Amy Eades, Provisional Psychologist at PsychMed
In 2018, the number of Australians living with chronic pain was 3.24 million, and it continues to be a growing health concern across the world. Sadly, many people who experience chronic pain do not have access to the variety of pain management options that are available. This can be due to factors like location, the cost of accessing treatment, and notably, limited awareness of available options, for example psychological support. An important part of finding an effective treatment is understanding the mechanisms that drive pain in our body, so let’s take a closer look.
Pain is made up of three components:
- Sensory (or physical) – like the impact you would feel if you stubbed your toe or the heat you would feel if you touched fire;
- Cognitive – memories, attention, learned responses, thoughts etc., like remembering that last time you stubbed your toe;
- Affective (or emotional) – a combination of your body’s regulation systems like the stress-response cycle and hormones, as well as emotions that you’re experiencing. For example, if you had a really stressful day at work and you are feeling frustrated, this may have an impact on what pain you experience.
Together, our brain uses these three components, or information inputs, to process a situation and decide whether or not we need protection. If yes, then it will send out a pain signal.
When we look at pain this way, we understand that the way we experience pain is going to be unique. This is because no-one else is going to have exactly the same informational inputs for our brain to consider when processing potential pain. Pain is a highly individual experience and its purpose is to protect us in our own unique life.
In chronic pain, our brain goes into overprotection mode. Even after we’ve sought help and our injury is healed (e.g., we finally saw a physio for that sore back), our brain can still stay in overprotection mode, so much so that it can stop relying on physical input altogether and activate pain regardless of whether the injury is there or not. In this situation, our brain learns to emphasise the emotional and cognitive components of pain, resulting in real pain. This unrelenting pain can lead us into some unhelpful thinking patterns, uncomfortable emotional experiences, and restricted movement that can impact our quality of life in a big way.
So, how can psychology help? Psychologists are experts in providing treatments that help us to readjust those unhelpful thoughts, regulate our emotions, and practice new behaviours. Psychologists can help us to retrain our pain system, so that our brain can come back out of overprotection mode and we can get back to living a life where pain is our ally again. Some evidence-based interventions that psychologists use for pain management include: Cognitive Behaviour Therapy, Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy, and Mindfulness-Based Stress Reduction.
It is important to note that psychologists are one part of a greater team of professionals that work together to help you manage chronic pain. Always make sure you consult your doctors, specialists and allied health professionals to make sure that there are no ongoing physical issues, and to learn other skills that will complement your psychology work. Together, we can help you manage pain and improve your quality of life.
Australian Psychological Society. (2020). Chronic pain in adults: Practice guide. https://psychology.org.au/getmedia/8f4ca513-4512-46d7-bc2d-113f73aa55cb/20pw-pg-chronic-pain-p1-s.pdf
Deloitte Access Economics. (2019). The cost of pain in Australia: Final report. Painaustralia. https://www.painaustralia.org.au/static/uploads/files/the-cost-of-pain-in-australia-final-report-12mar-wfxbrfyboams.pdf
Department of Health (Commonwealth of Australia). (2021). National strategic action plan for pain management. https://www.health.gov.au/sites/default/files/documents/2021/05/the-national-strategic-action-plan-for-pain-management-the-national-strategic-action-plan-for-pain-management.pdf
Goldberg, D. S., & McGee, S. J. (2011). Pain as a global public health priority. BMC Public Health, 11, Article 770. https://doi.org/10.1186/1471-2458-11-770
Hashmi, J. A., Baliki, M. N., Huang, L., Baria, A. T., Torbey, S., Hermann, K. M., Schnitzer, T. J., & Apkarian, A. V. (2013). Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain, 136(9), 2751-2768. https://doi.org/10.1093/brain/awt211
Latremoliere, A., & Woolf, C. J. (2009). Central sensitization: A generator of pain hypersensitivity by central neural plasticity. The Journal of Pain, 10(9), 895-926. https://doi.org/10.1016/j.jpain.2009.06.012
Melzack, R. (1999). From the gate to the neuromatrix. Pain, 82, S121-S126. https://doi.org/10.1016/s0304-3959(99)00145-1
Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education, 65(12), 1378-1382. https://doi.org/10.1002/j.0022-0337.2001.65.12.tb03497.x
Moseley, L. (2003). Unraveling the barriers to reconceptualization of the problem in chronic pain: The actual and perceived ability of patients and health professionals to understand the neurophysiology. The Journal of Pain, 4(4), 184-189. https://doi.org/10.1016/S1526-5900(03)00488-7
The Australian Pain Society. (2017). APS guiding principles for pain management.
The Australian Pain Society. (2021). The role of the Psychologist in the management of pain. https://www.apsoc.org.au/PDF/Position_Paper/20210421_APS_Psychology_Position_Statement_Third_Edition_APR21.pdf