“Why do I need therapy? My pain isn’t all in my head!”

• If someone has suggested to you that having therapy may help if you are in pain, do you worry that you are being dismissed from getting the medical help that you need?

• If you have pain that does not have a medical explanation, do you think that others are telling you that you are making up the pain?

• If you have been treated poorly by healthcare professionals in the past, do you feel that nobody can help you?

• Have you exhausted your options for pain management and been told to go to therapy to “learn how to live with it”?

If you have answered yes to any of these questions, it can make psychological therapy seem like a second-rate choice or something you have to ‘tick off’ to prove to your doctor that you have done it to get more help.

But I am here to briefly explain why psychological therapy can be hugely beneficial if you are struggling with chronic pain and why it is a really important part of pain management. I’m here to provide you with hope that things can get better if you are finding life difficult.

I am writing this both as a person who lives with chronic pain and as a professional who has spent years specialising in working with people struggling with pain and illness. The focus in this post is on Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT).

THE PAIN YOU FEEL IS REAL!

The first thing I want to make clear is that regardless of the diagnosis you have, this pain is not ‘all in your head’. It is almost impossible to understand how difficult chronic pain is to live with and well-meaning friends and family may say things like “well you managed to go out yesterday”, “you look better today” or “I’ve read that x, y, z will be good for you, you should try it”. All these reactions can be incredibly dismissive.

One of the very first things that can be beneficial about having therapy is that someone actually listens and understands what you are experiencing. They get it. Especially if the therapist has a chronic pain condition themselves, this in itself can be hugely validating.

Understanding

Another helpful aspect of therapy tailored to chronic pain is that the therapist can explain to you why you feel pain. The science behind it is beyond the scope of this blog but even when no medical cause is found, there is still a reason why people experience pain. In many cases, doctors and specialists do not have the time to sit down and explain this to their patients.

Therapy can allow as much time as is needed to fully understand what is happening, which in many cases can reduce anxiety and fear around movement and pain.

Pain management

Pain management from a psychological therapy perspective looks at ways in which we can make small changes to make life more meaningful and manage pain differently. Many things can be looked at in therapy but here are a few examples.

• ‘Boom and bust’ cycle. Have you noticed that you have days of feeling good or ‘not so bad’ so you do all those things you have been putting off? Maybe it is the housework, exercising, socialising, food shopping, etc. (This is the boom part). Following this, do you then need days in bed or on the sofa after to recover? (This is the bust part) To help break this cycle, there are a whole host of techniques that we can look at: from pacing activities in a realistic way to noticing unhelpful thoughts and dealing with them in a different way.

• Are you following the advice from healthcare professionals? Are you taking medication as you should be, practicing your physio exercises regularly, etc.? If not, therapy can explore and problem solve anything that is getting in the way of you doing these things without any judgement.

• Do you feel in a constant battle day after day fighting this pain that you don’t want? Ultimately this pain isn’t going anywhere, however much we wish it could. The time and energy spent on fighting against the pain though is taking you away from doing activities that you find meaningful. If this is the case, we can look at how to live a valued, fulfilling life even though the pain is still there and learn to stop that exhausting battle.

Mental Health

Physical and mental health come hand in hand and it is difficult to address one without the other. The research shows that people in chronic pain are more likely to experience symptoms of depression and anxiety than someone who has no health problems. This isn’t surprising given how difficult it can be to live with.

In therapy, we can look at how to manage symptoms of depression and anxiety (or other common mental health disorders such as trauma, health anxiety, insomnia etc.) and see how they link together with pain. An improvement in symptoms of depression and anxiety can help you feel more able to cope with the demands that living with chronic pain brings.

Conclusion

There are many ways that psychological therapy can help you if you are experiencing chronic pain. It is not a replacement for medical advice or a second-rate option, but a complement to what you are already doing and can be extremely helpful. Seeing you as a whole and looking at how to manage both physical and mental health can help you to take steps to live an enjoyable and fulfilling life.

What next

If you would like further information on ways therapy can help when you have pain or a health condition, please click here.

If you are interested in learning more about CBT and/or ACT, I have summarised these here.

If you feel ready to take the next step and book an appointment, you can contact me here.