Chronic Pain Treatment
Learn about Chronic Pain and Evidence-Based Treatments
We all experience pain from time to time, but how bad does it need to be to be considered chronic? The clinical definition of chronic pain is experiencing recurrent or persistent pain for at least 3 months. Commonly, clients experienced an event that led to the onset of pain, such as an injury, incorrect posture while doing an activity, or chronic emotional stressors. There are also times where they may not know what the trigger event was, but started experiencing persistent pain that just wouldn’t budge.
Persistent pain often develops because the central nervous system (CNS) becomes extra sensitive. Normally, the CNS sends signals to the brain when there is a potential threat - like an injury or strain. But in chronic pain, the system gets stuck in “high alert” mode. The brain receives these signals and treats them as a real threat, even when there is no new injury. To protect you, it keeps turning up the volume on pain. It’s not that the pain is “in your head” - it’s that your body is sending false alarms that make you feel like you’re always under threat. The good news is that the nervous system can relearn safety. When it realizes you’re not in danger, the alarms quiet down and the pain can ease.
Pain Psychology & Treatment
What is pain psychology?
It is important to know that your pain is very real and seeing a psychologist to help manage the pain does not discount your experience. Pain psychology commonly involves a multidimensional approach to treatment. A pain psychologist will often ask for your permission to consult with your medical team to have a better understanding of their viewpoint and treatment approach.
The psychologist will then work alongside you and your loved ones to provide psychoeducation about pain and the mechanisms behind it - a major factor in working with pain is understanding the brain’s response to pain. Research shows there is a strong connection to environmental conditions, social interactions, and behavior that reinforce the pain cycle, so therapy ends up addressing other aspects of life as well. One particular evidence-based treatment that is commonly used to help individuals get back to living a life they enjoy is Cognitive Behavioral Therapy for Chronic Pain (CBT-CP).
What does treatment look like?
CBT-CP is a structured treatment to help improve the quality of your life by managing chronic pain. Together, we will look at the 4 components that impact living life with chronic pain: emotional, environmental, social, and cognitive stressors. You will learn to identify the connections between them and explore how persistent pain can shift when stressors are lower or higher. Additionally, we will discuss specific goals you would like to work towards and create a plan for practical weekly behavior. Often, we will also discuss how to engage in behaviors while preventing pain flares, how to cope with a pain flare when one does arise, and how to pace activities. Overall, you will feel empowered through a better understanding of the interconnections between thoughts, emotions, behaviors, and pain sensations.
Mindfulness Based Therapies
It is common that your journey to regain confidence in managing chronic pain would lead you through multiple therapeutic approaches. Two of the therapies we will also be using are Acceptance and Commitment therapy (ACT) and Mindfulness.
ACT draws on bringing awareness to what is most important to you in life, while learning how to disengage from the autopilot of daily living. Instead, you will learn how to observe your thoughts and watch them go by without judgement, which helps increase awareness to everyday thinking. ACT mainly focuses on important life skills and questions, such as what your values are, what is getting the mind hooked on a thought, how to disconnect from language that is unhelpful, and how to work with challenging emotions.
Mindfulness techniques such as body scans and meditation allow you to slow down in a safe space. This process helps to retrain your interpretation of sensations and learn that the body is not in danger. Over time, this replaces danger signals in your brain by learning to invite curiosity and exploration to the sensations in a neutral manner.
What is Pain Reprocessing Therapy (PRT)?
PRT has some similarities to CBT-CP as they both focus on how chronic pain is impacted by our thoughts and the brain's response to pain signals. PRT focuses on a somatic, body-centered approach, acknowledging pain as a sensation and providing tools to observe the sensation without emotional attachment. When working from a PRT framework, we will work on practices throughout the day that promote mindfulness, curiosity, as well as on exposures to retrain how your brain perceives pain signals. This means retraining your brain to understand that chronic pain is not causing damage but is a learned response over time.
Common Myths
Chronic Pain Is Dangerous
People commonly believe that pain is automatically dangerous and means the body is going to be harmed in some way. Let’s clear this up - pain is actually a signal that our brain sends us as a warning sign. For example, if you touch a hot pan, the common reaction is to flinch back because it is hot! This is your brain telling you to be careful.
However, when pain becomes persistent, the warning signal is often overactivated, which sends inaccurate pain signals.
A large part of chronic pain management is retraining the brain and how it interprets these signals to learn that they are, in fact, not dangerous.
Pain Never Changes
Fact: Persistent pain is going to fluctuate throughout one’s life, due to a variety of factors. Here are a few reasons the experience of pain may change:
Psychological stressors (anxiety, depression, anger, grief)
Environmental stressors (work stress, local stressors in the area)
Social stressors: (political stress, familial and relational stress)
When the stressors compound together, they often impact the experience of persistent pain. In therapy, mindfulness and stress management teach us how to calm the mind and body in order to alter the experience of pain.
Movement is Harmful
Fact: Lack of movement causes muscles to atrophy, joints and ligaments to stop getting lubrication, and the body to remain stiff and rigid. In managing persistent pain, you want to be moving within the limits your medical providers have defined for you. This could even be small movements for a couple of minutes a day - it does not have to be in long stretches, but movement in general will help.
Activities Should be Pushed through
A common thought that people have is pushing through the activity is better than taking breaks during the activity.
Fact: The best approach is to break down the activity to prevent a flare (worsening pain from baseline) occurring after. This could look like painting for 20 minutes and then taking a 10 minute break. This way, you are teaching your brain the activity is safe and a pain signal is not warranted. Understandably so, individuals have a difficult time with pacing their activities, but it is a large part of therapy and soon you will feel confident and excited to get back into your hobbies!
This service is ideal for…
Individuals seeking relief from chronic pain
Eagerness to learn about the mind-body connection
Willingness to practice small daily skills
Potential benefits include…
Management of chronic pain
Reengaging in your values and hobbies
Improved mood and sleep
FAQs
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