Think your way to better pain management

Chronic pain can have a devastating effect on our wellbeing and quality of life. Having reflected on her own experience of chronic pain, Chartered Psychologist, Dr Caroline Marlow of L&M Consulting, explains the role of psychology in how we experience chronic pain and some of the beliefs that she helps people consider to manage their pain better.

Two fifths of the UK population are affected by chronic pain. Whilst everyone experiences pain differently, each faces its potential effect on their physical, mental or social wellbeing and everyday lives.

I am one of them. Four years ago, sitting for more than half-an-hour would bring excruciating lower-back pain. It, and my attempt to prevent it, affected my self-identity, work and family life. I saw a physiotherapist numerous times, but one day she said she couldn't help and that there was nothing wrong with my back. I felt incredulous, abandoned and fearful of being in pain forever.

Eventually, I decided to review the chronic pain research and reflect on my experience. I came to understand that how we think about pain affects our experience of it and our ability to reduce it. This is the crux of what I learnt ...

What is chronic pain?

1. Chronic pain is pain that persists beyond the normal tissue healing time of 3 months.


2. Pain is the warning system that protects us from danger and injury.


3. When damaged, tissues release chemicals that reduce the level at which nerves are stimulated to send messages to the brain. If, on receiving these messages, the brain perceives pain, it sends messages back down the spinal cord to enable our body to continue protection. The level of nerve stimulation should return to normal with healing, but in some people, it remains low and the brain continues to receive messages. The alarm keeps ringing, even after healing.


4. Within the brain, these messages go to our emotion centre which regulates the amount of pain experienced. Our emotions affect this regulation, with negative states (eg. anxiety and stress) amplifying pain and positive states (eg. joy, gratitude and interest) reducing pain.


5. Over time, if the cycle of messages and pain perception repeats, we can rewire our brain and spinal cord to expect, and to feel, continuous pain.

The good news is that, by understanding how emotions affect our pain experience, and by focusing on improving our emotional state, we can also rewire the brain to become less pain sensitive, thus reducing the cycle.

How can I think my way to better pain management?

What we believe about our pain, ourselves and our life, influences our daily emotions and our longer-term traits eg. optimism, resilience and compassion. But, alas, what we often believe about pain and, therefore, what we do for protection and management, can be counter-productive.

Below I contrast some frequently-held, unhelpful, pain-related beliefs with positive alternatives. I hope they enable you to reflect upon and challenge your pain experience and to consider more helpful beliefs and actions that fit your life.

I can take control

It's easy to feel helpless when experiencing chronic pain, but accepting pain and believing in your ability to take control, cope and be flexible in how best to self-care, provides the best mind-set. Consider what brings pain into your life and be open to trying both small and big changes.

I can be kinder to myself

Many people with chronic pain view themselves negatively, particularly if they make comparisons. Yet, self-compassion brings many benefits including: pain acceptance; reduced tension and stress; improved mood; and less pain disability. Consider how you can: be kinder to yourself; acknowledge that you're doing your best; or accept that imperfect is OK.

I can think about pain differently

Anticipating, paying attention to and reinforcing our pain eg. wincing or telling ourselves or others about it, strengthens the pain pathways. Consider how to: distract yourself from pain; think of it as something other than harmful; or notice it as a prompt for positive action.

I can keep moving

When in pain, we often believe we must rest more and reduce our activity. But, over time, this can limit our ability and confidence to move. Consider how to balance rest and movement better. Gently increase movement within your daily life and pace yourself towards regular physical activity.

... and move well

Being anxious that moving might cause pain can lead us to complete even simple movements differently eg. limping or tensing muscles. This 'guarding' increases self-reported pain intensity and the likelihood of developing chronic pain. Consider how to challenge this anxiety and relax.

I can gain good support

Social support helps us through difficult times, but chronic pain can lead us to inaccurate, negative beliefs of how others perceive us. It can also place strain on relationships. Consider how you communicate with others and how, together, you can consider your pain and daily choices more positively.

Having chronic pain is not easy. Neither is realising that pain has psychological causes. But this does give us the opportunity to take control and think our way to better pain management.

I hope the above is useful: I can help if needed