The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
Of note within this definition is that pain is by nature an experience that creates an emotional response. Pain is often considered an alarm system for the brain to create awareness of a problem of bodily harm that may require action for survival. This is the essence of acute pain, a conditional state that has ensured our wellbeing by calling us to action (or at least be aware of possible threats!). However, when pain lasts longer than this survival intention, it can shift from an acute state to a chronic condition, long past the time needed for the body to mend cuts, bruises, and broken bones. At this point, the emotional response to pain also shifts from one expecting recovery to one wondering what life will look like next.
There are many chronic pain conditions, some that have resulted from clear precipitating factors such as injury or surgery, those that are diagnosable disease processes, those that have a relation to chronic stress and those that seem unexplained or follow an unusual medical course. Neuropathic pain is an alteration of the sensitisation to areas within the central nervous system and is often involved in conditions of chronic pain. The source and diagnosis may have implications for how someone understands their pain, but the tools needed to live with chronic pain are similar amongst conditions. Because chronic pain symptoms interfere with one’s ability to engage in regular activities, pain can create the condition where one feels he has no choice but to cut out more and more of life’s activities. The sense of loss along with the painful symptoms can develop a cycle of low mood, shifts in identity, worry about practical considerations of work and home, struggles with sleeping and eating, and heightened stress. Research has demonstrated this emotional response can have impact in exacerbating the pain symptoms and creating greater sensitisation of the central nervous system.
Psychology works with the individual to identify this cycle and to put a wedge in it. The work helps a person identify valued living within their limitations, focuses on participation, and reviews concepts of pacing. A person’s thoughts about himself, his relationship to pain, and his expectations for the future are clarified to get rid of unhelpful, biased thinking heightening distress. Concepts of identity and purpose are prioritised with a focus on enhancing wellbeing, even with an ongoing condition. The goal is to shift a person from coming into treatment stating, “pain has taken over my life!” to instead feeling confident saying, “I may still have pain, but I’m living my best life!”