Chronic Pain

The extent of the problem
Chronic pain is a common problem, affecting around 10% of adults. Impact pain on their lives varies from minor restrictions to complete loss of independence.

What is chronic pain?
Pain is best defined as a sensory and emotional experience, as described by the person suffering the pain, whether or not a cause can be identified. Chronic pain is long-lasting pain which has not been relieved by treating the cause, if known, or by trying to relieve the pain itself. For this reason, it usually refers to pain arising from conditions which are not life-threatening, for instance, low back pain, rheumatoid arthritis, recurrent headache.

Causes
Pain represents activity in the nervous system. Often this signals danger, and prompts us to take the necessary action. In chronic pain, even when it started with an injury, pain can arise where no damage or harm is involved, through complex patterns of over-activity in the nervous system. Unfortunately, we are not able to ‘switch off’ this over-activity.

Mood
People with chronic pain are often unhappy or depressed; they may also be worried about the pain and its implications. They often describe themselves as frustrated by the ways in which pain limits them, and by the lack of a medical solution.

Thoughts and beliefs
It is very hard not to attend to pain, unless it is mild, and to want to stop it, even though many previous efforts have failed. Worries about it may be about the physical meaning of the pain, and whether it means disease or damage, and about the emotional cost to the sufferer. The depressed person may think that the pain has taken away all that is important to them in their lives, and that the future only holds further losses and isolation.

Behaviour and motivation
Responding to high levels of pain as a danger signal tends to mean resting, and sparing the painful area by using physical supports and aids. However, over the long term these contribute to disability. It is common to get into cycles of overexertion to try to achieve goals, followed by rest to recover from the pain which results. In addition, seeking medical help often ends in disappointment, and sometimes in unnecessary and damaging treatment.

Treatment
Once the pain sufferer has been properly investigated and the identified cause treated, but without the success, the pain itself becomes the focus of drug, physical and electrical attempts to block it. If these do not work, or work well enough, the focus becomes pain management; attempting to rebuild as satisfying a life as possible despite continuing pain. Part of this consists of physical methods and practical problem solving to regain valued and necessary activities, and confidence and pleasure in them. These new habits can be applied to minimize the impact of pain in all areas of life. Another part consists of examining the beliefs and thoughts which lead to worries or depression, and challenging them using accurate information, new experiences in regaining activity, and appreciation of personal and social resources.

Pain management is usually delivered by a team – at the minimum, a psychologist and physiotherapist following screening by a doctor experienced in pain treatments. At best, pain sufferers return to happy and productive lifestyles; at least, they recognise that they are not alone, and broaden their range of coping strategies.

What are behavioural and cognitive psychotherapies?

Behavioural and Cognitive Psychotherapies are psychological approaches which are based on scientific principles and which research has shown to be effective for a wide range of problems. Clients and therapists work together to identify and understand problems in terms of the relationship between thought, feelings and behaviour. The approach usually focuses on difficulties in the here and now, and relies on the therapist and client developing a shared view of the individual’s problem. This then leads to the identification of personalised, time-limited therapy goals and strategies which are continually monitored and evaluated. Behavioural and Cognitive Psychotherapists work with individuals, families and groups. The approaches can be used to help anyone irrespective of ability, culture, race, gender or sexual preference.

Behavioural and Cognitive Psychotherapists are usually health professionals such as nurses, psychologists, doctors, social workers, counselors, etc. Whilst all behavioural and cognitive psychotherapists share the above principles, individual therapists may call themselves Cognitive Psychotherapists, Behavioural Psychotherapists, Cognitive Behavioural Psychotherapists or Rational Emotive Behavioural Therapists. These different titles often reflect the preference and training of the individual therapists for specific techniques which addresses problematic thoughts, assumptions and beliefs directly (Cognitive Psychotherapists), address behaviour directly (Behavioural Psychotherapists) or a combination of techniques aimed at addressing thought and behaviour (Cognitive Behavioural Psychotherapists, Rational Emotive Behavioural Therapists). However, whatever techniques they prefer to use, all therapists aim to help clients achieve desired change in the way they think, feel and behave.