The nature of pain

Pain is an all-too-familiar problem and the most common reason that people see a physician. Unfortunately, alleviating pain isn't always straightforward. At least 100 million adults in the United States suffer from chronic pain, according to the Institute of Medicine. The American Academy of Pain Medicine reports that chronic pain affects more Americans than diabetes, heart disease and cancer combined.

Pain serves an important purpose by alerting you to injuries such as a sprained ankle or burned hand. Chronic pain, however, is often more complex. People often think of pain as a purely physical sensation. However, pain has biological, psychological and emotional factors. Furthermore, chronic pain can cause feelings such as anger, hopelessness, sadness and anxiety. To treat pain effectively, you must address the physical, emotional and psychological aspects.

Medical treatments, including medication, surgery, rehabilitation and physical therapy, may be helpful for treating chronic pain. Psychological treatments are also an important part of pain management. Understanding and managing the thoughts, emotions and behaviors that accompany the discomfort can help you cope more effectively with your pain — and can actually reduce the intensity of your pain.

Seeing a psychologist about pain

Psychologists are experts in helping people cope with the thoughts, feelings and behaviors that accompany chronic pain. They may work with individuals and families through an independent private practice or as part of a health care team in a clinical setting. Patients with chronic pain may be referred to psychologists by other health care providers. Psychologists may collaborate with other health care professionals to address both the physical and emotional aspects of the patient's pain.

When working with a psychologist, you can expect to discuss your physical and emotional health. The psychologist will ask about the pain you experience, where and when it occurs, and what factors may affect it. In addition, he or she will likely ask you to discuss any worries or stresses, including those related to your pain. You also may be asked to complete a questionnaire that allows you to record your own thoughts and feelings about your pain.

Having a comprehensive understanding of your concerns will help the psychologist begin to develop a treatment plan.

For patients dealing with chronic pain, treatment plans are designed for that particular patient. The plan often involves teaching relaxation techniques, changing old beliefs about pain, building new coping skills and addressing any anxiety or depression that may accompany your pain.

One way to do this is by helping you learn to challenge any unhelpful thoughts you have about pain. A psychologist can help you develop new ways to think about problems and to find solutions. In some cases, distracting yourself from pain is helpful. In other cases, a psychologist can help you develop new ways to think about your pain. Studies have found that some psychotherapy can be as effective as surgery for relieving chronic pain because psychological treatments for pain can alter how your brain processes pain sensations.

A psychologist can also help you make lifestyle changes that will allow you to continue participating in work and recreational activities. And because pain often contributes to insomnia, a psychologist may also help you learn new ways to sleep better.

Progressing and improving

Most patients find they can better manage their pain after just a few sessions with a psychologist. Those who are experiencing depression or dealing with a long-term degenerative medical condition may benefit from a longer course of treatment. Together with your psychologist, you will determine how long treatment should last. The goal is to help you develop skills to cope with your pain and live a full life.

Stress and chronic pain

Having a painful condition is stressful. Unfortunately, stress can contribute to a range of health problems, including high blood pressure, heart disease, obesity, diabetes, depression and anxiety. In addition, stress can trigger muscle tension or muscle spasms that may increase pain. Managing your emotions can directly affect the intensity of your pain.

Psychologists can help you manage the stresses in your life related to your chronic pain.

Psychologists can help you learn relaxation techniques, such as meditation or breathing exercises to keep stress levels under control. Some psychologists and other health care providers use an approach called biofeedback, which teaches you how to control certain body functions.

In biofeedback, sensors attached to your skin measure your stress response by tracking processes like heart rate, blood pressure and even brain waves. As you learn strategies to relax your muscles and your mind, you can watch on a computer screen as your body's stress response decreases. In this way, you can determine which relaxation strategies are most effective, and practice using them to control your body's response to tension.

Stress is an unavoidable part of life, but managing your stress will help your body and your mind and lessen your pain.

Tips for coping with pain

Consider the following steps that can be helpful in changing habits and improving your sleep:

• Stay active. Pain — or the fear of pain — can lead people to stop doing the things they enjoy. It's important not to let pain take over your life.
• Know your limits. Continue to be active in a way that acknowledges your physical limitations. Make a plan about how to manage your pain, and don't push yourself to do more than you can handle.
• Exercise. Stay healthy with low-impact exercise such as stretching, yoga, walking and swimming.
• Make social connections. Call a family member, invite a friend to lunch or make a date for coffee with a pal you haven't seen in a while. Research shows that people with greater social support are more resilient and experience less depression and anxiety. Ask for help when you need it.
• Distract yourself. When pain flares, find ways to distract your mind from it. Watch a movie, take a walk, engage in a hobby or visit a museum. Pleasant experiences can help you cope with pain.
• Don't lose hope. With the right kind of psychological treatments, many people learn to manage their pain and think of it in a different way.
• Follow prescriptions carefully. If medications are part of your treatment plan, be sure to use them as prescribed by your doctor to avoid possible dangerous side effects. In addition to helping you develop better ways to cope with and manage pain, psychologists can help you develop a routine to stay on track with your treatment.

The American Psychological Association gratefully acknowledges Daniel Bruns, PsyD, a psychologist at Health Psychology Associates in Greeley, Colo., and Robert D. Kerns, PhD, director, Pain Research, Informatics, Multimorbidities and Education Center at the VA Connecticut Healthcare System, for contributing to this article.

December 2013