When it comes to our physical health problems, it’s important that we also consider our mental wellbeing. As a psychotherapist with a background in Health Psychology, the link between our physical and mental health is always at the forefront of my mind when I’m working with clients with long-term health conditions. It makes a lot of sense that when we don’t feel physically well, our mood will also be affected. I regularly work with a lot of clients who are struggling specifically with chronic pain as well as depression and/or anxiety. Here, I wanted to share some insights about the effect that chronic pain can have on mental health.
What is chronic pain?
NHS guidance states that pain is medically recognised as being ‘chronic’ if it lasts longer than 12 weeks despite treatment. They also advise that certain long-term health conditions could make you more susceptible to developing chronic pain, such as: diabetes, arthritis, back pain and fibromyalgia. However, much of chronic pain is also acquired through accidental injuries such as falls and car accidents. If you’ve had an injury or suffer from a long-term health condition and it has resulted in pain, the guidance is that if it doesn’t show improvement or response to medication within three months, you should speak to your GP.
One of the key issues that makes chronic pain so difficult to live with is that often, medication may not lead to any pain relief. Within chronic pain, the body’s pain system is not operating as it should be. There’s a lot that we still don’t understand about how our pain system works which means we haven’t figured out why some people don’t experience pain relief when they should be. It’s estimated that over two fifths of the British population suffer from some form of chronic pain – that’s a staggering 28 million people who are suffering from intrusive and often unmanageable symptoms!
How is it treated?
Usually, pain is a signal from our body that we need to stop because something is wrong. However, we know that with chronic pain, the pain system isn’t acting as it should be so stopping each time we feel pain would actually be quite unhelpful to us both physically and practically. Within the NHS, the recommendation is that exercise and physical therapy are to be the frontline treatments for the management of chronic pain. Light exercises such as yoga or walking are particularly recommended. As well as that, medical professionals and mental health professionals alike are putting a real emphasis on encouraging sufferers to retain as much normal function as they can – whether this includes doing the school run, or going to work, or just doing the housework. We know that this is better for you both physically and emotionally. Painkillers are also offered but they often do not provide any relief for chronic pain sufferers.
Finally, your GP can also refer you to a specialist pain clinic. Pain clinics can be a fantastic gateway into accessing a wide variety of therapeutic options for pain, including pain-relief injections, physical therapy and even psychological therapy.
Where does mental health fit into all this?
Understandably, living with something that is unpredictable and often unmanageable is going to be an incredibly distressing experience. Therefore, it is normal that some sufferers will experience depression and/or anxiety because of their illness. Experiencing regular and debilitating pain can have a profound impact on all areas of your life. Many sufferers struggle to stay in work, a strain can be placed on relationships and it can be hard to socialise or get much done if you’re regularly being interrupted by bouts of pain. It makes a lot of sense that for some people, this cycle of pain can be very demoralising and result in feelings of hopelessness. The good news is that through time and effort, sufferers are usually able to find a therapeutic technique that works for them – whether it’s painkillers or exercise of some sort. However, the journey that it takes to get there can be a tough one and this is where getting some help to manage how you feel about what you’re going through can be immeasurably helpful. We know that when you feel stressed or low, it can take a toll on your body. If your physical pain results in stress or low mood, and then your stress/low mood results in more strain on your body, then that’s quit the vicious cycle to find yourself in! Therapy is all about breaking that cycle.
How does a therapist help?
Cognitive Behavioural Therapy (CBT) is shown to be the most effective in helping individuals to manage depression and anxiety. If you live in England, you can access CBT for free through the NHS, either by asking your GP to make a referral for by making a self-referral into your local IAPT service. CBT is a talking therapy that firstly focuses on helping individuals understand their problems and potential triggers. Next, the aim of therapy is to teach you practical tools and techniques that will help you manage your problems better but also help you to learn how to deal with reoccurring triggers. As CBT is a therapy that is all about teaching you how to self-manage your mental health, you can access it in a variety of modalities depending on what is comfortable for you: online, face-to-face, over the telephone or in some cases, in group settings. If going somewhere to meet someone on a regular basis is going to be hard for you because of your pain, telephone or online therapy would be just as effective as seeing someone.
As well as that, most CBT therapists will have experience and training that enables them to work with individuals who are struggling with chronic pain. This means that your therapist will be looking at how the demands of your physical health can be balanced with what you need to improve your mental wellbeing. For example, if your pain and low mood has resulted in you doing less housework and one of the things that will make you feel better is having a less cluttered house, your therapist would look at improving your motivation and mood but also be mindful that you might not be able to do as much as you once were able to do. For many chronic pain sufferers, therapy helps them to acknowledge the emotions they have around their condition and how it might limit them. It then helps them to find a compromise with their physical health so that they can regain some function and some joy in their life again.