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Common unhelpful thoughts in pain

A person with persistent pain, more often than not, requires help from a psychologist. This help may be in the form of counselling, teaching relaxation techniques or cognitive-behavioural therapy. It will help the pain sufferer extinguish unhelpful thoughts and emotions, and will help the psychologist to work along with them with their positives. From a pain physician’s perspective it is a challenge, as all too often such suggestions are met with an accusatory look. A look, which at once is ‘I am not having a mental health problem,’ and ‘Is the doctor thinking I am faking my pain?’ and ‘What if the psychologist thinks I am deviant?’ There is then the all too prevalent stigma attached to visiting a mental health professional.

Pain & thoughts – the relationship

Pain is closely related to our thoughts and behaviour. Persistent pain induces negative thoughts, which in turn reinforces negative behaviours. Both negative thoughts and behaviours contribute to the suffering associated with pain. It is essential that these unwanted thoughts are addressed early to prevent a life filled with misery.

Thought distortion in pain

Over course of time, people with persistent unrelieved pain start developing what are known as cognitive distortions. The kind of thinking that is more detrimental than pain itself. These are automatic negative thoughts, which occurs automatically, reflexively, unintentionally and habitually. ‘I have to clean the entire house or not at all,’ ‘My doctor didn’t cure my pain… so he must be incompetent,’ ‘Before chronic pain, my life was perfect,’ and ‘I am not working for the past few months and so I must be a loser,’ are some such cognitive distortions known as ‘All or Nothing’ thoughts. Seeing the reality of life with chronic pain in such binary ways is when people start losing hope, feel lonely, suffer exhaustion and believe that they are going to be stuck in the rut forever.

Catastrophising in pain

When in pain, it is not uncommon to think that a catastrophe has struck. ‘Pain catastrophising’ is the tendency to describe a pain experience in more exaggerated terms than an average person; to ruminate about it (I kept thinking ‘this is terrible’); and feel more helpless about the experience (I thought it was never going to get better). Such catastrophising tends to exaggerate the pain experience, and believing that the pain would never reduce or go away is detrimental to recovery and wellness. Untying this complicated knot requires much counselling and not least a thorough assessment. A pain physician in association with a psychologist could be of help in overcoming this glitch in the thought process.

Fear-avoidance behaviours in pain

‘If hope can help you survive cancer, fear can kill you from an ulcer,’ goes a saying. This could not be more closer to the truth for some persistent pain sufferers. Fear of recurrent pain prevents one from initiating or doing even minimal physical activity, resulting in deconditioning of the muscles. This increased tension in the muscles worsens pain, thereby kickstarting another vicious cycle. It is known as ‘Fear-avoidance behaviour,’ and extensive research has found it to be a major player in promoting chronicity. When in pain, a psychologist could educate the harmful effects of fear-avoidance behaviour and the benefits of controlled activity in regaining muscle strength and vitality.

Hypervigilance in pain

‘Hypervigilance’ plays an important role in the development of chronic pain. It occurs when one chooses to focus on an ache or pain and continue to revisit the sensation in the painful area, on what many might consider to be a pathological or unhelpful number of times during the day. Usually, there tends to be some meaning attached to the sensation. In the event that these meanings attach a sense of worry, danger, or fear to the painful sensation; the spark for a burning problem is ignited. Reassurance by the physician or the psychologist could be of help in decreasing such thoughts.

Locus of Control in pain

When in pain, some tend to think that they can control their pain as well as the thoughts and feelings associated with it. While some others could think that they need someone else to take care of their pains. ‘Locus of control’ refers to the extent to which individuals believe they can control events affecting them. For instance, an individual’s ‘locus’ is conceptualised as either internal (he believes that he can control his pain) or external (he believes his pain is controlled by environmental factors which he cannot influence, or it is by chance or fate). A psychologist could assist in encouraging the sufferers to internalise their locus of control in order to achieve satisfactory pain relief.

Attitude when in pain – resilience vs. resignation

People living with pain face a choice of either accepting their pain with resignation – ‘I’m stuck with this pain and the lousy life it has given me,’ or accepting with resilience – ‘Yes, I have pain, but I am still going to live well!’ They may not be aware that they are making a choice of attitude, but they are. And their attitude will have an immense influence on the kind of life they can expect to live from then on. People who are resilient are physically active and mentally alert. They report lower pain than they otherwise might, and in the midst of their pain they find ways to achieve meaning, purpose, and fulfilment in life. They are involved with other people as equals, making a contribution in their families and community. They appear to others as heroes, and consequently they inspire the people around them to overcome their own obstacles.