Chronic pain: The mental and physical aspects of coping

Health care providers no longer see chronic pain as a strictly physical condition. They understand it comes with significant impacts on the emotional and social well-being of the patient. The connection between chronic pain and mental health is so evident that studies show up to 85 percent of patients with chronic pain are affected by severe depression. A psychologist and a family medicine physician discuss the ways these two issues—a decline in mental health and the presence of chronic pain—intersect and what you can do about it.

What is chronic pain?

Chronic pain is defined as pain lasting for weeks, months and even years. “A health care provider may make a diagnosis of chronic pain if the pain lasts longer than three months,” said Joyce Hnatek, MD, a board-certified family medicine physician who specializes in hospice and palliative care and clinical assistant professor at the Texas A&M College of Medicine. “At this point, they will help you create a plan to manage your pain. You have options, so it is important to work closely with your provider to find what works best for you and your specific pain.”

The other type of commonly diagnosed pain is acute pain. Typically, this type of pain is fleeting and goes away on its own or with minimal intervention. Pain that lasts longer than three months may still go away, but other times it will last a lifetime.

Physical wellness when living with chronic pain

“A significant part of living with chronic pain is the fear of reinjury or a fear of worsening the pain,” said Meredith Williamson, PhD, licensed psychologist at Texas A&M Health Family Care and clinical assistant professor at the College of Medicine. “To cope with this fear, people tend to withdraw and limit their activity, even with something as seemingly simple as walking down the stairs or going to dinner with friends.”

A severe decrease in activity can significantly increase the possibility of chronic diseases associated with sedentary behaviors like diabetes or heart disease. “For a vast majority of chronic pain cases, many things that improve your overall health can improve your ability to cope with chronic pain,” said Hnatek. “Do not underestimate what regular exercise and good nutrition can do.”

However, Hnatek cautions about participating in exercise or other physical activities without first consulting your primary care provider. In situations involving chronic pain, it is important to rely on your primary care provider. She recommends finding one you trust and getting his or her help as you make your pain management plan.

Mental wellness when living with chronic pain

Often, people stop looking at chronic pain as something they can overcome, but as something they have to deal with for the rest of their lives. Williamson said this realization can be distressing. “The catch with chronic pain is that relief is not guaranteed,” she said. “The question and concern should be about how you cope with the pain that you do have, instead of how you fix it.”

The sudden decrease in activity impacts mental health just as much as it impacts physical health. “Coping with chronic pain is cyclical,” said Williamson. “Many people tend to over- or under-do it. They have trouble managing their activity level, which puts them in a position where both their physical and mental health can decline.”

Depending on the specific pain condition, one of the best ways you can help your mental health is to stay active. If you restrict your movements and limit your activity, you may lose muscle mass and your joints may stiffen, which may make it even harder to move. Similarly, Williamson mentions certain therapies like cognitive behavioral therapy and acceptance commitment therapy have been helpful in people with chronic pain. “Evaluate what used to bring you joy before your pain, and speak with your provider about ways you can adapt it to fit your limitations now,” Williamson said. “For example, if you enjoyed backpacking, perhaps trying walking on flat trails without a heavy pack or driving to a camping spot instead of walking to one. Work with your provider to find what works for you.”

The importance of a holistic approach to living with chronic pain

Although opiates have been utilized to help treat all kinds of pain, they have significant risks associated with them including dependence and potential addiction. “With the Centers for Disease Control and Prevention (CDC) reporting that an average of 130 Americans are dying every day from an opioid overdose, we have to be proactive in avoiding unnecessary contribution to the opioid epidemic,” said Hnatek. “Additionally, there are better medications that are more effective for some types of chronic pain.”

Furthermore, medication is not the only way to treat chronic pain. Both Hnatek and Williamson emphasized the value of cognitive behavioral therapy on chronic pain management. “It is important to note that chronic pain alters one’s quality of life and can contribute to feelings of depression and anxiety,” Williamson said. “Certainly, depression and anxiety can adversely affect one’s perception of pain, so it is imperative to address mental and emotional health when addressing chronic pain.”

In addition to cognitive behavioral therapy, your provider may recommend other non-drug modalities that help people with chronic pain find relief. “Certain groups of patients benefit from physical therapy, topical agents and/or massages,” Hnatek said. “Rarely, patients with chronic pain find a single solution or therapy that works for them. They find more success when using multiple modalities that address the problem holistically.”

Many of these modalities for chronic pain relief involve managing the social, emotional and mental well-being of the patient. With the opioid epidemic, many providers are starting to clearly see the relationships between pain conditions and mental health. According to Hnatek and Williamson, a primary care provider with a well-rounded approach including mental, physical, social and emotional considerations is a great place to start if you have chronic pain.

 Helping someone with chronic pain

“If you are a friend or family member of someone with chronic pain, I encourage you to validate their experience,” Williamson said. “Let them talk and communicate their feelings and frustrations, but, if you can, also find ways to encourage them to live their life then engage in that life with them.” If you are a caregiver, Williamson recommends finding ways they can participate in their own care, even if at a diminished capacity.

“Unfortunately, people tend to want a quick fix to chronic pain,” said Hnatek. “However, chronic pain is often not the result of one single reason, so the solution is often not going to be one thing. It may take a mix of counseling, good sleep hygiene, different nutritional habits and more to find something that works for you.”