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Pain Management

Living with ongoing or chronic pain is usually an exhausting experience and often really difficult for most people. Pain can also be very unpredictable and can bring with it a multitude of emotions such as anxiety, frustrations, anger, depression and despair. It can also cause a profound sense of social isolation; loss of friends and relationships, loss of job opportunities and so on. Your pain may have even been minimized by people around you, perhaps for years following a multitude of medical procedures. You may even have begun to distrust the health care system and may feel angry with your medical providers. But there is a way out. It takes work but with some effort, it is possible to improve your quality of life.

Until recently, pain was considered an entirely biomedical problem, i.e. the result of tissue damage or system failure. The solution to removing pain relied entirely upon medical and surgical interventions. Although that approach can be useful in treating more acute or short-term pain (and even ongoing pain, e.g. EDS pain caused by repeated injury), it's considerably less helpful for chronic pain and, to a decent degree, ongoing pain too. Indeed, we now know that to adequately treat more persistent, chronic pain, we need to take a broader, more holistic, approach; a biopsychosocial approach. Indeed, the biological, psychological and the social are very much interconnected in the experience of chronic pain and are of equal importance when treating it. That means that your physical health, your psychological health and your social health are intrinsically intertwined, each contributing to both increasing and reducing perceptions of pain by the brain.

  • The biological component refers to genetics, age, tissue damage, mechanical and anatomical dysfunction, immunological issues, inflammation, hormones, diet, sleep and pathology in the pain transmission system. As mentioned above, these issues are commonly treated with medication and/or surgical procedures that can be very useful for acute and short term pain. However, although still very important, they are, alone, less helpful when treating chronic pain. 

  • The psychological component refers to cognitive, emotional and behavioural factors and may involve thoughts, beliefs, the meaning assigned to pain, distress, attentional processes, prior experience, expectations and coping behaviours. For example, negative expectations such as "I'll never get better" can actually amplify pain by automatically increasing the signals to the brain's pain centre. Emotions such as anxiety, depression, distress and anger are understandably a common consequence of chronic pain but they can also make pain worse. Stress in general can make pain spike. The psychological domain also refers to how we cope, react and respond to pain. Some stay in bed or become very inactive when they hurt while others may push themselves hard and pay the price. Indeed, the decision to avoid or engage in activities when we're in pain can determine how much pain we're in (and this one can be tricky!).

  • The social component refers to family factors and friends (social support), socioeconomic factors, adverse childhood events and trauma, the environment, culture and society. Humans are social animals and we have evolved to need each other to survive. That means that we release health promoting chemical when we're in the presence of others and health suppressing stress hormones when we're lonely or isolated. Indeed, receiving good social support is usually a wonderful stress buffer. Studies have also shown a relationship between traumatic events in childhood such as abuse, neglect or a dysfunctional home and later development of chronic pain in adulthood. For example, when we are threatened, our bodies have what is called a stress response, which prepares our bodies for fight or flight. However, when this response remains highly activated in a child for long periods of time, and without the calming influence of a supportive parent or adult figure, toxic stress occurs and can damage crucial neural connections in the developing brain and perhaps also affect the developing immune system. This creates a vulnerability towards ill health in adulthood including pain.

The biopsychosocial domains are all interconnected and interact, often in complex ways. For example, social factors affect brain chemistry and hormones as well as thoughts and emotions; changes in emotions like stress and anxiety alter brain chemistry, hormone levels and immune function too and that may determine the type of signals that are sent to and by the brain's pain centre; tending to sleep, exercise and nutritional needs can also serve and important role, and all this contributes to both increasing and reducing perceptions of pain by the brain. It's a game of multitask! Indeed, understanding how pain works can be really empowering and is often the first step towards much improved quality of life. 

I take an evidence-based, biopsychosocial approach to pain management. However, my approach is never the same for each client that I see. Indeed, everyone's needs are different. That means I use an 'Integrative Therapeutic Approach' that adapts to the unique needs of each client as opposed to using one method alone (e.g. CBT).

My main goal in your care is to:

  • Help you regain control of your brain and body.

  • Reduce pain intensity and frequency.

  • Reduce the impact of pain and illness on your life.

  • Manage triggers so that you have fewer episodes and flare-up's.

  • Teach you how to cope more effectively with pain flares once they start.

  • Reduce reliance on pain medications.

  • Improve your quality of life so that you can live a life that's meaningful even if you have some pain.

However, adding psychosocial approaches to pain management doesn't mean your pain is 'all in the head'. All pain is real! Some pain may never go away completely but it can be reduced significantly and managed better through a biopsychosocial approach. Overall, the aim is to restore your daily functioning and minimize the many consequences of pain on your quality of life. Indeed, with some consistent effort, there is a way out! (For more information on my approach to therapy and what to expect, click here.)