Chronic pain model

The focus of psychology to pain management is not on directly reducing pain, but rather on the patient's adjustment to pain. The interaction between your feelings, thoughts and behaviour are important as they can and do affect your pain experience.

Feelings and emotions

Living with chronic pain can be stressful. There are many changes and losses such as work, home, friends, being less active and not being able to do the things you used to do. You may not feel you have control over your pain and don't feel able to cope with it. Depression eventually results from helplessness over a long drawn illness that does not have a cure. Experiencing pain can also lead to fear and anxiety about what might be causing the pain and what the future might hold. It can make you feel tense, especially if you expect the pain to come back or get worse. Often, other feelings, such as anger, frustration, irritation and helplessness may also follow.

Beliefs and thoughts

Feeling unhappy, frustrated, irritable and all the other negative feelings that often go with pain, is more often the result of the way you are thinking than simply the pain alone. Do you have unhelpful thoughts/beliefs that lead you to think that you are and should be disabled by pain? Beliefs such as "pain equates harm", "one has little personal control over pain", or "pain will be an enduring part of life in the future"?

Ruminating over negative thoughts about yourself ("I am useless"), others ("No one understands my pain") and the future ("I am going to become an invalid") makes it difficult to move your attention from them and do heighten your pain experience.

Behaviour

Exaggerated and generalised statements above, not only do not hold much truth but will directly/indirectly affect your emotions and eventually your daily activities and function. It becomes a "self-fulfilling" prophecy. You become what you perceive yourself to be. As such, your common response to pain will be to decrease activity, increase rest and eventually you find that you are not able to do as much as before or you as would like to. You allow pain to control your life by responding to each pain sensation. Often, allowing your focus to shift from living life to living out pain. Any activity you choose to engage in is no longer for pleasure or by choice but to get rid of pain. 

Connections between thoughts, feelings, behaviour and pain

How much pain affects us emotionally and what we do is influenced by the way we think about pain and vice versa. The link between thoughts, feelings and behaviour in the context of chronic pain can be illustrated as such: If you believe that pain is a signal of damage, you are likely to avoid movements or activities that you perceive/fear would trigger pain. Seeking to avoid or reduce pain, you choose to decrease your activity level, spending more time resting and eventually give up many of your usual activities.  Patients have given up their job, hobbies and family. Many also lose their confidence, become very isolated and depressed. You can however choose not to follow suit.

In contrast, when your chronic pain is perceived as non-threatening, you are likely to increase your activity level despite the pain, through which these fears will ease and you will start feeling good and develop more confidence in yourself.

Summary

  • The chronic pain model highlights the notion that pain is a complex experience that is not only influenced by its underlying pathophysiology, but also by your thoughts, feelings and behaviour.
  • Negative feelings such as depression, anxiety, helplessness and frustration can develop as a result of suffering.
  • Unhelpful thoughts/beliefs and negative self-statements move you away from the motivation to manage pain effectively.
  • In sum, chronic pain can influence your thoughts, feelings and behaviours and these in turn have influenced your adjustment to pain.