Chronic Pain

Person pinching bridge of nose

Chronic pain is any pain that lasts for longer than six months. It stands in contrast to acute pain, which is short-lived pain that often has a clear medical cause. Muscle aches such as back and neck pain are common sources of chronic pain, but the pain can occur anywhere in the body and can range from a mild irritation to a severely debilitating condition. Because chronic pain can affect one's mental health, an individual experiencing chronic pain may wish to speak to a therapist, in addition to pursuing other lines of treatment.

Causes of Chronic Pain

Chronic pain can occur as a result of either a physical or mental health condition. Long-term conditions such as arthritis, cancer, multiple sclerosis, diabetes, and AIDS might all cause chronic pain. Ulcers, poor posture, repetitive stress injuries, traumatic injuries, or nerve damage might also contribute to an individual's development of chronic pain. The condition fibromyalgia is also characterized in part by chronic pain, and although medical professionals agree that the pain experienced by those with fibromyalgia is real, it is still debated whether the condition is a physical or mental one. An individual may also experience pain as the result of a health condition or injury and still continue to have that pain after the physical condition is resolved.

Due to these factors, chronic pain is not always easy to understand or treat, and health care professionals might have difficulty identifying the cause of an individual's chronic pain, especially when there is no physical cause.

Chronic Pain and Mental Health

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Chronic pain can often develop as a result of a mental health condition, and it is a more common symptom of psychological concerns than many people may realize. Chronic pain and depression are also often closely related: the stress of living with chronic pain can often lead to depression, and because some people may manifest depression in the form of physical symptoms instead of psychological ones, depression can also result in chronic pain.

An individual experiencing chronic pain may wish to rule out medical conditions that can lead to chronic pain by talking to a physician. However, in some instances, chronic pain may be a sign of untreated:

The stress that chronic pain might cause an individual to experience can also lead to increased pain by triggering muscle tension and spasms. Stress can also lead to certain health problems, such as heart disease, diabetes, and obesity. Managing emotions and stress with techniques such as meditation can often both help to relieve pain and improve an individual's general health.

Somatization

Muscle pain or fatigue, shooting nerve pains, back tension and pain, and headaches can often be reactions to unexpressed emotions, needs, or desires. This unconscious conversion of a mental state into physical symptoms is known as somatization. The presentation of somatic symptoms is a diagnosable condition: Individuals with somatic symptom disorder (SSD) have actual physical pain, not imagined pain, and their symptoms may be severe enough to affect work, relationships, and daily life. Stress and worry resulting from the symptoms tend to cause an individual's condition to worsen, and an individual with SSD may wish to see a therapist as well as a health care provider in order to receive treatment for psychological symptoms as well as the physical ones.

Coping with Chronic Pain

In addition to treatment, pain management strategies might include activities like light exercise, social visits, and distractions such as hobbies and outings, while being mindful of one's physical limitations. Social support can be especially important, as the help of family and friends has been shown to mitigate symptoms of depression and anxiety that may be experienced by those with chronic pain. Keeping busy with the same activities enjoyed before the onset of chronic pain may help an individual to better manage his or her condition and help prevent feelings of hopelessness.

Some forms of treatment for chronic pain include acupuncture, physical therapy, electrical stimulation, and nerve blocks. Some individuals are prescribed medication, and others may undergo surgery for relief of persistent, severe chronic pain. Sometimes, simple lifestyle changes can reduce or eliminate chronic pain, depending on the source of the pain. Many people are able to find relief from pain through vigorous exercise, for example, which releases endorphins that act as natural pain killers. Addressing workplace ergonomics can also benefit those whose pain may result from repetitive movements, prolonged sitting or standing, eye strain, and other workplace stressors.

How Psychotherapy Can Help with Chronic Pain

People with chronic pain may sometimes resist exploring the possibility that their pain has an emotional root, perhaps out of fear of being accused of inventing the symptoms or causing them on purpose. However, individuals with SSD or emotionally rooted chronic pain do experience real pain, a fact that therapists and medical providers generally accept. Reluctance to admit to the emotional roots of pain may also stem from the belief that emotion-based chronic pain is less likely to have a medical cure. In addition, the prospect of confronting the deeper emotions that may be causing the pain can seem like a daunting task.

However, confronting those emotions and achieving catharsis—a release of pent-up emotions—may provide both short- and long-term relief. Relief may not be permanent, though, as emotions held for a long time in the body can transform to primarily physical symptoms, and they may not be relieved by emotional release in all cases. In this case, therapy may be more effective when combined with another form of treatment.

Biofeedback is a form of therapy that can be useful in learning to identify the ways the body experiences pain. Understanding the body's response can help a person develop ways to manage and relieve pain. Therapy can help individuals remain hopeful, and it can be an effective treatment to supplement any prescribed medications. Relaxation therapy and cognitive behavioral therapy have both been shown to be effective at treating people who live with chronic pain.

Case Examples

  • Exploring roots of chronic pain in therapy: Giulia, 47, complains of several chronic pain issues, including muscle aches, headaches, and a stiff back. She refuses the therapist's suggestion that her pain may have emotional roots, preferring instead to talk about her friendships, which are conflicted and troubling to her. The therapist follows Giulia's lead and does not bring up the interpretation of her pain again but simply explores Giulia's feelings towards her relationships with her. After several weeks, Giulia begins crying regularly in session and reveals that she feels ashamed of herself for doing so. After normalizing the need to cry, the therapist is able to uncover deep feelings of fear of abandonment, about which Giulia continues to cry. Before long, she reports that her physical pains are diminishing. However, the pains have led her to adopt a sedentary lifestyle, which has led to muscle atrophy, so her pain does not disappear entirely, and the therapist recommends physical therapy.
  • Chronic pain after mother's death: Paul, 56, has been depressed and anxious since his mother died two years ago and enters therapy hoping to resolve these issues. He also reports muscle aches and shooting nerve pain, but he does not make any connection between the two. He is open to the therapist’s suggestion that his pain is related to the feelings of depression and anxiety, and he is willing to talk about his mother with the therapist, although he has thus far been reluctant to speak about her since her death. By fully grieving his loss—as well as the loss of his father five years earlier—and by talking about his guilt over some unresolved issues in his relationship to his parents, Paul is able to relieve his physical symptoms.

References:

  1. Cherney, K. (2014, April 11). Is Fibromyalgia Real or Imagined? Retrieved from http://www.healthline.com/health/fibromyalgia-real-or-imagined#2.
  2. Chronic Pain: Symptoms, Diagnosis, & Treatment. (2011). NIH Medline Plus, 5-6.
  3. Managing chronic pain: How psychologists can help with pain management. (2013, December 1). Retrieved from http://www.apa.org/helpcenter/pain-management.aspx.
  4. Rogge, T. (2014, September 2). Somatic Symptom Disorder. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000955.htm.
  5. What is chronic pain? (n.d.). WebMD. Retrieved from http://www.webmd.com/pain-management/guide/understanding-pain-management-chronic-pain.

 

Last updated: 07-03-2015

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