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Chronic pain management and the Psychologist




Chronic pain can lead to hopelessness, depression, anger and anxiety disorders such as panic, generalised anxiety, hypochondriasis and post traumatic stress disorder (see studies cited in Winterowd, Beck& Gruener, 2003). This is not surprising as chronic pain sufferers may have many other negative events and stressors to deal with such as: losing a job, experiencing financial hardship and having increased stress upon families.

Sufferers also may have to contend with unpleasant side effects of medication such as constipation, weight gain and tiredness. Furthermore, chronic pain patients may find that they can no longer engage in activities that they enjoyed such as hobbies, crafts and sports, or that their participation in such activities is greatly reduced. (Nicholas, Molloy, Tonkin & Beeston, 2000) Sufferers often end up (1) inactive because they fear exacerbating their pain through activity, (2) socially withdrawn and losing contact with friends, and (3) overweight due to inactivity and/or overeating.

Research has shown that having realistic, helpful thoughts is an important part of chronic pain management. The cognitive model of chronic pain is that negative, unhelpful, unrealistic thoughts can lead to : increased perception of pain, anxiety, anger and depression, social isolation and withdrawal, underactivity, overreliance on pain medications and poor sleep (Winterowd et al, 2003). Therefore, cognitive behavioural psychologists aim to help chronic pain sufferers to change their negative, unhelpful, unrealistic thoughts in relation to: their pain, the effects it has had on their life, and other stressors ( e.g. legal issues, financial difficulties, unemployment).

Cognitive behavioural therapy, according to Winterowd et al (2003), has been found by researchers to be a beneficial treatment for chronic pain conditions including: arthritis, whiplash, back pain, tendonitis, carpal tunnel, rotator cuff syndrome, bursitis, noncardiac chest pain, knee pain and irritable bowel syndrome.

Psychologists, using cognitive behavioural therapy, can assist sufferers to develop pain management skills. Many people can learn the skills in as few as 12 sessions; however any treatment plan has to be tailored to an individual’s needs so the number of sessions required may vary from person to person.

Cognitive behavioral therapy usually includes:

relaxation techniques
distraction techniques
the pacing of activity
challenging negative thoughts and beliefs about: pain, other stressors, the future and disability

Relaxation techniques can reduce muscle tension and stress and therefore sufferers who practice relaxation are better able to cope with their pain. Increased muscle tension can further aggravate chronic pain. Helpful relaxation techniques include, but are not limited to: deep breathing, progressive muscle relaxation, biofeedback, guided imagery, meditation and yoga. Relaxation is a skill which gets better with practice so practice your favourite technique (e.g. yoga, meditation or biofeedback) regularly. Relaxation can also help chronic pain suffers to improve their ability to sleep (Winterowd et al, 2003).

Cognitive Behavioural therapy entails identifying, evaluating and changing negative, unhelpful, unrealistic thoughts , beliefs and images, Sufferers may have unhelpful beliefs about their pain, for example, ” If may pain increases I must be doing further permanent damage to myself” or ” I can’t control my pain”.Patients may also develop negative beliefs about themselves as being weak, unlovable or incompetent. Pain patients may also have negative thoughts and beliefs about other people as being uncaring. Sufferers may also predict bleak futures for themselves. For example, ” If I’m in this much agony now just wait till arthritis sets in in my old age” or ” I can barely walk now, so in a few years time I’ll probably end up in a wheel chair” (Winterowd et al. 2003).

Distraction techniques purpose is to get the sufferer to focus their attention on something other than their pain. Distraction techniques may enable the sufferer to experience somewhat less pain (Nicholas et al , 2000).

Chronic pain sufferers often get into an overactivity -underactivity cycle where they do more activity on their ‘good days’ when their pain is lower, but then they spend a day or more resting and recoverng from their burst of activity which has flared up their pain. Pacing techniques aim to spread activities evenly over the day and week so that flare ups in pain are minimised and the pain sufferer can gradually increase the amount of activity performed (Nicholas et al, 2000).

Catherine Madigan, is a Melbourne clinical psychologist who works with chronic pain sufferers and provides cognitive behavioural therapy for it as well as anxiety disorders. Catherine has worked in pain management programs in Victorian private and public hospitals and currently sees patients in her private practice in Richmond . Catherine is a registered provider of psychological services for TAC and Workcover.

Nicholas, M., Molloy, A., Tonkin, L. & Beeston. L. (2000) Manage Your Pain. Practical and Positive Ways of Adapting to Chronic Pain. ABC Books. Sydney, Australia.
Winterowd, C., Beck, A.T., & Gruener, D. (2003). Cognitive Therapy for Chronic Pain Patients. Springer Publishing Company. New York, New York.


It is important to consult a qualified mental health practitioner such as e.g. a psychologist or psychiatrist to confirm any diagnosis you think you might have. You must not rely on the information on this site as a substitute for professional medical advice, diagnosis or treatment. No assurance can be given that the information on this site will always include the most recent developments or research with respect to a particular topic.

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