It’s Not All In Your Head! Talking About Chronic Pain

1. It’s Not All In Your Head! Talking About Chronic Pain Chronic pain is a massive topic, and causes a lot of problems (and misery), for a large percentage of the population (In 2020 it was estimated that one third to one half of adults in the UK suffer from chronic pain at any one time), yet it is still a mystery for many health professionals and common treatments still rely on pain killers and nerve blockers. Both of these may help initially, but as the body gets used to them, their effectiveness reduces over time, resulting in greater doses being needed to control the pain effectively. The definition of chronic pain is any pain which has lasted longer than 3 months, so it actually does not take very long before pain is deemed to be chronic. All sorts of conditions can cause long term pain, from sports injuries due to accidents or wear and tear on a joint, other unfortunate sudden accidents, such as falls in the home, back problems due to gardening, or car accidents. Then there are long term conditions which cause general pain all over the body, such as fibromyalgia, ME (Myalgic encephalomyelitis or Chronic- Fatigue Syndrome), rheumatoid arthritis, and others which doctors may describe as having “Medically Unexplained Symptoms”, such as long standing headaches, facial pain, IBS, colitis and conditions such a long Covid. People with chronic pain can often spend many months or years trying to get help, and can feel very dismissed by physical health services who cannot find a definitive cause for the pain or no effective cure, or others feel that they are treated as hypochondriacs and told that “it is all in your head”. There is a huge impact on quality of life for sufferers of long -term pain. They are less able to get out of the house, hold down a job, or have to take frequent sick leave if their pain becomes too bad. Relationships suffer when someone is in constant pain, very tired all the time and has little energy. However, there is help out there, and our understanding is growing about how to help people manage these very frightening and difficult conditions. There is recognition that although chronic pain is definitely not all in your head, it is influenced by emotions, the way we think, how we interpret physical symptoms, and behaviour. If you or a loved one are dealing with chronic pain the following tips may be helpful: Ask your GP to refer you to a multi- disciplinary pain clinic. They will do a full assessment, including physiotherapy for mobility and strength, a psychologist for assessing mental health needs, such as help for stress, tension, social and family needs, and identifying unhelpful behaviours, and a medical doctor, to review medication and help you to optimize pain relief and other medical interventions. Relaxation techniques are very helpful for learning how to relax tense muscles, which put extra pressure on nerves, and how to mentally switch off from daily pressures which add to stress levels. Cognitive Behaviour Therapy (CBT) is very helpful for tackling depression and anxiety, which can often build up with the constant demands involved in dealing with chronic pain (find qualified therapists in the BABCP register)   

2. Learn to pace your activities to stop the Boom – Bust cycle of pain flare ups happening. This is an unhelpful cycle of doing too much when you feel better (boom), followed by being laid up and unable to function for a few days when you seize up, and muscles complain (bust). This cycle is understandable, but it is not good for managing pain long term. It is better to have help to learn this properly as it can be hard to get it right on your own.  My online course “Tame Your Chronic Pain step by step” teaches all the CBT techniques needed to manage pain successfully and to pace properly, providing all the tools you need to achieve this.