As a society we tend to think about and talk of pain as a negative thing. Aside from someone bragging about how much they squatted yesterday, and how it hurts to walk up the stairs today, pain is typically considered something to avoid. Further, we tend to consider all pain to be much the same. Research actually shows that our experience of pain can be caused by different physiological and psychological factors, and, can even be helpful sometimes.  

So, what is pain and why do we feel it in the first place? 

Pain can be adaptive, telling us when we are in danger or if there is a problem with our body. There are four different types of pain: 

• Nociceptive pain: the instant, intense pain we feel when we stub our toe or burn ourselves on a pot. Ouch! 

• Inflammatory pain: the dull throbbing pain that tells us if we have damaged or swollen tissue. For example, the soreness of an ankle after rolling it.  

• Dysfunctional pain (a type of chronic pain): this is the pain we feel even if we are not physically hurt or suffering from any illness, or there is no clear explanation for the pain we are experiencing.  

• Neuropathic pain: this refers to pain that results from damage to the nervous system. For example, this occurs in conditions that cause injury to nerves, such as shingles.  

When we know the cause of our pain, or have an understanding of what treatment is required, we can generally tolerate our experience and adapt our behaviour for the appropriate period of time. When pain lingers, or when we, or our medical team don’t understand what is causing the pain, the experience can be much more distressing.  

Understanding chronic pain: 

Chronic pain is when a person has experienced pain on most days, and this has lasted for longer than the time it takes to heal after an injury (usually more than 3 to 6 months). This pain is complex. It can be felt in different ways and varies in pain severity.  

 Some people might experience chronic pain because of medical conditions like cancer, musculoskeletal conditions such as arthritis, or from injuries or surgery. Others might experience chronic pain without an obvious physical cause. People often start to feel distressed by chronic pain, and when the cause is not clear to perceive others “think it is all in my head”.  

Who is impacted by chronic pain and how? 

Chronic pain is a common condition in Australia, affecting one in five Australians over the age of 45 – that’s 1.6 million people! It is more likely to affect females and older individuals, as well as those with long-term health conditions. People who experience chronic pain are more likely to experienced reduced quality of life. They are also more likely to be limited in their ability to participate in housework, employment, exercise, and social activities.  

How does chronic pain relate to mental health? 

Feeling pain can negatively affect a person’s emotions, activities, and relationships. It is not surprising then, that people with chronic pain are more likely to experience mental health conditions such as depression and anxiety. This is because pain may lead to mental health symptoms. Additionally, a person’s mental wellbeing can also influence their feelings of pain, thus creating a vicious cycle.  

How can psychotherapy help? 

Firstly, we want to emphasise that the experience of chronic pain is complex with many factors contributing to how much pain impairs ones ability to function. Pain is not “all in your head”, however research shows that they we we respond to our pain can have an important influence on how much we feel the pain, and how it impacts our life. 

Psychotherapy (aka talk therapy), such as cognitive behavioural therapy (CBT), can help people understand how chronic pain is affecting their mental health. There is lots of evidence that CBT is effective in treating chronic pain. It can reduce pain and distress. It can also help a person engage in activities that would otherwise be hindered by pain.  

CBT focuses on understanding how thoughts, feelings, and behaviors may influence one another. For example, catastrophizing thoughts (e.g. “I will never be able to cope with this”) can make people feel more distressed. This then affects how they behave and experience pain.  

When treating those with chronic pain, a therapist may collaborate with the patient to positively shift thoughts, feelings, and behaviors in accordance with a patient’s goals. This may involve a several techniques including supportive counselling and challenging negative thoughts. It may also involve pain and distress-management techniques like meditation and mindfulness. 

In summary… pain can be both helpful and unhelpful. Chronic pain is persistent pain experienced most days of the week for an extended period of time. It can impair a person’s mental health and ability to function day-to-day. Psychotherapy may help manage pain intensity and emotional distress. 

Author: Jacinta Anderson

Psychologist & Clinical Registrar