reason you will visit your GP and the most common reason people are unable to continue to work.
Where is the Pain?
Pain is often thought of as being in the body so you may wonder how a psychologist who focuses on the mind and brain can be of help. Actually, it is impossible to feel pain without a brain. The idea of pain being controlled by the brain can make people feel their pain is less real or that they are making up their pain. While pain is felt in the body all pain signals go through your brain and the pain signal is actually produced by your brain. Your brain produces pain signals if it thinks you are in danger. Your brain tells you how strongly your pain should be felt. It helps to decide whether it is important to pay attention to your pain and how to react to your pain. As a result, your brain can be a powerful tool to combat the negative effects of chronic pain.
Many people want to fix their pain and cannot imagine living the rest of their lives with chronic pain. However, once someone has chronic pain they will often continue to live with some level of pain for the rest of their lives. Some pain may be disabling, and some people have a condition where the pain may actually increase over time. It is important to work towards accepting that pain may be part of your life. Once this happens you can then figure out how to live a happy and fulfilling life in spite of the pain.
Chronic pain affects all areas of your life. As discussed previously chronic pain can stop you from working which can lead to financial difficulties. On average people with chronic pain lost $2606 per month due to work absence. Your relationships can suffer and many people with chronic pain find it difficult to exercise which can further affect their health, weight, and well-being. Chronic pain also costs a lot of money. On average people with chronic pain in Australia spend $473 per month on pain treatments. People are searching for cures and are willing to spend large amounts of money in hopes the pain will go away. Many chronic pain conditions require lifelong management so having good supports around you is the best step you can take.
Pain and Mental Health
Pain is associated with a range of mental health conditions. In one study over 60% of people who had chronic pain also met the criteria for depression. Other studies have found people with chronic pain had more than twice the prevalence of anxiety disorders as the general population. The relationship with pain and mental health can be a cycle where pain leads to depression or anxiety and then the depression and anxiety leads to more pain. Many people who experience pain also self-medicate with drugs and alcohol. In one recent study the use of illegal drugs, the use of prescription drugs in a way other than had been prescribed and high-risk alcohol use was examined in the context of chronic pain. They found 87% of people who used these substances suffered from chronic pain. The idea that mental and physical health conditions are connected is a recent development. These ideas developed because of the advances in understanding our immune system, in particularly its inflammatory response.
We know that sad and scary events in our lives affect our physical health even in the absence of actual physical harm. At the extreme, a relationship breakup or death of a loved one can lead to Takotsubo cardiomyopathy or Broken Heart Syndrome. The heart is literally weakened to the point where some people die of this condition luckily most people recover after a few months. We also know that adversity during childhood is linked to later health problems including chronic pain. Adverse childhood experiences are linked to more severe chronic illnesses including pain related chronic illnesses. Doctors are only beginning to understand why childhood adversity, in particular child abuse leads to poor health outcomes. However, there are a range of pathways which are proposed to lead a child from an abusive childhood to later health problems. The pathways researchers have identified include:
- psychological pathways such as beliefs about health;
- physiological pathways including our inflammatory response, nervous system activation, and somatic memory in cells; and
- behavioural pathways in terms of choosing unhelpful coping behaviours such as substance abuse.
If you want to read further on this topic Dr Bessel Van Der Kolk in his book The Body Keeps Score describes the way stress changes our physiology. He details the way our childhood experiences can lead to us constantly feeling like we need to fight, flee, or dissociate. Being in a constantly heightened state has numerous consequences for our bodies. He states that “traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs” such as pain. Another resource on this topic is The Body Remembers By Babette Rothschild. She describes the way that people can hold post-traumatic stress in their bodies as implicit memories of past trauma. She discusses the way trauma can change our central nervous systems, muscles, and reflexes all the way down to a cellular level. With many affects lasting long after the trauma has occurred.
Pain and Relationships
Intimate relationships and the ways in which chronic pain can affect these relationships is another area which has been well researched. The effect of chronic pain on relationships deserves its own post as the consequences can be large and complex. Studies have shown that 75% of couples where one partner has a chronic illness end up divorcing. Couples reportdecreases in marital and sexual satisfaction at the onset of a pain condition. We know intimate relationships can affect a person’s health and pain status for better and for worse. The quality of the relationship can affect the expression of pain symptoms and the choice of coping strategies. Including a spouse in therapy can be helpful to ensure they understand the psychological skills needed for pain management.
The PsychHelp Psychologists can help you live a happy and healthy life where you can understand and manage your pain. We can teach you a range of evidence-based psychological techniques, which have been shown to help reduce pain and disability. If you are ready for Psychological Help with your pain, please make an appointment today.
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