Chronic pain comes with unique challenges that span the medical realm and virtually every area of one’s life. Pain can impact one’s ability to engage in activities and relationships with others. One’s sense of self and self-worth may be impacted by pain. Exercise, sleep, work capacity and finances may suffer. These are a few examples of the challenges that may come with chronic pain, and all of them will be influenced by other psychological factors, such as anxiety or depression. Often, anxiety or depression may worsen with chronic pain. Things that would normally bring a person joy or emotional stability (e.g., time with friends, exercise) may not be possible any more, or only in very limited doses.
People are often surprised to hear that pain psychology is a psychological specialty. Pain psychologists typically have a PhD in clinical psychology and completed an APA-accredited post-doctoral fellowship in chronic pain. Pain psychologists may have a private practice. More commonly, a pain psychologist works as part of a multidisciplinary pain treatment team within an academic pain clinic, private pain clinic, in a hospital rehabilitation setting, or in an outpatient chronic pain functional restoration program.
You may think of pain as being something negative (noxious) that you feel in our body. However, the International Association for the Study of Pain defines pain as being both a sensory and an emotional experience. Psychology is built into the very definition of pain! How you think and feel impacts pain processing at the neural level, and this establishes one of the foundations for the mind-body connection. Learning techniques to better regulate sensory experience begins with learning how to best regulate your thoughts and emotions. This is one important part of pain psychology.
Another important part of pain psychology involves looking at how our thoughts and emotions influence our daily choices and therefore our pain. As an example of this, “Susan” was a woman I worked with who had chronic head and neck pain. As her pain worsened she was less able to parent her children, and this caused her extreme guilt and began to rattle her sense of identity, which was very much linked to her role as a good mom who was engaged in her children’s lives. She coped with her guilt by pushing herself hard each day in an effort to maintain her old role. Her guilt-driven ‘pushing’ was serving to flare her pain, leading to greater need for medication, and more ‘down days’ due to uncontrolled pain. I worked closely with Susan to develop skills that helped decrease her emotional distress and physiological hyperarousal—two factors that feed pain. She learned how to set limits with herself and others to best manage her pain—something that lead to growing pain within her whole family, but ultimately served her well and got her on the road to recovery.
There’s much more to pain psychology—tune in to future columns to learn more!