How to Manage Chronic Pain for Improved Mental Health

In the medical world, pain—the body’s way of telling us that something may be wrong—is classified as either acute or chronic. While acute pain tends to be severe but temporary, chronic pain can vary in intensity and persists for long periods of time. Sometimes, chronic pain is a symptom of long-term disease, but in some cases, it’s difficult to identify a specific cause.

Chronic pain can be treated with prescription and over-the-counter medications, but the latest issue of Psychological Science in the Public Interest (PSPI) looks at how psychological interventions can be part of the treatment plan. 

“For the last 16 years I have never found a case of chronic pain that was only physical,” says Los Angeles, California-based holistic health consultant Peter Bedard, who has an MA in consciousness studies and extensive training in hypnotherapy and alternative health. In Bedard’s experience, every wound has a mental, physical, and spiritual/energetic component. 

Psychological Therapies for Pain Management 

Western medicine has long been in the habit of treating the mind and the body as separate entities, says therapist Susan Epstein, LCSW, who runs chronic pain workshops for her clients.

"Medical doctors often look for mechanical/physical explanations of and fixes for pain, when the real answers lie in misfiring messages from the brain due to psychological, emotional, environmental, and even nutritional factors," Epstein explains. "There is more and more recognition that the mind-body is a complex interconnected organism and that holistic approaches may offer relief where surgeries or pharmaceuticals have failed."

The PSPI research highlights many effective non-medical treatments for chronic pain, and describe psychological therapies as among the strongest options in terms of reduction in pain and improvements in both physical health and emotional well-being, including cognitive behavioral therapy (CBT) and biofeedback. 

“CBT is a form of psychotherapy that focuses on a person’s thoughts (cognition) and behaviors (actions) that are the source of their problem,” explains psychologist Sheila Forman, PhD. For example, someone may say, “This pain will never go away—what’s the point of seeing the doctor again?” 

In this case, the CBT therapist would help this person identify patterns of negativity embedded in these thoughts with the goal of changing them in a way that would lead to a healthier way to think about and respond to pain. For example, they may change the narrative to something like, “This pain comes and goes and when I see my doctor; she helps me get some relief.”

Biofeedback involves using sensors to monitor patients’ physiological responses to stress and pain, such as increased heart rate and muscle tension, then teaching them how to gain control over these responses. “This form of therapy is useful because stress exacerbates pain, so learning to manage stress can help manage pain,” says Forman. 

Clients also can use scales to assign objective measures to what is a very subjective experience. "If you ask someone to rate their pain on a scale of 1 to 10, it gives them some sense of perspective on the pain and may help them tolerate the experience because they know the intensity does change," Epstein says.

Other psychological therapies for chronic pain include supportive psychotherapy, breathing exercises, hypnosis by a trained clinician, and mindfulness meditation.

Chronic Pain vs Grief

The experts agree that chronic pain is comparable to grief. “Like grief, chronic pain is asking us to grow, forgive, expand, and learn,” says Bedard. “Chronic pain—any pain really—is a calling to evolve and become your greatest self. Radical acceptance and taking responsibility for the pain allows acceptance to happen.”

Forman adds that chronic pain itself can lead to a type of grief. “People who suffer with chronic pain experience a sense of loss,” she explains. “It can lead to an inability to participate in activities, do meaningful work, and maintain relationships. All of these are losses—and losses need to be grieved.”

When we grieve, we go through various phases, ending with acceptance. “We don’t like that we have lost something or someone but we accept the loss and learn to live with it,” says Forman. “Pain clients don’t want to be in pain, they don’t want the losses that are causing their pain. But when they allow themselves to grieve the loss pain brings, they create the possibility of a happier and satisfying future.” 

When Forman works with clients with chronic pain, she typically suggests a few different coping strategies. The first is mindfulness meditation, to teach the person to use their breath to have a different relationship with their pain. Forman is also an advocate of support groups for people with chronic pain. “Being able to talk with others who are in the same situation can be very helpful,” she says. 

Her third suggestion is to find ways to enjoy life more. “When we focus on pain, we make it worse,” she explains. “By building a life that is enjoyable you can distract yourself from your pain. Finding a hobby or interest that takes your mind off your pain is also valuable. If nothing else, it gives you something else to think about!”