Chronic Pain

Chronic or persistent pain can be an incredibly challenging experience. It is defined as pain, in any part of the body, lasting longer than 6 months. But this definition does not really capture what it is like to live with pain. The “symptoms” and impact of chronic pain are not restricted to the area which hurts, but can include the following:

●     inability to perform once-important daily tasks

●     a drive towards conservative behaviour of the fear of making the pain worse

●     worry about one’s ability to live with the pain if it changes for the worse

●     loss of certain roles in family, work, or life

●     grief, fear, and sadness

●     changing relationships

●     difficulty with acceptance

●     challenges of integrating pain as a life transition

For most people with chronic pain, it is safe to say that it isn’t just a physical experience, but rather it’s something that impacts family, relationships, lifestyle, work, and identity. 

Therapy for chronic pain is best as part of a multidisciplinary approach. Chronic pain is a widely misunderstood phenomenon, sometimes even in the medical profession. But modern pain science has made tremendous advances in how we conceptualize and understand persistent pain. What is revealed is a profound connection between the body and the mind, and this is what guides our interdisciplinary approach. Seeing a “talk” therapist can sometimes feel like a judgement that the pain is “all in your head,” but nothing could be further than the truth. Pain is a multi-system syndrome, which affects the very neural structures which connect the brain to itself and one’s body, and talk therapy is the only method that allows us to actually influence those “wires.”

 Nightingale is one of the only group counselling therapy practices that have an office embedded in a multidisciplinary clinic. Our team of counsellors has direct access to kinesiologists, physiotherapists, and other bodily modalities, and can help you find the right help for managing the physical and psychological challenges associated with chronic pain.

Body and Mind

The traditional way that we understand pain is that a damaged nerve/body part sends a signal of this damage to the brain, which is then interpreted as pain. Awful pain, therefore, is just a reflection of whatever is happening in that part of our body—the neck, the back, the joints, wherever. This model leaves very little room for therapeutic intervention, as it sees the pain as a direct reflection of a simple biological/physical problem.

Fortunately, that is not how pain actually works. Instead, when that initial signal is received by the brain, the brain DECIDES WHAT TO DO WITH IT. And then, it sends signals back to that body part which either REDUCE or ELEVATE the pain signalling. What this means is profound: it means that the brain (and therefore the mind) actually has a say in HOW MUCH PAIN we are feeling.

How do we influence our pain?

1.    We can discuss and learn about experiences which generate pain, and which don’t, and learn to navigate life in a more pain free way.

2.    We can influence how the brain“modulates” the pain response.

3.    In the case of emotionally or trauma-driven pain, we can create fundamental shifts in how we “embody” our emotions.

 When the first pain signal is sent to the brain, the mind can determine how “seriously” to take the message. Pain signals have a distinct purpose: pain causes us to stop what we are doing, to immobilize and protect the part of us that is hurt. This is the most common and natural response to pain signals: to stop, and that is its purpose.

But we can DECIDE how serious our pain is. When we stub our toe, we know that it hurts, but it’s not deadly serious. For most of us, the brain sends messages back which rapidly diminish the pain-sending signals, and we are back to walking in a minute or so. But other pain experiences are not so simple. Take for example an injury that leads to hospitalization. In the future, when pain signals come from that same part of the body, the brain has all kinds of evidence that this is VERY SERIOUS. So, it amplifies those signals, increasing the pain, and increasing your need to stop everything and get yourself immobilized.

How can therapy change how we influence our pain?

Counselling therapy for chronic pain can be a powerful tool. By exploring the meaning, the emotions, the thoughts, and the worries associated with specific sites of pain in the body, we can begin to understand just what drives the brain’s decision to either diminish or elevate the pain intensity. And once we understand it, we can begin making shifts in this thinking, just as we do with more traditional “psychological” or “emotional” things in our life.

The second way therapy can influence this “modulating” potential of the brain is through deep learning and awareness of the sensations of pain. Pain, because it’s so uncomfortable and scary, is rarely something that we focus our attention and awareness on. This makes sense: we want to avoid and distract ourselves until the pain disappears. But for those who cannot hope for this disappearance, we can become experts at our own pain. We can listen, and begin to understand just what it’s telling us. Over time, we can learn to distinguish for ourselves which pain is SERIOUS, and which isn’t, instead of relying on the intuition of our brain.  

An example: many people experience “low back pain,” and for some people this can be scary and disabling, and therefore the brain codes it as SERIOUS. But, when we begin to become experts in our own sensations, we learn that the low back is actually gigantic, filled with a diversity of sensations, not all of which should signal “disabling fear.” By learning the VERY SPECIFIC nature of serious pain, we can help our brain code other sensations as not-serious, and therefore help it send pain-reducing signals down into the body.

Pain is a Family Affair

Beyond the therapeutic goal of reducing pain, therapy can also be very helpful in managing the impacts of persistent pain.

For many people who have pain, it will impact their working life, their home life, their friends, their family, etc. Pain can create shifts and changes in the ways we relate to the people in our life, and this can require adaptation. By learning about how these impacts cascade through our life, we can start to take ownership of our place in the world again. New roles can sometimes feel “less than” what we are used to, but they needn’t be that way. Shifts and changes in life happen to everyone. They are opportunities to reshape the way we are in the world.

Secondary Emotions

The pain is one thing, and therapy can help. But what about the secondary emotions that can accompany chronic pain:

●     grief about what has been lost

●     fear about a future that is anything but pain-free

●     shame about our changing capacities and abilities

●     doubt about our ability to keep coping

●     despair about what life might look like if this doesn’t get better

The Benefits of Therapy for Chronic and Persistent Pain

These are all normal responses to chronic pain, and they are worth discussing with a counselling therapist. The primary goal of all treatment for chronic pain in a multidisciplinary team is to reduce the pain itself, or eliminate it entirely. And as is written above, there are several avenues in which counselling therapists can work to influence the severity of your pain. But it’s worth recognizing that beyond trying to reduce the pain itself, the benefits of managing these secondary emotions are extraordinary on their own:

●     enhancing our sense of resiliency

●     greater understanding of the mind-body connection

●     learning to reassure ourselves in the face of fear

●     accepting our new roles and identities in the world

●     discovering legitimate causes of optimism about the future

Chronic pain has a wide range of severities, but there are pathways toward healing for everyone.