Verified by 
Thomas Rutledge Ph.D.
Chronic Pain
Understanding the Psychology in Chronic Pain
Why pain psychology treatments can help.
Posted May 23, 2019
Most people consider chronic pain—such as pain that lasts for months or years from a bad back or arthritis—a medical condition that should be treated exclusively by a physician or physical therapist. Although this view of chronic pain is common, it is often incorrect—and has resulted in much unintended harm, particularly in recent years. In this post, we’ll learn how a simple medical model for chronic pain frequently produces disappointing treatment results and examine an alternative model for chronic pain based on the best available pain research that reduces harms while improving results.
How people think about chronic pain is important for two reasons. One reason is that chronic pain is one of the most common types of health problems among U.S. adults. Statistics from the Center for Disease Control, for example, indicate that chronic pain affects 1 in 5 (20 percent) of adults. This translates to more than 50 million Americans! Whatever becomes the consensus thinking about chronic pain, therefore, will influence a lot of people.
The second reason is that when people with chronic pain see their condition only as a medical problem, they run the risk of over-relying on medical treatments such as pain medicines and surgeries. Clearly, some patients with chronic pain obtain excellent results with medical treatments alone; however, many other patients either obtain limited improvements or even suffer harms such as surgical complications or addictions to pain medicines. The more a patient relies on medical approaches as their primary treatment for chronic pain symptoms, the higher their risk of experiencing these negative outcomes.
Based on more than a half-century of pain research, we now know that it is more accurate to think of chronic pain as being both a medical condition and a psychological condition. The psychological part of chronic pain refers to the degree of negative social, emotional, and quality of life effects experienced by a patient. In the same way that patients with chronic pain differ greatly in regards to how much the medical side of their condition affects them—one patient with chronic back pain may continue to work and maintain most of their social activities in modified form, for example, whereas another patient with chronic back pain may be unemployed and socially isolated—so too do patients vary in the degree to which they struggle with the psychosocial side of chronic pain. Research shows, for instance, that 33 to 50 percent of patients with chronic pain report clinically elevated levels of depression or anxiety.
To appreciate the psychology of chronic pain, it is useful to refer to a classic psychological theory called Maslow’s hierarchy of needs. Shown in the left figure, psychologist Abraham Maslow believed that human motivation could be understood in terms of innate drives to fulfill physical, social, intellectual, emotional, and spiritual needs. He also believed that these needs could be ordered from basic needs shared across animal life—such as safety—to the highest-level, human-only need he called self-actualization. In Maslow’s model, psychological pain and emotional suffering resulted when people were unable to find ways to fulfill their human needs or when they become trapped in a low-level need and unable to grow (e.g., financial stress causing a person to struggle to meet basic housing and security needs or a divorce producing depression by disrupting important social and emotional needs).
Chronic pain is a rare condition with the ability to disrupt ALL levels of Maslow’s hierarchy. Beyond the unpleasant experience of pain itself, consider some of the ways that chronic pain affects our human needs:
- Pain limits our ability to maintain our family roles as breadwinners, parents, and spouses. Guilt is a common experience among patients with chronic pain when they feel inadequate as parents or romantic partners.
- Pain increases our dependence on others. Over time, many patients with chronic pain come to feel like burdens.
- Pain creates uncertainty about the future, upsetting financial stability and future goals. Anxiety and fear are the most common emotional responses to chronic pain.
- Pain harms relationships with family, friends, and work. Patients with chronic pain frequently become isolated and disconnected from others.
- Pain often steals sources of happiness, contribution, and achievement as a patient’s ability to engage in hobbies, work, and recreational activities is reduced.
The result is that chronic pain adds many sources of stress—while simultaneously subtracting many of our sources of reward and meaning.
Because chronic pain includes a medical side and a psychological side, many patients with chronic pain benefit from including a pain psychologist as part of their treatment program. Patients often react to a pain psychology recommendation as a threat, believing that pain psychology is for patients whose pain is “in their heads.” However, this is simply not true. Pain psychology treatments are potentially useful for every patient with chronic pain. This is because pain psychology aims to help each patient address the ways in which their pain condition is interfering with their ability to fulfill their human needs, using many different treatment approaches to restore relationships and improve function, meaning, contribution, and sources of personal growth.
LinkedIn Image Credit: Roman Samborskyi/Shutterstock
This article doesn't go far enough
While this article describes the way chronic pain can cause emotional distress, it doesn't discuss the way that emotional distress can create or exacerbate chronic pain. For instance, the more childhood trauma a person has experienced, the more likely they will develop chronic pain or other chronic illnesses. Working through this trauma can decrease pain. Chronic stress can also cause or contribute to chronic pain because the physiological changes we experience during stress changes the body and brain in ways that can create pain. Please see my article, "Six Ways to Use Your Brain to Heal Your Pain" on the online Alternative Pain Treatment Directory.
Psychological Side of the Chronic Pain ???
I too feel that this article doesn't say anything unexpected. Chronic Pain is bound to affect all areas of Life, as chronic unemployment or shame would do. In fact, any debilitation / deprivation will reduce the quality of Life. What is required in this article is about how the psychological treatment can significantly reduce the Pain!
The point of these articles is to replace medical care.
We can see why pain patients are despairing and turning to suicide. Psychologists have been running a long false narrative to discredit, demean and isolate people with pain. Since they have been promoting the psychological approach instead of medical treatment, more people with intractable chronic pain are turning to suicide, Psychologists repeatedly conflate people with chronic pain, and drug addicts, in order to promote their services. They will say anything the media wants to hear, to please their corporate funders.
I know people who have died due to this false narrative, and i know people who had their cancer diagnosis postponed because the pain could have been psychological. We won't see any of these clever content marketers and wanna be social media influencers, write about how they turned the pain in other human beings into an opportunity for profit.
They are Gas Lighting us all!
Costructive criticism
Although this can be true. The point of this article is a sales pitch, reason for quick ending. Society also plays a large part of in the depression. Those who continue to work, and can no longer perform their full duties, are looked and and harrassed as a slacker. I have learned to deal with most. Just tired of Drs. telling me my outcome will be less than I am willing to accept.
You are right Joann!
This entire site, is a sales pitch. They continue to misrepresent facts, and distort data and statistics, to promote their industry. Psychologists made all of this a personal, individual problem, and the behest of the corporations funding their research. For decades now they ignored the sociological problems, and blamed the individuals.
These articles are meant to mislead, they are no closer to understanding depression than they were 50 years ago, even with all of the high tech crap they keep promoting. The content on here has to follow a certain allowed false narrative, that does not interfere with corporate marketing.
It should be staggering that none of the researchers ever studied the proliferation of this kind of content marketing, and the rising rates of depression, and suicide. This type of marketing is targeted at the high value patients, people with comfortable lives, and plenty of money for "therapy." There is an entirely different experience for low income working Americans. Psychologists and social workers can expand their incomes exponentially with a few well written articles, that appeal to the corporations.
These clever individuals are in denial over all of the negative effects. They allow people in their profession to continue to mislead the general public, in pursuit of profit. We have to remember this is a profession that endorsed torture, and they are finding new ways to re frame the real distress in our society as a good thing.
The FTC really should put a stop to this kind of marketing, but these ghouls found it was incredibly profitable.
Pain patients are dying at higher rates now
I found psychological approaches, cognitive behavioral, and emotional support type treatments made my condition worse. Mental health professionals are some of the least intelligent people medically that I've ever worked with and don't seem to know even basic things like that relaxation is not always appropriate because it can actually induce migraine. And they rarely appreciate by extension that stress itself can actually prevent migraine. They almost worship calmness or something.
None that I've met have known why talking aloud for long periods of time is often contraindicated in the cranial or trigeminal neuralgias.
They are often using very dated understandings of clinical medical diseases and "guiding" patients to the wrong things in my experience.
Not surprised myself the patients are dying at higher, rather than lower, rates with all these "psychological" healers around. Mostly just overpaid theorists who don't choose to do very much reading in the Neurology or Anatomy sections of the library (Cognitive Neuroscience doesn't count) and often delay prompt medical care for patients who often have serious neurological conditions that are being inadequately, if at all, treated medically speaking.
I'm a big advocate for pain patients in particular being able to get refunds from professionals like this guy. Or reallocating "psychological" healthcare reimbursement dollars to better things emotionally over the long term for patients like housing or better health insurance to see exorbitantly expensive doctors who are often better clinically and can also deliver the emotional support component when they can bill for forty five minutes of talking to patients like me at their regular medical doctor reimbursement rate.
Instead, patients like me often get medically useless commentary like the above for like $150 an hour from a therapist claiming to be psychologically supporting us who doesn't actually know what they are even talking about.
Bizarre, frankly. I thank god I see an anesthesiologist and a Neurologist and an ENT and an Allergist now. All doctors. The psychologists were going to cause me to suicide if it went on much longer with the hierarchy of needs and emotional wellness frou frou BS stuff.
I'm still in pain myself, the condition going back five generations in my family - identified finally once a million doctors took over my care, but deleting the pains in the behind mental health specialty definitely helped a lot emotionally in supporting them not talking to me anymore about things they didn't actually understand.
Ha, I just thought about all the "soothing nature walks" psychologists always seemed to like psychologically manipulating me into doing that I kept telling them I liked alright but didn't really "feel like" doing often. They love the "feel like" in the mental health specialty.
All the talk therapists I saw framed this as a depressive response...
Turns out, once a psychologist stops talking, a patient can be told by an actual doctor that it's terrible for allergy sufferers to walk around wetland marshes and the patients will often "resist" - which is normal. So comforting psychologically to see doctors for me personally as a patient. but hey - if it looks like a behavior or activity a middle class white person who's psychologically well and and maybe goes to church and talks softly or meditates and isn't on heroin or swearing like a truck driver would do - and it's essentially free like relaxation or stress reduction or meditation or mindfulness - a psychologist or talk therapist can definitely help you - for a fee...
Post Comment