Insights into Chronic Pain
Physical pain is a normal human experience. It’s a signal that something may need our attention, a signal to seek help. Pain is essential to survival. Without pain, we would not be aware of the risk of injury, illness or harm. In the 21st century, we are fortunate to have access to medical knowledge and technology that can ease pain quickly and effectively. However, there are pain conditions that do not respond to treatment, and this can lead to the experience of chronic pain. Chronic pain is defined as pain that lasts for longer than three months.
Chronic pain can occur as a result of medical injury or illness. There are also a range of pain conditions that don’t have an identified medical cause such as injury, degeneration or disease. These are often referred to as medically unexplained symptoms or functional pain syndromes. These account for a significant proportion of visits to medical practitioners. Examples include fibromyalgia, chronic fatigue, IBS, chronic pelvic pain, tension headache, non-cardiac chest pain. Although pain is experienced in different parts of the body, these conditions share common symptoms, including fatigue, sleep disturbance, anxiety and fear of movement.
People that experience these conditions can face many challenges. The search for an explanation and cure can lead to multiple medical visits. People tend to restrict movement as a way of minimising or avoiding pain. Over time, this can lead to withdrawal from social activities and other interests. Stress tends to exacerbate symptoms. Worrying also reinforces the sense that movement will make symptoms worse, leading to anxiety or hypervigilance about everyday activities. These factors tend to reinforce the experience of pain, leading to what is called Central Sensitisation. Pain receptors in the brain lose their ability to distinguish between different types and levels of pain or discomfort. This results in a one-size-fits-all response that amplifies body sensations. Over time it becomes a pain memory, acting like a default program in the brain.
Advances in Understanding
Advances in neuroscience, neurophysiology and psychology research in recent years, have helped in developing a better understanding of these conditions. An important finding is that these conditions should be treated as a mind-body
problem. This involves going beyond physical symptoms to considering the role of other factors, such as prior illnesses/infections, adverse events/trauma and associated psychological vulnerabilities.
Advances in Treatment and Neuroplasticity
Research has established that non-pharmacological treatments can help in managing symptoms, reducing pain and improving quality of life. Cognitive behavioural therapy is useful in helping people to re-train how the mind interprets and responds to pain signals. This reduces catastrophic thinking and fear of movement. Physical exercise complements and reinforces brain-training.
Psychological therapies such as clinical hypnosis and EMDR can be used to help “re-calibrate” the mind-body communication pathways that are maintaining pain memories and default pain-response programs. Given the role of prior trauma in the onset of chronic pain conditions, EMDR is an evidence-based treatment for helping people process and resolve traumatic memories. All of these treatments work on the principle of neuroplasticity, which is the ability of the brain to rewire and change the neural connections formed and strengthened through the experience of chronic pain.
Persistent pain should not be ignored, and medical advice should be sought to examine the cause. Chronic pain is not “all in the head”. It is a mind-body problem that can benefit from an integrated treatment approach that considers the biological, psychological and social factors at play. Medical practitioners play an important primary care role in advising and guiding treatment options.
Anne Ward is principal psychologist of Mindinsight, providing evidence-based psychology and coaching services. Mindinsight is located in the T&G Building at 45 Hunter Street Newcastle. Phone 4942 7660 or visit www.mindinsight.com.au for more information.