What is Chronic Pain?

Healthcare providers define chronic pain as persistent pain that lasts more than three months. The pain does not necessarily have to occur every day, but it often does. Millions of people around the world suffer from chronic pain due to a wide variety of conditions, including arthritis, injuries, amputations, cancer, and bursitis.

Why is it Important?

People with chronic pain often experience tremendous changes in their lifestyles as a direct result of the pain. For example, many people find that they are no longer able to work or engage in many physical activities they once enjoyed in their leisure time. They sometimes stop spending time with friends and family because of the pain. Chronic pain, and all of the lifestyle changes that come with it, may also lead to psychological problems, such as anger, depression, and anxiety.

In the United States, chronic pain sufferers often spend thousands of dollars seeking a cure for their pain, only to be disappointed and frustrated when nothing gets rid of the pain. Treatments for chronic pain range from physician-prescribed medications and surgery to alternative therapies such as acupuncture and herbal remedies.

Currently, many healthcare professionals who specialize in pain treatment believe that psychological interventions may be important in treating people with chronic pain. Psychologists can be particularly helpful by teaching chronic pain sufferers how to manage the negative feelings that occur with the many lifestyle changes that accompany chronic pain.

If you suffer from chronic pain, or are unsure if you do, you should consult your physician regarding treatment options before engaging in any treatment for your pain.

Negative Cycles

People with chronic pain often experience three cycles: The Anger Cycle, The Anxiety Cycle, and The Depression Cycle. Not every person with chronic pain experiences all of these cycles, but many people experience at least one of them.

The Anger Cycle

People with chronic pain often report that they become irritable and angry more easily than they used to. This happens because of the Anger Cycle.

You may find yourself becoming angry and irritable over little things that never would have bothered you before your pain began. Perhaps you become angry because no one washed the dishes after dinner, when previously, you would have simply washed them yourself and would not have thought much about it.

Here is what happens in the Anger Cycle:

• the person experiences pain;
• the pain triggers negative thinking (e.g. "My life is ruined now!");
• the negative thinking then produces anger and frustration;
• the anger and frustration lead to increased stress and muscle tension;
• the increased muscle tension produces more pain;
• the increased pain keeps the cycle going.

The Anxiety Cycle

Maybe you find yourself feeling nervous and worrying a lot about things that would not have worried you before your pain began. You might find yourself worrying about bending over to pick up a piece of paper, about lifting a heavy bag of groceries, or about taking a long trip in the car. Before your pain began, you probably never gave these things much thought at all. Now, however, they make you feel nervous and worried. If so, you could be experiencing The Anxiety Cycle.

Anxiety occurs when you are worried about something before it even happens. Often the worry is not based on fact, but on negative speculation. Many people with chronic pain often become fearful and worried about doing many of the things they enjoy because they are afraid that activity will increase their pain.

These fears trigger the Anxiety Cycle which looks like this:

• the pain triggers negative thinking (e.g. "What if my back gives out when I bend over?");
• the negative thinking produces feelings of nervousness and fear;
• as a result of the nervousness and fear, the person begins to avoid lots of activities thinking that they will avoid the pain;
• as a result of the reduction in activities, the muscles weaken;
• the weakened muscles make the person susceptible to feeling more pain than they normally would, when they are forced to do something;
• this increased pain then tells the person that they were correct to have avoided activities in the first place.

On the other hand, if the person had remained active all along, then he or she may not have experienced the sudden increase in pain after a long period of inactivity, and could have avoided the Anxiety Cycle.

The Depression Cycle

Because people with chronic pain have often undergone many life changes as a result of their pain, they feel depressed and hopeless easily. For instance, your friends call and ask you to go to a restaurant with them. You decline because you feel tired and sad. When your grandson comes to spend a weekend with you, you may find that you have to force yourself to play with him for even an hour, whereas before the pain, you might have planned an entire weekend of fun activities.

If so, you may be experiencing The Depression Cycle which looks like this:

• the person experiences pain;
• the pain triggers negative thinking (e.g. "I might as well just go to sleep and never wake up. I'm useless!");
• the negative thinking makes the bad feelings more pronounced, giving rise to hopelessness and worthlessness;
• the feelings of hopelessness and worthlessness deprive a person of energy;
• as a result of the lower energy, the person participates in fewer physical activities;
• as a result of fewer physical activities, the muscles are weakened and the person experiences more pain.

And so, people who are caught in the Depression Cycle end up feeling stuck, sad and hopeless.

The Importance of Physical Activity

As mentioned previously, many people with chronic pain tend to avoid physical activities. Sometimes the avoidance is because of anxiety. The person is just very afraid of getting hurt or of experiencing an increase in pain. Sometimes the avoidance is related to depression. Depressed people often feel exhausted and have difficulty getting motivated to participate in physical activity.

Some people with chronic pain avoid just a few activities, like lifting a heavy box or carrying an armload of groceries. Other people with chronic pain try to avoid all physical activity. They may sit in a chair or lay in bed all day long, watching television.

When you avoid physical activity, your muscles become weak. When your muscles become weak, it hurts even more when you actually have to move them. So, if you've been laying in bed for a week and then have to walk to the mailbox one day, your pain will be greater than if you had just walked to the mailbox every day that week!

If you have chronic pain, you should speak with your physician about developing a program of physical activities that are safe and helpful for you. It is very important to remember that there is a difference between feeling hurt (i.e. feeling pain and discomfort) versus harming yourself (i.e. where you are doing damage to your body). People with chronic pain often experience "hurt," but that does not mean that they are "harming" themselves. You doctor or a physical therapist can help you learn to tell the difference.

Negative Thoughts

Chronic pain is often accompanied by a lot of negative thinking. While you may not be able to make the pain go away, by effectively dealing with your negative thoughts, you can learn to live with your pain and still enjoy life. In Part 2 of this article, I will discuss in detail some of most common forms of negative thinking which accompany chronic pain, and will show you how you can counter these negative thoughts. Please see link below for Part 2.

NOTE: The purpose of this article is to offer readers general information about the ways in which psychology and psychotherapy can help a person cope with chronic pain, and is not intended to serve as treatment in any form. Please check with your physician if you have specific questions about pain management.