Chronic pain

How chronic pain and illness affect your mood

As I sit writing this, I am in a moderate amount of pain. Like millions of people around the world, I suffer from chronic musculoskeletal (back and hip) problems, so most days come with either a small or large dose of pain, depending on how well I am looking after myself, how stressed I am, how much sitting I do that day, and various other factors.

Having been in some degree of daily pain for almost two years now, I have learned a few things about the relationship between physical pain and mental suffering:

  • It's important to distinguish between 'primary' and 'secondary' pain. I learned this from Vidyamala Burch, founder of the excellent Breathworks. This organisation provides the Mindfulness-Based Pain Management programme, which has a strong research base behind it and helps many people in the UK and beyond deal with chronic pain and illness.
  • Burch also co-wrote Mindfulness for Health: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing with Danny Penman. In this superb book the authors explain that primary pain is the actual raw data caused by, say, a gash in your leg. Intriguingly, the majority of the pain you end up experiencing is secondary – the pain created by your brain as it amplifies that raw data, depending on the way you think about and respond to your primary pain.
  • This only became clear to me recently when I visited my osteopath during a bad patch physically, feeling down and hopeless about resolving my problems. He reminded me that the pain was significantly better now than when I first came to see him; and that it was crucial to remain as positive as possible, because my negative thoughts ('I will never get over this'; 'Nothing will help'; 'I can't stand the pain any more') were undoubtedly making the pain worse (this is essentially what the Buddha taught – that human life inevitably involves pain, but we create suffering by our response to that pain. But that's a topic for another day).

Managing the pain

I think it's important to note here just how hard it is to maintain a positive, optimistic mood in the face of chronic pain or illness. As anyone with a long-term condition knows, it grinds you down, especially when it flares up or your symptoms get worse for whatever reason. Please don't think I underestimate the impact of physical ailments on your mood – it is a struggle and gets everyone down from time to time, as well as causing stress and worry/anxiety about the future.

I couldn't understand that vicious cycle any better. But once you understand the relationship between pain sensations in the body and the way that your brain either amplifies or minimises those sensations, it seems crucial to me that you do all you can to use your brain/mind to help your body.

 When I first hurt my back and was really struggling, Vidyamala Burch's guided meditations really helped pull me through. Here is a great one on being more compassionate to yourself, available for free, if you would like to try it. And if you are dealing with chronic pain or illness, my thoughts and well wishes go out to you – I hope you get the medical help you need and manage to overcome your problem soon.

If you would like some help with the psychological aspects of your condition, call me on 07766 704210, email dan@danroberts.com or use my Contact form to get in touch.

Warm wishes,

Dan

Cognitive therapy and chronic pain

If you suffer from a medical condition that causes you chronic pain, life can be gruelling. Nobody likes being in pain, so over time it can really grind you down. Musculoskeletal problems like hip, knee or lower-back pain, arthritis and other ongoing, hard-to-treat conditions can sap your strength and energy over time, making it hard to stay positive or hopeful that a solution will eventually be found. Dealing with pain can make you stressed or depressed, as the ongoing struggle – unsurprisingly – causes sadness and low mood.

But if you or someone you care about is struggling with a painful condition, it's important to know that there is very good evidence for the impact that psychological treatments can have – in particular, cognitive therapy and mindfulness meditation. Of course, thinking differently about your problem, the core strategy in cognitive therapy, will not take away the pain (although it can significantly decrease the amount of pain you are in). Instead, it will help you stop thinking so negatively about the problem, which will boost your mood and stave off the risk of depression. 

The mindful approach to stress

Since the 1970s, mindfulness – in particular, mindfulness-based stress reduction, or MBSR – has been used to help people with a wide range of psychological and physical ailments. MBSR's founder, Jon Kabat-Zinn, developed his revolutionary approach to help people who had been failed by traditional Western medicine. He worked with patients suffering from treatment-resistant spinal problems and even terminal illness – and had a remarkable success rate at lowering their stress levels and improving the quality of their daily lives.

As with all forms of suffering, whether emotional or physical, the mindful approach is to change our relationship to the thoughts, feelings and physical sensations, enabling us to stop fighting or resisting them and – counterintuitively – accept them, even if we do not want them to be there. Over time, we find that this stance of acceptance is an extremely powerful one, allowing the 'aversive' experiences to come and go, so they don't get stuck or morph into other forms of suffering like self-criticism or anger.

I want to be clear: I am not minimising how hard or upsetting it can be to live with chronic pain (as someone with ongoing back, hip and other musculoskeletal problems, I know that only too well). But being human inevitably means dealing with stressors, large or small; and, if we cannot free ourselves from them, we must find the best possible way to live with them.

If you would like help with chronic pain, email dan@danroberts.com

Warm wishes,

Dan