What is chronic pain?
Chronic Pain is pain that does not go away. When pain lasts longer than 3 or 6 months, or beyond the usual time of recovery, it is said to be chronic. Different types of chronic pain exist, many of which are not clearly understood. Chronic pain may be associated with an illness or disability, such as cancer, arthritis, or a phantom limb. Some types of pain start after an injury or accident and become chronic over time. Others may begin gradually, as is sometimes the case with low back pain. In some types of chronic pain, like migraine headaches, the pain is recurrent, rather than constant. There are many other kinds of chronic pain, such as postsurgical pain, fibromyalgia, and neuropathic pain. In some cases, the cause of the pain remains unknown.
Research indicates that between 10% and 30% of Canadians experience chronic pain. The direct and indirect costs associated with this are staggering, with estimates in the billions of dollars annually. Women tend to have slightly higher rates of chronic pain than men. People of all ages can experience chronic pain, but it is most common in middle age (for additional information about pain in the elderly, please see the CPA “Chronic Pain Among Seniors” Fact Sheet). Chronic pain can make simple movements hurt, disrupt sleep, and reduce energy. It can impair work, social, recreational, and household activities. People who have been injured in accidents may develop other symptoms, such as anxiety and depression. Chronic pain can have a negative impact on financial security and, in some cases, it can contribute to alcohol or drug abuse. It can also disrupt marital and family relationships.
Pain is invisible. As a result, many people who experience chronic pain feel misunderstood and/or alone in their suffering. Some people feel judged or stigmatized, whereas others believe pain is “all in their head.” Pain is, indeed, “all in the head” because the brain is located in the head, and the origin of pain resides in the brain. Because chronic pain can negatively impact quality of life and functional abilities, it is not surprising that more than a quarter of people who experience chronic pain also experience significant depression or anxiety.
Medications are often used to treat chronic pain. Indeed, medications can help, however, the suitability of long-term use needs to be carefully considered and monitored.
How can a psychologist help a person with chronic pain?
Psychologists focus on many aspects of chronic pain, including assessment, treatment, research, teaching, and advocacy. In terms of treatment, psychologists use several different approaches and techniques to help people with chronic pain improve their quality of life, regain their sense of purpose, and improve their functional abilities. Psychologists address important themes, such as acceptance and loss, and they help people with chronic pain through support, education, and skill building in areas such as relaxation, mindfulness, problem solving, goal setting, sleep, assertiveness, and adaptive thinking.
Cognitive behavioural therapy (CBT) is a form of psychological treatment that focuses on thoughts, feelings, and actions. It aims to help people think and behave in more adaptive ways. Acceptance and commitment therapy (ACT), another psychological approach, focuses on acceptance, choice, and committed action. It aims to help people live in ways that are consistent with their core values. Mindfulness meditation is yet another approach that can help individuals with persistent pain. In all cases, a basic treatment goal is to improve functioning and quality of life, as opposed to eliminating pain symptoms. A vocational assessment examines a person’s interests, aptitudes, and abilities. It can be useful for individuals who may need to change the way they work or the type of work they do. Psychotherapy for anxiety and/or depression can be helpful for individuals experiencing chronic pain, as can treatment for drug or alcohol abuse, when required. Couple, marital, or family therapy can also be beneficial for addressing pain-related interpersonal difficulties.
Are psychological approaches effective?
Numerous scientific studies have demonstrated the effectiveness of psychological approaches in helping people with chronic pain. Psychological treatments have been shown to improve quality of life and functioning in many life domains, such as activities of daily living, emotional health, and interpersonal relationships. Following psychological treatment, people report they are more active, more confident, and more in control of their lives, as well as less depressed and less anxious. In many cases, they endorse reductions in pain and physical symptoms. Even though people may continue to experience pain, it is often more manageable.
Although individual therapy may be offered, people experiencing chronic pain are often treated in groups where they are able to share their experiences with others. Because chronic pain is complex, psychologists frequently work in interdisciplinary or multidisciplinary teams comprised of other health care professionals, such as physiotherapists, occupational therapists, physicians, nurses, and social workers. Again, the primary treatment goal is to help people with chronic pain develop satisfying and healthy lifestyles. Interdisciplinary chronic pain rehabilitation programs are as effective in reducing pain intensity as medications and medical interventions; however, they are more effective in decreasing medication use, reducing health care utilization, improving functional activities, improving mood, and promoting return to work.
How can research help?
In addition to working directly with people who experience chronic pain, psychologists have contributed significantly to our understanding of chronic pain through many types of research. For example, some studies focus on reducing the incidence of chronic pain through injury prevention or early intervention programs. Other studies examine the effectiveness of chronic pain treatments. Some researchers examine how psychological variables influence pain and suffering, whereas others study the role of the central nervous system in a variety of chronic pain conditions.
Where can I get more information?
For information about chronic pain, you could contact the Chronic Pain Association of Canada (www.chronicpaincanada.com) or the Canadian Pain Society (www.canadianpainsociety.ca).
Information about pain in children is available at the web site entitled “Pediatric Pain – Science Helping Children” at Dalhousie University, http://pediatric-pain.ca/ .
Consultation with or referral to a registered psychologist can help guide you as to the use of the therapies mentioned in this Fact Sheet.
You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, please visit: https://cpa.ca/public/whatisapsychologist/ptassociations/
This fact sheet has been prepared for the Canadian Psychological Association by Dr. John Kowal, a private practice psychologist.
Revised: January 2021
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