Updated: Jan 30
Chronic pain affects the lives of approximately 100 million Americans (IOM, 2011). While prescription medication is the most common form of pain management for chronic pain, only 23 percent of patients with chronic pain found opioids effective, according to a 2006 survey carried out by the American Pain Foundation (The CHP Group, 2014). It’s a challenge for health care providers to treat it because the cause is sometimes unclear and medical treatment, including medication, is often not completely effective (MacDonald, 2017). For people with chronic pain, this is extremely frustrating and often results in them feeling hopeless. I decided to write this as a caregiver of someone with severe chronic pain, to: (1) educate those who are relatively pain-free about what people with chronic pain experience and its effects on their quality of life; and (2) to share research on helpful and effective things that chronic pain sufferers can do as well as ways their loved ones may be able to help.
What is Chronic Pain?
Chronic pain is any pain that lasts more than six months, versus acute pain, which is pain that last less than thirty days (MacDonald, 2017). When we experience pain, the pain signal travels from the physical site of the pain to the brain via a sensory pathway, enabling us to be aware of the sensation and emotionally react to the perceived “threat level” of the pain (Borgini, 2011). Pain levels for chronic pain suffers can fluctuate due to a number of factors, including an increase in inflammation, hormonal cycles, and emotional stressors, which can cause changes in pain levels lasting hours, days, or weeks (Gatchel et al., 2007).
Our pain experience is influenced by our emotional state and our perception of the severity and nature of the cause of pain. For example, chronic stress involves the release of the cortisol hormone, which can lead to atrophy of muscle tissue, impairment of tissue growth and repair, suppression of the immune system, and even changes to brain structure that would set up conditions for development and maintenance of chronic pain (Gatchel et al., 2007).
How Does it Effect Quality of Life?
Some people with chronic pain often experience cognitive problems such as forgetfulness, difficulties in performing everyday tasks, problems with communicating, difficulty concentrating, reduced attention span, and the inability to respond with any quickness or adeptness when performing certain tasks (MacDonald, 2017). These difficulties can make it more challenging to cope with the other impacts of chronic pain. For example, people with chronic pain often have difficulty sleeping, a critical time when the body heals and purges toxins from the brain. Insomnia can then further contribute to the problems with thinking and communicating clearly, which can make them feel even more isolated.
Along with cognitive functioning problems, a very common issue for people with chronic pain is developing pain-related fear. Pain-related fear is the fear that emerges when sensations that are related to pain are perceived as a main threat (Leeuw et al. 2006). The body’s response to fear includes physiological (e.g. heightened muscle reactivity, increased heart rate), behavioral (e.g. escape and avoidance behavior), as well as cognitive (e.g. catastrophizing thoughts) elements. The fear response toward feeling pain often leads a person to avoid behaviors that could lead to feeling pain.
However, pain avoidance behaviors are unhelpful strategies for long-term pain as they offer only temporary relief from pain symptoms and also increase disuse (and chronic pain), occupational difficulties, depression, and social withdrawal (Norton and Asmundson, 2003). Researchers also found that pain-related fear sometimes may be related less to pain severity and more to fear of physical disability or other concerns such as inability to work, having surgery, having to sell the house, being a burden to family members, and social isolation. Furthermore, some have reported that isolation is sometimes self-imposed because social interactions deplete them of energy they need to cope with pain and ability to function. Studies have also shown that sensitivity to pain and sensitivity to social rejection were mutually reinforcing (Leeuw et al. 2006).
In addition to anxiety about feeling pain and seeking to avoid it, people with chronic pain often feel rejected by the medical system, believing that they are blamed or labeled as complainers by their physicians, family members, friends, and employers when medical treatment is ineffective. Chronic pain sufferers may be worried that, on the one hand, people will not believe that they are suffering or are exaggerating it or they may be told that they are beyond help and will just have to learn to live with it (Gatchel et al., 2007). In response to these reactions and their own internal self-judgments, people with chronic pain also often feel hopeless, unwanted, demotivated, and unable to take care of themselves, which over time can lead to depression. Over the long term, depressive symptoms can increase other problems such as reduction in energy level or fatigue, decreased activity level and libido, as well as unhealthy coping methods such as use of drugs or alcohol to manage the pain (MacDonald, 2017).
It should not be surprising that anger is also found to be common among sufferers of chronic pain, given the frustrations related to persistence of symptoms, possible confusion about the causes of their pain, and repeated treatment failures. They may have anger toward others (employers, insurance companies, the health care system, family members) and anger toward themselves (the most common) for not being able to control their pain and allowing it to take over their lives (Gatchel et al., 2007). However, frequent anger may exacerbate pain by increasing physiological arousal and muscle tension.
How Can Mental Health Counseling Help?
Our thoughts about our experiences are formed from past thought habits or patterns as well as our interpretations of current experience. For example, if a person with chronic pain has a history of low self-esteem, they may be more likely to respond to pain with negative automatic thoughts such as “I am never going to get better,” “I cannot bear this much pain,” or “I am a failure in life because I am in pain.” Although they may not logically believes these statements, such thoughts lead to feelings of hopelessness, helplessness, and despair.
On the other hand, even those who do not have such a history of negative self-talk may fall into these thought habits because of their interpretations of their present circumstances which can be overwhelming (Gatchel and Rollings, 2008). Such negative thinking can lead to or maintain depression, which, as previously mentioned, can lead to increased pain-related suffering or maintenance of their current pain.
Although it’s not be possible for people with chronic pain to avoid feeling pain, there are tools they can use that can help to maintain or improve their quality of life. For example, a mental health counselor or other mental health professional can engage the client in cognitive therapy and teach them mindfulness training. Research in the last fifteen years have shown that, when combined with medical treatment and physical therapy, these methods can be effective for people learn to cope more effectively with chronic pain for a better quality of life (Jensen et al, 2001; Norton and Asmundson, 2003; Leeuw et al., 2006; Gatchel and Rollings, 2008; Hilton et al., 2017).
Cognitive behavioral therapy (CBT) can help patients to challenge and question the rationality of their negative thoughts that increase depression, anxiety, and other emotional factors that impact their quality of life. Such therapy can be combined with appropriate medical treatment and possibly increase the effectiveness of that treatment. In CBT, the therapist helps their client actively challenge their negative thoughts and to reframe their present and future situations, as well as their environment. In addition, a typical CBT session would involve learning to control emotional reactions to chronic pain and cope more effectively with other stressors.
Researchers have found that those patients who believed that they could continue to function with pain, and that they could maintain some control despite their pain, were less likely to become depressed (Gatchel and Rollings, 2008). For example, Jensen et al. (2001) found that changes in beliefs regarding pain as an illness accounted for improvement in depressive symptoms and physical functioning (Jensen et al, 2001).
Additionally, increased belief in control over their pain and decreases in catastrophizing thinking, along with decreases in the belief that one is disabled, were associated with decreases in self-reported patient disability, pain intensity, and depression (Jensen et al, 2001). However, Norton and Asmundson (2003) indicate that treatment should not just address negative thoughts but also by assisting the person in reducing physiological arousal, such as through mindfulness training or yoga.
Acceptance and commitment therapy (ACT), which is similar to CBT, focuses on acceptance rather than control of negative experiences. ACT treatment aims at improving quality of life by helping persons accept their situation as it exists and it involves a willingness to engage in activity with the presence of pain and to allow pain to register without attempts to control or avoid it. The focus of ACT is not on pain reduction but rather on engaging in valued life activities together with pain that is unavoidable (Thorsell, et al., 2011)
Mindfulness helps a person by increasing awareness and non-judgmental acceptance of unpleasant and distressing thoughts, emotions, and physical sensations as they occur in the present moment. When practicing mindfulness, which can be done during sitting meditation or any other activity, we are able to notice when we are falling into the pattern focusing on what we want or don’t want or how things should be, despite evidence to the contrary. These unmet desires lead to disappointment, frustration, and then can develop into depression.
When applied to chronic pain, mindfulness can help people to step back and detach from pain-related thought patterns that can increase their suffering (Buhrman et al., 2013). The increased awareness gained through mindfulness makes it possible for them to step back and reframe their pain experiences in a way that lets them choose how they want to live, in accordance with their values. Simply put, when using mindfulness, we don’t try to change the pain, to make it other than what it is; we simply observe it. Our mind is what tells us that we are suffering. We feel a futility, a sense of helplessness when we can’t make the pain go away. However, by not taking ownership of it, we can eliminate the feeling of failure associated with not being able to make it “go away.”
Recent research has demonstrated that mindfulness training, when used with acceptance of their experiences, can improve a person’s pain tolerance, depression symptoms, and quality of life (Hilton et al., 2017). However, it’s important to note that practicing mindfulness may be more challenging for people with specific mental health conditions such as post-traumatic stress disorder, panic disorder or schizophrenia, as they are likely coping with heightened alertness and fear responses. As coping mechanisms for these conditions, including avoidance, mindfulness may initially cause an increase in symptoms for these people if not done carefully with a trained mental health professional so they can help the person to maintain control of any intense symptoms that may arise (Lustyk et al., 2009).
As mentioned previously, mindfulness can be used during any activity or in sitting meditation. With chronic pain, the intent is to be nonjudgmentally aware of the pain to consciously reduce suffering, not to eliminate the pain. Some activities that can be practiced include:
Focusing on a non-painful body part to divert the mind away from focusing on the site of pain.
Mentally separating the painful body part from the remainder of the body; use dissociation to keep the pain away.
Dividing different sensations of pain into separate parts: If you feel burning associated with pain, you might find it helpful to focus solely on the burning sensation, and not on the pain by using such “sensory splitting.”
Imagining a numbing injection of some miraculous medicine.
"Traveling" back in time, when you were pain-free.
Imagining a symbol for one's chronic pain, for example, a loud noise; turn the volume down and reduce the pain.
Using positive imagery to focus on something pleasant or peaceful.
Counting silently to divert the mind from the chronic pain.
Our Services at Mindful Ways to Wellness
At Mindful Ways to Wellness in St. Petersburg, Florida, we believe that there are many different avenues to improve our quality of life and wellness, including for those suffering from chronic pain. In addition to mental health counseling, we offer a variety of wellness services that can help you to live the life you choose, including life coaching, nutritional counseling, Tibetan bowl sound therapy, and Mindfulness-Based Stress Reduction programs. Call us at (727) 489-4888 if you have questions, or you can click here to schedule an appointment on our website.
References Cited and Further Reading
Borgini, M. (2011, May 1). Mind control: Coping with chronic pain. Psychology Today. Accessed online on August 29, 2017 at https://www.psychologytoday.com/blog/overcoming-pain/201105/mind-control-coping-chronic-pain.
Buhrman, M., Skoglund, A., Husell, J., Bergstrom, K., Gordh, T., Hursti, T., Bendelin, N., Furmark, T., and G. Andersson. (2013). Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial. Behaviour Research and Therapy, 51:307-315.
The CHP Group. (2014). The Cost of Chronic Pain: How Complementary and Alternative Medicine Can Provide Relief. Accessed on September 17, 2017 at: http://www.chpgroup.com/wp-content/uploads/2014/12/CHP-WP_CAM-Chronic-Pain_Sls_12.12.2014.pdf.
Gatchel, R., Peng, Y., Peters, M., Fuchs, P., and D. Turk. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4):581-624.
Gatchel, R. and K. Rollings. (2008). Evidence-informed management of chronic lower back pain with cognitive behavioral therapy. The Spine Journal, 8(1):40-44.
Hilton, L., Hempel, S., Ewing, B., Apaydin, E., Xenakis, L., Newberry, S., Colaiaco, B., Maher, A., Shanman, R., Sorbero, M., and M. Maglione. (2017). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 51:199-213.
Institute of Medicine (IOM). (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. Accessed online at https://www.nap.edu/read/13172/chapter/1.
Jensen, M., Turner, J. and J. Romano. (2001). Changes in beliefs, catastrophizing, and coping are associated with improvement in multidisciplinary pain treatment. Journal of Consulting and Clinical Psychology, 69(4):655-662.
Leeuw, M., Goossens, M., Linton, S., Crombez, G., Boersma, K., and J. Vlaeyen. (2006). The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30(1):77-95.
Litt, M., and H. Tennen. (2015). What are the most effective coping strategies for managing chronic pain? Pain Management, 5(6): 403–406.
Lustyk, M.K., Chawla, N., Nolan, R., and A. Marlatt. (2009). Mindfulness meditation research: Issues of participant screening, safety procedures, and researcher training. Advances, 24(1):20-30.
MacDonald, C. (2017). Learn to live with chronic pain. Accessed online on August 29, 2017 at http://healthpsychology.org/learn-to-live-with-chronic-pain/.
Norton, P. and G. Asmundson. (2003). Amending the fear-avoidance model of chronic pain: What is the role of physiological arousal? Behavior Therapy, 34:17-30.
Thorsell, J., Finnes, A., Dahl, J., Lundgren, T., Gybrant, M., Gordh, T., and M. Buhrman. (2011). A comparative study of 2 manual-based self-help interventions, Acceptance and Commitment Therapy and Applied Relaxation, for persons with chronic pain. Clinical Journal of Pain, 00(00):1-8.