Psychology and Pain

By Dr Catherine Cronin, Senior Clinical Psychologist at The Victorian Rehabilitation Centre

 

This week is Psychology Week in Australia and the theme focuses on the role of psychology in helping people with pain. Here Dr Catherine Cronin, Senior Clinical Psychologist at The Victorian Rehabilitation Centre shares insights on pain and its relationship with emotions, as well as treatments, tips to tame pain, and multidisciplinary pain management programs offered by Healthscope.

Persistent pain is a debilitating condition that affects one-in-seven people, impacting the individual, families and workplaces – including the healthcare system and wider community, with an estimated annual economic impact of up to $139.3 billion.

 

Defining Pain

We understand pain as an aversive sensory and emotional experience that is associated with actual or potential tissue damage. Pain can have many different causes, including medical illnesses (e.g., cancer, arthritis etc.), nerve damage, psychogenic factors, dysfunctional movement patterns, peripheral and central nociceptive pathway changes in the nervous system, and can sometimes occur for reasons that are difficult to identify due to a number of contributing factors.  In contrast to acute pain, persistent pain is classified as pain that continues beyond the usual healing period of three months or more.  We tend to think of acute pain as adaptive and helpful (signalling the need to rest and protect the area from further harm), and persistent pain as maladaptive and unhelpful.

 

Persistent Pain Treatment

Best practice treatment for persistent pain involves taking a multidisciplinary approach, involving medical, physiotherapy, occupational therapy, and psychological treatment. Psychotherapy is a key component, which is informed by evidence-based models of the mind-body-behavioural factors involved in persistent pain.  In therapy, individuals learn about the psychological and behavioural factors that are implicated in the maintenance of persistent pain, and develop skills to take back control, self-manage symptoms, and ultimately, improve quality of life and functioning.  Motivational techniques are another important factor that psychologists employ to assist with avoidance and factors that perpetuate pain.  Many individuals achieve a significant reduction in pain, as well as a range of positive functional outcomes.

Psychologists have made a significant contribution to how we understand persistent pain. In addition to cognitive and behavioural factors, we have progressed our understanding of neurobiological factors and have made some important and exciting discoveries. The following videos provide more information on our current understanding of pain:

 

 

Established psychological therapies such as Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) are some of the few evidence-based treatments available for persistent pain.  Secondary psychological comorbidities are highly common, and are important to assess and treat when treating pain-related concerns.

 

The Relationship between Emotions and Pain

Our moods and emotions are thought to have a direct effect on pain.  Anxiety and stress, for example, are associated with increased muscle tension and are also thought to upregulate the sensitivity of the nervous system, which amplifies persistent pain.  For these reasons, pain management strategies that reduce stress and calm a sensitised nervous system are essential components of the treatment of persistent pain. These strategies fall into three general categories:  Mood enhancing and stress-reducing activities, healthy thinking skills, and emotion management skills.

 

Tips to Tame Pain:

• Speak with your General Practitioner about what you are experiencing and the potential value of engaging with a pain specialist and/or pain management program.
• Utilise mindfulness strategies (see: https://www.smilingmind.com.au/smiling-mind-app/), relaxation techniques, controlled-breathing, and progressive muscle relaxation.  
• Practice self-care - healthy routines, personal boundaries, and ‘me time’.
• Watch your pain-related thinking to make sure it is accurate, adaptive, supportive and encouraging.
• Pace your activity appropriately.
• Absorb yourself in pleasurable and rewarding activities.
• Access support by speaking with someone that is knowledgeable and understanding.