Psychology: The missing P in the Persistent Pain Treatments




Almost every person with persistent pain will find themselves going through a number of different health professionals over the course of their pain experience. The process often begins with our GP, then possibly a Physiotherapist or Chiropractor, quite possibly a specialist surgeon and then later maybe a pain specialist as well. For acute pain just after an injury or surgery, this is usually helpful and the injury will resolve within an expected time frame, but for those with chronic pain, being passed from health professional to health professional, and not really getting a clear treatment plan or prognosis, just adds a whole new problem to something that is already very complex and stressful. It also very quickly gives us the impression that our problem might be something particularly rare and dangerous because we’ve been to all these professionals and no one really knows what is going on.

The other issue that we commonly see in people, who have had persistent pain for quite some time, is that they have become highly dependent on a mix of pain relief medications, and then have to deal with all the side-effects that accompany them, on top of the already existing pain. There are studies show that long-term opioid use for chronic pain patients is ineffective, and yet it is still routinely used. This isn’t to say that it is being used dangerously, but it highlights the point that persistent pain management needs to move away from a medical model of treatment, that is trying to find something physical to “fix” and take into account a much more complex set of factors such as the psychological and social aspects that are involved.

Before we knew very much about how chronic pain worked, the idea of getting a Psychologist involved would have been completely dismissed unless the person also had obvious mental health concerns, and even then it would not have been expected that Psychology could offer anything to actually treat the pain itself. Fast forward then to today’s understanding of chronic pain; that is we know the experience of pain is generated by the brain, we know that nociception (physical touch/sensation) is not even necessary for pain to occur, and we know that pain is the outcome of the brain’s perception of threat or danger to our body (whether real or even imagined).

So we now know that the brain or mind is right at the centre of the pain problem, and yet there continues to be so many people with persistent pain, who have probably never thought to try a Psychologist. I’m not trying to blow the trumpet of my own profession (well maybe just a little bit), and I can understand that lots of people assume that if they see a Psychologist it must mean things like “I’m making my pain up” or “it’s all in my head” “my insurer will think there is nothing wrong with me”. But, we know none of these are true! Your pain is 100% real, but at the same time that doesn’t mean it’s not controlled by your brain. Our blood pressure is controlled by our brain too and yet no one ever told us that we were faking high/low blood pressure. In fact your brain controls lots of things all over your body and our pain experience is one of them.

So you might be thinking, “Well what does Psychology” have to offer for persistent pain then? Well to begin with Psychologists have been using a range of techniques for many years to teach us more helpful ways of perceiving ourselves, others and the external world around us. We know that what we think impacts what we feel and they both impact how we behave and the physical responses of our body. If we know that pain can be turned up or down based on our brain’s perception of danger or threat, then we need to change how our brain perceives threat, to start to treat our pain. This takes some time and hard work but it can be done. In fact Psychologists have been treating those who are suffering traumatic stress and anxiety for many years with very similar techniques and there is a stack of evidence to show that it works.

At STEPP we are a pain management service that specialise in adapting these successful techniques to your individual experience, in a way that’s gradual and relevant to the goals that mean the most to you. It might be time to ask yourself; “Is what I’m doing now really working for me?” If you’re not so sure, give us a call, because we can’t just focus on the body alone, what’s in our head is important too.

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