Can Psychology Cure Chronic Pain?

Pain in backs, shoulders, knees, necks and more can significantly limit enjoyment of life. Yet relief may seem impossible dream

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Whether minor or life-crippling, chronic—that is, long-lasting—pain can appear to be permanent. With severe chronic pain, anxiety with regard to how to cope with it plus depression about seeing no relief ahead can add to the suffering. Chronic pain patients typically have sought help again and again from the medical world without success. Fortunately, however, clinical and research psychologists are now pioneering a new treatment that is opening encouraging horizons.

Research has shown that as many as 80% of adults suffer from lower back pain at some point. About 30% of American adults report some form of joint pain in the previous 30 days. Stunningly, the percentage of older adults reporting knee pain doubled over two decades (1974 to 1994) and is still on the rise.

A clinical example of chronic pain

Sandra, an active 75-year-old grandmother still working at her profession, had loved playing tennis and hiking. Yet starting about five years prior, pain in her knee had prevented her from enjoying even short walks. Knee pain was steadily eroding her quality of life.

The pain seemed to have started from too much sitting. After sitting, pain shot out from her knee each time she first stood up. In a few minutes, the initially intense pain would ease. It even might diminish to zero eventually, but lengthy or vigorous exercise would bring it back full force.

Once, a few months prior to seeking treatment, Sandra walked home carrying several rather heavy bags from her nearby neighborhood mini-grocery store.

Sandra suddenly shrieked. A sharp pain in her knee, unlike any she had felt before, prevented her from putting any weight at all on her knee. Realizing that she was unable to walk even a single further step, she flagged down a passing car for the short ride back to her home. Her knee discomfort had escalated to a crippling disability.

By avoiding most walking and, when she did walk, using crutches, the acute pain gradually subsided. A return of her former pain pattern, though, frightened her every time she tried to walk. Stairs scared her. Sports felt out of the question.

“Is surgery my only way back to health?” Sandra worried. “Will I ever walk comfortably again?”

Sandra's orthopedist diagnosed that, according to his x-rays, nothing structural was wrong with her knee. “Yes, your knee is swollen,” he explained, “but nothing is wrong with the bones. Surgery won’t help.”

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What causes the brain to send you an experience of pain?

The scientific evidence for brain-body connection is well established. Pavlov’s classic experiments with dogs made it strikingly clear that expectations (bell ringing signals food is coming) can create physical responses (dog salivates). A part of the body that once radiated pain can evoke an expectation and even a repeat experience of similar pain.

When the brain remembers prior pain it may wrongly interpret and even perpetuate the experience of pain by sending you false alarms in situations that in the past have evoked pain. Pain is the brain’s way of screaming, “STOP!” This pain message aims to prevent you from repeating the same injurious action that in the past genuinely did create a physical problem.

The brain can interpret a smell, an image, a sound, or a particular action (as in Sandra’s case), as signaling the need to protect you via a message of pain.

For example, one study (see reference below) had subjects sit in a car. An unseen speaker played a loud car crash sound while a second car pulled up behind them. The second car never hit the car in which the subject was sitting. No actual injuries occurred. Yet after this “accident,” which in fact involved just sitting in a car and hearing a car-crash sound, a significant percentage of the subjects experienced whiplash pain.

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Sandra sought out help from Lin, an internet-based program for people seeking to end chronic pain. After clarifying that Sandra's pain did not emanate from a structural problem, Sandra's coach at LiN arranged for her to work with a psychologically savvy physical therapist.

During Sandra’s initial consultation session, the physical therapist underscored that, like the orthopedist, he saw no indications of physical damage to Sandra’s knee. He then shared a stream of positive stories about people with similar knee pain with whom he had worked. They, like Sandra, had believed that they would never be able to walk or do sports again, and yet soon were cured.

One story in particular impacted Sandra. The physical therapist described a man significantly older than Sandra who had suffered knee pain similar to hers. Within a matter of weeks of his physical therapy, this fellow not only had recovered fully but had gone on to run a marathon—at the age of 80. Wow! Sandra felt an immediate shift in her thinking. Maybe her knee pain could be ended too.

Why did Sandra’s knee pain begin to lessen immediately after that first “physical therapy” experience? She had barely even started the exercises she was assigned. Yet within a month or two, Sandra was back to walking as long as she wanted, all pain-free.

Sandra’s recovery started when the physical therapist’s comments began to re-train her brain. The therapist had explained, “For the knee to get better you needed to know that your brain has been remembering that certain motions are supposed to hurt. It has therefore been sending habitual but mistaken pain signals in order to 'protect' you."

Re-instilling optimism was the first step in the psychological process of brain-retraining. Other cognitive interventions such as teaching Sandra to interpret pain sensations in new ways furthered the pain-relief process.

In addition to using psychological interventions, the physical therapist told Sandra, "Your muscles may have weakened from not having been used, so you will need for a while to do daily knee exercises."

The bad news and the good about ending chronic pain

Sadly, all too many chronic pain sufferers have yet to find a program whose treatments include psychological pain-removal tools. That's understandable, as the new approach is just in its infancy.

Happily, however, as a psychologist, I have been delighted to discover that an essentially cognitive therapy treatment combined with minimal physical exercises can accomplish what can feel like a miracle for many chronic pain sufferers.

Actually, I personally am especially delighted. That's because “Sandra,” in fact, is me.