Chronic Pain

When we think of treatment for pain, we usually think physiotherapy, medication, and surgery. While these methods are all effective, psychological therapy can help with pain management too.

To understand this, we need to consider what pain is – an alarm system in our brain, telling us to stop engaging in the action that is causing the sensation to prevent further damage. If we are anxious, our body’s alarm system is more sensitive, therefore these signals are likely to be more intense.

Cognitive behavioural therapy (CBT) can help individuals experiencing chronic pain to understand how their thoughts, emotions, behaviours, and physical symptoms interact. From here, the therapist can help the individual to identify how to facilitate positive change within this cycle, improving their wellbeing.

For an example of how this cycle may play out in the context of pain, if John injures his leg while running, he might begin to catastrophise – jump to the worst possible conclusion about the nature and consequences of his injury, “I’ve done some serious damage here, I’ll never be able to run again”. In this scenario, John’s anxiety around his pain will increase, his brain’s alarm system becomes more sensitive, and his pain feels worse. He may avoid moving his leg altogether, which can cause an increase in stiffness and a further increase in pain sensitivity when engaging in day-to-day activities. John could use cognitive restructuring – a technique which uses evidence from the current and past situations to promote a more balanced way of thinking. He may consider that while his leg is extremely sore and he is currently not able to run, he has had injuries in the past which have healed with time. This could lead him to a more balanced conclusion such as “My leg is really sore, but I have had injuries before which have recovered, therefore, with some time, I’ll probably be able to get back to running”. As a result, John may be more encouraged to find some other ways to exercise which don’t exacerbate his pain, such as swimming, while his injury heals. His anxiety reduces and pain sensitivity decreases, leading to a faster and less stressful recovery.

While pain can be complex and anxiety provoking, CBT and other psychological therapies can help an individual develop helpful ways of understanding and managing it.