The Psychological Management of Chronic Pain

Chronic pain, sometimes known as persistent pain, is pain that persists for 3 months or more. Pain is a warning signal from your brain and your nervous system, and can persist after a person has healed from the original injury or wound. However, that is not to say that “it’s all in your head”, or that chronic pain is not real. Pain serves as a protective mechanism, a survival mechanism. A good explanation of this, and how we think about pain, can be found in a Ted talk by Lorimer Moseley, and includes what can happen in the brain when we experience pain https://www.youtube.com/watch?v=gwd-wLdIHjs

With chronic pain, the brain and nervous system become overprotective and send unnecessary warning signals. Understanding your pain is important, because you can then make changes in how you respond to pain.

There are three main mechanisms that contribute to pain – tissue injury (nociceptive), nerve injury (neuropathic), and nervous system sensitisation (nociplastic). For the majority of people, if an injury occurred more than two months prior, their injury has mostly likely healed. Chronic pain tends to occur if a pattern of nervous system sensitisation develops (pathological pain).

There are a range of factors that can contribute to chronic pain, including:

  • Medication and medication side effects
  • Lack of or inappropriate physical activity
  • Thoughts and feelings including worried and negative thoughts, stress, anxiety, depression, adjustment difficulties, etc.
  • Nutrition
  • Inflammation
  • Sleep
  • Social isolation

Some people think that medication is the only effective treatment for pain. However, medication also comes with some risks and side effects, and over time the effectiveness of medication diminishes, particularly with chronic pain. As chronic pain is a complex problem, effective treatment requires a coordinated approach that addresses multiple factors. These include self-management, and support from medical and allied professionals, family and friends.

A holistic approach to pain management includes addressing biomedical needs, mind-body factors, social and environmental factors (connection), activity, and nutrition to retrain the brain and nervous system, and maximise tissue health.

So how can a mental health professional assist with chronic pain? Mental health professionals can address a range of issues that contribute to pain, and provide a comprehensive assessment followed by interventions that may include:

  • Providing education about pain, its causes, and contributing and maintaining factors.
  • Developing a pain management plan.
  • Working with your treating medical professionals around weaning off unnecessary or ineffective medications.
  • Addressing fears and emotions associated with pain.
  • Assisting with adjustment to pain and the associated limitations.
  • Increasing safe physical activity, movement, and strengthening activities (in conjunction with other health professionals, where required).
  • Assisting you to build a support network and engage in social activities and other activities.
  • Decreasing negative and worried thinking patterns.
  • Addressing symptoms of anxiety, depression, adjustment difficulties and stress.
  • Improving sleep.
  • Enhancing motivation.
  • Appropriately balancing activity and rest.
  • Introducing relaxation and mindfulness activities.
  • Finding meaningful activities and instilling a greater sense of purpose.
  • Working on improving relationships that may be impacted by pain and associated limitations.

Some good resources for understanding pain better include:

Our clinicians at The Hummingbird Centre are skilled and experienced in the psychological assessment and treatment of pain.

Page Last Updated: 21 April 2021

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