Chronic Pain: Taking Back Control

Updated: Sep 5

Michelle Taylor, PsyD, LMHCA


According to the Institute of Medicine (2011), 100 million Americans suffer from chronic pain. Chronic pain affects individuals of all ages, with headache, back pain, cancer pain, arthritis, and neurogenic pain being the most common chronic pain complaints. In addition to physical disabilities, chronic pain is associated with high levels of emotional distress. Roughly half of chronic pain patients meet criteria for depression (Peters et al., 2017); furthermore, individuals with chronic pain are at least twice as likely to report suicidal behaviors or to complete suicide as the general population (Racine, 2017).


While acute pain is a normal sensation triggered in the nervous system to alert you of a possible injury, chronic pain is different. Chronic pain persists and pain signals keep firing in the nervous system. From an evolutionary perspective, pain is perceived as a threat or damage to one’s biological integrity. Pain has sensory and emotional features, which provide information for adaptation and survival. While pain serves us well in these respects, disability and suffering can occur when pain persists relentlessly (Chapman, 1995).


Some individuals who experience sustained unrelieved pain suffer because the pain changes who they are as person. At a physiological level, chronic pain fosters an extended and destructive stress response characterized by neuroendocrine dysregulation, fatigue, dysphoria, myalgia, and impaired mental and physical performance. This sequence of discomforts and functional limitations can promote negative thinking and create a vicious cycle of stress and disability. The person in chronic pain can therefore feel trapped in a situation that evokes a sense of helplessness. Individuals can further suffer when this cycle contributes to the inability to sustain productive work, have a normal family life, and have supportive social interactions (Chapman & Gavrin, 1999).


There is mounting evidence that positive psychological well-being is associated with reduced risk of physical illness, and prolonged survival (Steptoe et al., 2009). Additionally, higher levels of resilience are associated with higher levels of pain acceptance, active coping strategies, and adjustment to pain (Ramirez et al., 2012): positive psychology interventions, Acceptance and Commitment Therapy, and Cognitive-Behavioral therapy have all been shown to increase resilience in individuals with chronic pain.


Research focused on relationships and social support theory suggests that relationships with others promote psychological and physical well-being for individuals with acute and chronic illness (DiMatteo & Hayes, 1981). Positive family relationships, in which there is mutual understanding and good communication, has shown to increase the likelihood of sustaining employment and to decrease depression in the family member with chronic pain (Hung et al., 2017). Further, better martial quality is associated with less pain and lower pain-related disability: patients with partners who are responsive to their pain experiences report improved physical functioning (Wilson et al., 2017).


While chronic pain can make you feel like you’ve lost control of certain areas or aspects of your life, going to talk to someone in therapy is one way to start gaining back control. Therapy can help you to process how chronic pain is affecting your life, your partner’s life, or your lives as a couple. Like any challenging issue in life, the more support you have from others, the stronger and more capable you feel moving forward.


References

Chapman, R. C. (1995). The affective dimension of pain: A model. Advances in Pain Research and Therapy, 22, 283–302.


Chapman, R. C., & Gavrin, J. (1999). Suffering: The contributions of persistent pain. The

Lancet, 353, 2233–2237.


DiMatteo, R., & Hayes, R. (1981). Social support and serious illness. In B. Gottlieb (Ed.), Social networks and social support (pp. 117–148). Sage Publications.


Hung, M., Bounsanga, J., Voss, M. W., Crum, A. B., Chen, W. & Birmingham, W. (2017). The

relationship between family support; pain and depression in elderly with arthritis. Psychology, Health and Medicine, 22(1), 75–86.


Institute of Medicine. (2011). Relieving pain in America: A blueprint for transforming

prevention, care, education and research. The National Academies Press.


Peters, M. L., Smeets, E., Feijge, M., van Breukelen, G., Anderson, G., Buhrman, M., & Linton,


S. J. (2017). Happy despite pain: A randomized controlled trial of an 8-week internet-delivered positive psychology intervention for enhancing well-being in patients with chronic pain. Clin J Pain, 33(11), 962–975.


Racine, M. (2017). Chronic pain and suicide risk: A comprehensive review. Progress in

Neuro-Psychopharmacology & Biological Psychiatry, 87(20), 269–280.


Ramirez-Maestre, C., Esteve, R. & Lopez, A. E. (2012). The path to capacity: Resilience and

spinal chronic pain. Spine, 37(4), 251–258.


Steptoe, A., Dockray, S., & Wardle, J. (2009). Positive affect and psychobiological processes relevant to health. Journal of Personality, 77(6), 1747–1776.


Wilson, S. J., Martire, L. M., & Sliwinski, M. J. (2017). Daily spousal responsiveness predicts

longer-term trajectories of patients physical function. Psychological Science, 28, 786–797.

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