What’s the psychology behind chronic pain?

Chronic pain can be both a physical and psychological condition. Support from a psychologist can really help you to improve your quality of life, and the use of behavioural therapy techniques may guide you in addressing the thoughts that amplify your pain. In this article, one of our medical professionals Dr Sarah Barker explains how a psychologist can help you to manage your pain condition.
 

Can we treat chronic pain psychologically?

We can see that our body and the brain are connected, but traditionally we have only thought of pain as a physical experience. However, with advances in neuroscience, we now know that our thoughts and feelings can modulate pain messages from the first synapse. Pain has three components; a sensory component, an affective component (how we feel) and a cognitive component (what we think about it). Psychological therapy works with these latter two areas.
 

What chronic pain conditions do patients visit you about in your clinic?

Patients can experience pain in all areas of the body. I have experience of working in both a general pain service and a facial pain service. Examples of the commonest pain conditions are TMJ, headache, back pain and fibromyalgia. I also provide psychological assessment and advice pre and post-surgery and developed a programme for people undergoing neuromodulation implants.
 

How can a psychologist help in managing chronic pain?

Chronic pain is different from acute pain as changes in the central nervous system occur. This 'central sensitisation' can mean that pain messages become amplified. Vicious cycles can develop which have a knock-on impact on mood and life in general. Stress can exacerbate and add to this 'wind up' in the central nervous system.

Parts of our brain are wired for survival and when pain is perceived it can be seen as a threat, which sets the central nervous system into action. Therapy can help people to recognise this process and limit its impact. Psychological approaches can help to identify and reduce stressors and explore factors (e.g. fears about the pain) that are affecting your mood and quality of life.
 

Why is psychological support so important in dealing with chronic pain?

Pain impacts on your mood and your sense of your ‘self’, which in turn affects the experience of pain due to neurochemical changes. Quality of life can decline when pain prevents you from doing things you previously enjoyed, and support to improve your quality of life can be key to recovery. This in turn feeds back into the way pain is experienced, and fMRI has shown how techniques such as mindfulness have a positive impact on pain.
 

How would they help and how many sessions are required?

At an assessment, we formulate your difficulties and consider if a multidisciplinary approach is required, which would include medical/ physiotherapy treatment. I write a summary letter outlining the treatment approach, send information and we discuss our contract of sessions.

This shared approach means you embark on treatment with an idea of what would be worked on and the amount of time this is likely to take. The more factors that have led to a 'wind up' in the central nervous system (e.g. multiple surgeries, abuse), the longer therapy is likely to take. The aim is not a 'cure' but improvements in quality of life, although reduced pain can often occur.
 

What tips can you offer someone for coping with pain?

Think about which factors are contributing to the 'wind up' in your central nervous system and consider how these can be addressed. Practice mindfulness (apps such as Headspace can be useful). Get professional help if required.



If you would like to work with Dr Barker to address your chronic pain, you can book an appointment with her via her Top Doctor’s profile here. Can’t make the appointment in person? Dr Barker is available for a video call using our e-Consultation tool, which can be found on her profile too.