chronic pain and depressionChronic pain sucks. Research published in the British Medical Journal in 2016 revealed that almost half of all people in the UK live with chronic pain, with rates of pain rising as people age. I don’t know about you, but that’s a clear sign that there’s something wrong. Chronic pain is defined as being a pain that goes on for longer than 12 weeks despite medication or treatment. From a medical viewpoint, although more people than ever have access to painkillers and medical treatment, reported levels of pain keep rising.

For most of us, our conception of how pain works in the body is just plain wrong.  We think that we hit out finger with a hammer and there is a reaction of nerves in the surrounding area firing which causes the pain. That the pain is right there in our finger that we just walloped; we can feel it.  However, pain and sensations in the body are actually governed by the brain. The amygdala and other parts of the brain take in information about what’s happening in the body and the environment around us and control if we perceive pain or not. When someone experiences chronic pain, often the messages to the brain have become mixed up or certain areas of the cerebral cortex are over-activated leading to ongoing sensations of pain and discomfort.

In the UK and other parts of the world people with chronic pain are often referred to specialist pain clinics for chronic pain treatment. At those clinics they are prescribed ‘pain management programmes’ where they are taught stress reduction and emotional regulation techniques alongside gentle exercise to keep them mobile.  For many people these referral smack of being told ‘it’s all in your head’ and they feel dismissed and distrustful of the medical profession.

However, there’s a lot of evidence behind teaching people to regulate their emotional states and stress responses when it comes to living with chronic pain. Harvard Health Publishing writes that “people who have a poorly regulated response to stress are also more sensitive to pain.” I think most of us recognise that chronic pain can cause us to feel more stressed. This then sets off a neat feedback loop of increasing stress levels leading to higher pain levels, which leads to even more stress. This feeds into the situation where the areas of the brain that process pain signals become over-activated leading to the symptoms of pain.

The University of Utah performed a study which demonstrated this principle back in 2012. Researchers examined the pain responses of three different groups of people: 14 people with fibromyalgia, 16 people with no health concerns, and 12 experienced yoga practitioners. Using thumbnail pressure, this study showed that people with fibromyalgia experienced pain at lower pressure points. Functional MRIs of those participants showed greater activation in the brain to the pressure sensations than either the control group or the yoga practitioners (the yoga practitioners had the highest tolerance for pain / lowest levels of brain activation in the FMRIS).

So, why is this interesting? The researchers posited a couple of theories at the conclusion of their research; firstly, it wasn’t the pain itself that changed in the participants’ perceptions, it was the thoughts the participants had about pain, which for the fibromyalgia group participants included higher levels of anxious and catastrophic thoughts regarding the levels of pain. Secondly, from examining the yoga practitioners group they developed a theory that you can learn stress management and other lifestyle techniques which enable to you tolerate pain and discomfort more effectively.  This means that you can reduce the levels of activation in your brain that are signalling to your body ‘look out, we are in danger’ and change the relationship you have to whatever part of your body it is that’s giving you grief.

I’ve lived with chronic pain and illness myself, so I get it. When you’re in a cycle of flare ups it sometimes feels like there’s no way to find relief. The ever present pain changes the way you think, leading you down the path of feeling anxious or catastrophising because … IT HURTS! The pain stops you from carrying out activities that other people take for granted that help reduce and relieve stress, often something as simple as sleep is an ongoing battle because of constantly shifting, trying to get comfortable. It doesn’t seem to be treating the issue with enough gravity to be treating it with meditation or mindfulness.

This is all part of the spin cycle your brain goes into when it’s dealing with chronic pain.  Pain of any variety sets of our fight-or-flight stress response systems, even when we know it’s there and we are expecting it. Instead of being on alert for an outside enemy, the focus turns inwards towards the body. At the same time, because the body isn’t comfortable, it’s inevitable that some level of disassociation happens. It’s common to hate or resent your body for what it’s putting you through. Changing these thoughts and responses to that pain takes head space that’s difficult to find in the middle of the experience.

True ‘pain management’ needs a multi-faceted approach. This involves getting sleep back in order, connecting you back to family and community, and leisure activities that have gone by the wayside of the years. It involves learning different ways of dealing with stress, and perhaps even changing what you’re doing so there’s less stress overall in your life. Most of all, it involves changing the relationship you have with yourself, with your body, with those parts of you that are causing you pain. I know this, because I’ve walked this path (hobbling along with a walking stick at times). If you’d like to chat about this more, please book a free call with me using the link below.