Psychological therapy for chronic pain

Dr Lara Lagutina, London, Rotherhithe, UK


Understanding Chronic Pain

Chronic pain is surprisingly common. One in five people suffer from chronic pain on a long-term basis and probably most people at some point in their lives would have had an experience of chronic pain.

Pain experiences are usually subdivided into two main categories: acute pain, which can last from seconds to weeks and is usually a signal from the body, telling us that there is something wrong: perhaps we have had a sprain, a burn or an injury, etc. Chronic pain is more persistent and is usually still there 6 months after the initial injury or starting point.

It is important to mention that chronic pain does not always start with an injury. Sometimes the origin is unclear and can be hard to pin down. However, the most important point to remember is that if there is an injury of any kind, the healing process usually is complete within 6 months. So if your pain persists after that period – it is usually chronic pain, which means it is no longer a signal of damage or injury, but rather the sensation that persists due to changes in the functioning of the central nervous system (CNS). This process is called central sensitisation, meaning that signals related to normal sensations, such as warmth, cold, touch, pressure etc. are interpreted by the brain as painful.

These changes in the CNS are invisible and are not seen on scans or X-rays. However, the pain being invisible does not make it any less real for the sufferer. Chronic pain can lead to a lot of suffering and can strongly affect the person's ability to manage the demands of daily life, their social life, general quality of life, view of self and the future, self-esteem and much more.

Managing Chronic Pain

Many people with chronic pain often come to see a psychologist as a last resort, after they have tried numerous treatments and medical procedures with partial or no results. Part of the reason for this is a common misconception, that if you are referred to a psychologist, this means that your pain is not real, it is "in your head". This is NOT the view a psychologist would hold.

Instead, there are a number of important areas which can be explored and addressed through psychological therapy. One such area is the links between your pain and your mood. Chronic pain can have a strong effect on your mood, sometimes leading to depression and feelings of hopelessness, anger, vulnerability, fear and anxiety. These feelings can not only impact general quality of life, but can also effect the intensity of the pain, making matters worse.

Another common link often present in chronic pain conditions is that between pain and tension. Sometimes our habitual ways of managing stress is to tense up with it, thus subconsciously trying to limit the impact of stress and manage it by holding it tightly in our muscles or other body parts and systems. Such chronic tension in itself can overtime lead to chronic pain, some common examples of this being pain and tension in the shoulders or headaches. Once we have pain, we often continue to defend against it using the same mechanism – tensing up with it, which again is likely to worsen the pain. Psychological therapy can help people learn to manage the pain and stress differently, as well as address the effects of pain on the mood, self-esteem and view of future, thereby helping to enhance your overall quality of life, even if pain remains part of your life. Learning to live with the pain, while still experiencing life as full and meaningful, can be another important task to address through psychological therapy.

Read more: unexplained medical symptoms

Recommended reading:

1. Dr Michael Nicholas, Dr Allan Molloy, et al. (2003), Manage your pain. Souvenir press.

2. Maggie Phillips (2007), Reversing chronic pain. North Atlantic

  For information about the practical aspects of therapy, such as length of sessions please see FAQ.


Chronic Pain