• Pain is a complicated issue but it can potentially be tackled to improve quality of life

  • Therapist Elizabeth Turp explores the impact of chronic pain on mental health and how therapy can help

  • If you are struggling with persistent pain, you can find a therapist here

Pain is complex, with many causes and varied manifestations. Living with it long-term challenges your ability to work, earn, sleep, get around, socialise and engage in family life, which can seriously affect mental health.

If managed predominantly by medication, sometimes to minimal effect, it does not cure, and can bring additional issues in side effects, such as fatigue and cognitive difficulties. Taking a holistic approach to pain management, addressing the emotional impact can be transformative to quality of life.

Living with persistent pain poses a threat to overall wellbeing, involving obvious distress from the pain itself, alongside effects on daily functioning, fatigue and ongoing uncertainty – all adding up to chronic stress. Anxiety is common, as pain seems to be telling us that something is immediately wrong, which with chronic pain is often not the case. This can result in a perpetual state of hyper-vigilance, with multiple knock-on effects, including increased tension. Having to adapt to a very different life than you had hoped for can bring anger, guilt, grief and frustration.

An invisible condition that is not measurable in any simple way, it can also bring challenges to relationships: feeling misunderstood, isolated and even doubted. It’s also hard to engage in positive coping strategies while dealing with all that. If feelings are suppressed, this can lead to depression.

How is therapy relevant?

You may wonder how a mental health approach can help with a physical condition, and be understandably resistant if you believe others think that it is ‘all in the mind'. The reality is that the mind and body are not separate entities: pain can cause emotional distress, in turn amplifying pain, just as reducing tension and taking some control can help ease its dominance. Our behaviour in response to pain can also have a negative impact, sometimes avoiding things that might actually be helpful, such as movement. How we view our situation determines whether we feel stuck and hopeless, or able to adapt and find ways forward.

Helpful therapeutic ideas:

Grief models: chronic pain usually brings loss, so looking at what stage you are at with pain (denial, anger, searching, depression or acceptance) is helpful to determine what could help you regain some control, whether it’s making sense of emotions, accepting your diagnosis or grieving the changes it has brought. 

The cyclical models of cognitive behavioural therapy (CBT) are helpful in understanding and addressing how patterns of low motivation, negative thinking, avoidance, fear, lowered activity levels and social withdrawal can make coping harder. There is often nothing that can be done to ‘cure’ chronic pain and also no immediate danger indicated by it, so working with perceptions and beliefs can help reduce anxiety. 

Mindfulness assists the development of an attitude of awareness of the whole self and world around you, which is often compromised by the focus on suffering pain brings. Techniques such as breathing into pain and being able to choose where to place your attention are powerful self-management tools, and reaching a place of acceptance assists in being able to make the most of what you can do rather than getting overwhelmed by what you can’t.

Tasks of Therapy:

An emotional outlet

Grieving losses, expressing anger, dealing with feeling overwhelmed by breaking down individual issues; all can reduce anxiety and increase our sense of control. Talking openly about vulnerability cannot be underestimated, especially if we conceal our feelings to protect loved ones, greatly aiding understanding and bringing relief.

Addressing blocks to self-management

Developing good self-care can be hindered by the beliefs we have about our roles: if you’ve always cared for others learning to take care of you can be hard. While improving mood, therapy can help you adjust to limitations, improve sleep and develop relaxation strategies.

Living for the present 

Pushing against physical limitations with pain can make it worse, and learning to respect limits, pace and rest adequately can lead to reduced pain in some conditions, and ultimately increase mobility and functioning. Learning anxiety reduction techniques can improve quality of life and enhance use of coping strategies.

Dealing with changes to relationships

Therapy can be a helpful place to talk through ways of dealing with problems with loved ones and consider changes to improve your situation.

There are many ways counselling can help you improve your quality of life with chronic pain. An integrative counsellor with experience working with pain will be able to work with you on whatever areas you feel are relevant to you.

Further reading

How to build resilience against chronic pain

What is chronic fatigue syndrome?

The neuroscience of emotional wellbeing

Yoga for chronic pain