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Chronic Pain

Can Psychotherapy Do Anything for Pain?

How does psychotherapy address the multidimensional effects of pain?

Key points

  • Pain and depression are strongly linked; painkillers can cause depression and irritability.
  • Research shows ACT can help people with chronic pain to accept their pain and move forward with their lives.
  • Two other therapies to help with chronic pain are interpersonal therapy and compassion-focused therapy.
Geralt / Pixabay
Source: Geralt / Pixabay

When I first entered the mental health field, I did not see physical pain as something I would treat. I understood that many of the individuals I encountered were dealing with pain.

It's extremely common, affecting 20 percent of us (Kuehn,2018). I also understood that pain would naturally affect someone's well-being. No one likes to hurt.

It wasn't until I had my own, admittedly mild, brush with chronic pain that I started to appreciate this a little more. In my early 30s, I developed neck pain and migraines. At times, it is a daily thing.

I particularly remember preparing to go to a festival with friends when someone said, "Why are you even going to go if your neck is just going to hurt the whole time?"

"My neck is going to hurt no matter where I am," I snapped back.

That was true. I didn't want to stop doing things because of this, and, in all reality, the pain would likely be there tomorrow, the next day, and so forth.

As I met more and more people coping with pain, I became curious about the interplay between pain and mental health. There is a strong relationship between pain and depression. Pain serves as a natural stressor, placing one at higher risk for mental health issues of all kinds, both psychologically and in the body's response to that stress (Blackburn‐Munro, 2001).

It's not an all-or-nothing thing, either. Longitudinal studies suggest that the higher the intensity of pain, the worse the depressive symptoms (Angst, 2020). Unfortunately, many medications used to treat pain can also have psychological side effects, such as depression and irritability.

Pain also affects us on a broader scale. It is usually a signal for us to slow down. When we feel pain daily, we are primed to withdraw. It can feel like others' lives are moving forward while yours stands still. Behavioral interventions targeting depression encourage behavioral activation—getting out there and doing stuff. This is the opposite of what pain instructs.

Over time, chronic pain and its emotional aftermath can negatively affect relationships. It can breed resentment among friends and family who feel isolated by the withdrawal. Pain affects how we interact with others, and the stress of social strain can worsen pain.

Research has shown an interaction between social pains, such as rejection and grief, with physical pain at a neurological level. Both types of pain appear to be processed in similar brain regions and likely affect each other on multiple levels (Zhang et al., 2019). It seems to be a complex, bi-directional relationship.

Lastly, pain often feels without reason. The seemingly meaningless nature of this suffering can add an existential burden to pain, particularly if the affected perceives the pain as punishment (Telbizova, 2022).

But can therapy help?

Research suggests that it can.

Meaning in Suffering, Improved Relationships, and Decrease in Pain Intensity

One space where psychotherapy can be of use is in navigating how to readjust life after pain. Acceptance and commitment therapy (ACT) focuses on value clarification, allowing experiences, and moving toward what matters, among other objectives.

An effective ACT therapist can guide you in taking meaningful steps as you carry your pain with you. A study utilizing a short-term course of ACT in individuals experiencing chronic pain found a decrease in pain interference with life goals (Wetherell et al., 2011).

In addition, a meta-analysis of 21 studies exploring the effectiveness of ACT for individuals living with chronic pain found a variety of favorable outcomes ranging from a decrease in pain intensity to an increase in quality of life (Ma et al., 2023).

Psychotherapy with an emphasis on interpersonal things can also assist with relationships, pain intensity, and severity of depressive and anxious symptoms in people experiencing chronic pain (Monsen et al., 2002). One such therapy is interpersonal therapy.

Interpersonal therapy assists individuals in working through role disputes, life transitions, grief, and other social difficulties that affect their well-being. It is an evidence-based treatment for a variety of difficulties, including depression. The study Interpersonal Therapy for Pain and Depression found a large effect size in both a decrease in depressive symptoms and an increase in social functioning Poleshuck et al., 2010).

Finally, therapy that focuses on meaning-making and self-compassion can assist with how individuals relate to themselves in the face of pain. An intervention utilizing group compassion-focused therapy found a decrease in pain-related distress and anxiety as well as an increase in self-efficacy after the intervention.

Across all studies, a decrease in pain intensity appears small, but the gains in quality-of-life measures are more impressive.

In Closing

Pain is a real, physical experience that can affect all aspects of a person's life. While psychotherapy may not relieve the physical dimensions of pain (although some research suggests some efficacy in decreasing pain intensity), it can assist with other aspects of the experience. In particular, psychotherapy may effectively improve one's quality of life and relationships.

References

Angst, F., Benz, T., Lehmann, S., Wagner, S., Simmen, B. R., Sandòr, P. S., & Angst, J. (2020). Extended overview of the longitudinal pain-depression association: a comparison of six cohorts treated for specific chronic pain conditions. Journal of affective disorders, 273, 508-516.

Blackburn‐Munro, G., & Blackburn‐Munro, R. E. (2001). Chronic pain, chronic stress and depression: coincidence or consequence?. Journal of neuroendocrinology, 13(12), 1009-1023.

Kuehn, B. (2018). Chronic pain prevalence. Jama, 320(16), 1632-1632.

Monsen, K., Monsen, J. T., Svartberg, M., & Havik, O. E. (2002). Chronic pain patients: Patterns of change in interpersonal problems, pain intensity, and depression-anxiety. Psychotherapy Research, 12(3), 339-354.

Ma, T. W., Yuen, A. S. K., & Yang, Z. (2023). The efficacy of acceptance and commitment therapy for chronic pain: A systematic review and meta-analysis. The Clinical Journal of Pain, 39(3), 147-157.

Penlington, C. (2019). Exploring a compassion-focused intervention for persistent pain in a group setting. British journal of pain, 13(1), 59-66.

Poleshuck, E. L., Talbot, N. E., Zlotnick, C., Gamble, S. A., Liu, X., Tu, X., & Giles, D. E. (2010). An interpersonal psychotherapy approach for comorbid depression and chronic pain. The Journal of nervous and mental disease, 198(8), 597.

Tankha, H., Caño, A., & Dillaway, H. (2020). “Now I have hope”: Rebuilding relationships affected by chronic pain. Families, Systems, & Health, 38(1), 51.

Telbizova, T. (2022). Meaning of chronic pain in situations of risk and routine situations to patients with depression. Scripta Scientifica Medica, 54(4).

Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., Petkus, A. J., & Atkinson, J. H. (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain, 152(9), 2098-2107.

Zhang, M., Zhang, Y., & Kong, Y. (2019). Interaction between social pain and physical pain. Brain Science Advances, 5(4), 265-273.

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