Experiencing pain is a part of life. However, chronic pain is different as it is a long-term condition (around for more than three months). Examples of difficulties that are often related to chronic pain include; back pain, joint pain or pain from an injury or operation which continues after healing. Chronic pain is sometimes also related to conditions such as arthritis, cancer, fibromyalgia and diabetes.
With chronic pain there is sometimes an obvious cause, however this is not always true. Evidence increasingly suggests that in some cases the difficulty can be within the central nervous system – which continues sending pain signals to the brain despite there being no tissue damage. This can be frustrating and difficult to manage. It can also leave people feeling like they are not believed or being heard.
Increasingly, research suggests that the emotional impact of chronic pain can make the experience of pain more intense and more difficult to cope with. Anxiety, stress, depression, anger, and fatigue are all thought to interact with chronic pain (e.g. potentially decreasing the production of natural painkillers). Furthermore, these emotional experiences may increase the body’s arousal and awareness towards the pain; effectively amplifying pain sensations.
The evidence base suggests that sometimes people with chronic pain find themselves focusing on their pain to find a solution or to ‘fight back’. This can be helpful, for example in receiving recognition or a diagnosis. However, it can also leave people feeling exhausted and less able to manage or tolerate the pain they experience.
Therefore, experiencing pain is always painful. However, the methods used to manage pain influence how it affects a person’s life.
Do I have a problem with chronic pain?
Chronic pain can be mild or agonising. It can come in episodes or be continuous. It can be inconvenient or totally incapacitating. Given the longstanding nature of this difficulty, it can take both a physical and emotional toll.
Symptoms of chronic pain typically include:
- Mild to severe pain that does not go away
- Pain that is described as shooting, burning, aching, or electrical
- Feelings of discomfort, soreness, tightness, or stiffness
Other problems associated with chronic pain can include:
- Reduced activity and increased need to rest
- Weakened immune system
- Changes in mood including hopelessness, fear, depression, irritability, anxiety and stress
When is chronic pain a problem?
This can differ between people depending on their personality, their coping skills, the severity of the symptoms, the support they have around them and the demands of life. What is not seen as a problem by one person may cause a number of difficulties for someone else. It is about how it affects you, what it is interfering with and what it is stopping you from doing. Symptom severity in itself does not necessarily indicate how much of a problem the pain may be in a person’s life. What matters is whether it is a problem for you. However, there are a specific set of circumstances when help should be sought more urgently and these are outlined in the section below.
Due to the link between physical and mental health aspects of chronic pain, effective treatment requires addressing psychological as well as physical aspects of the condition.
The evidence base suggests that Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are effective in helping people manage their experiences of pain. However, there is also evidence to suggest that a ‘relational approach’ can be helpful with pain.
CBT has the strong evidence base for its effectiveness at managing the symptoms of pain and the long term effects of this treatment often far exceed those of medication. The NHS website (http://www.nhs.uk/Livewell/Pain/Pages/Painhome.aspx), which is based on the National Institute for Clinical Excellence (NICE) guidelines, recommends talking therapy such as CBT.
However, everyone is an individual and although CBT can be extremely effective for managing pain, sometimes a different therapeutic approach or a therapy tailored to the individual needs is more appropriate. The assessment stage of any therapeutic intervention provides an opportunity to develop an in depth understanding of your difficulties on which a tailored individual therapy can be developed specifically for you.