The experience of pain is necessary for our survival. People who are born without the ability to feel pain often die prematurely. Being in pain forces us to take it easy and give our body time to heal when it has become overloaded or injured. Pain can thus be a valuable message.
But the brain’s assessment of pain is not always accurate. It can both underestimate and overestimate the severity of the injury or illness.
In some forms of fatal cancer, the patient feels no pain until the final stage. Whilst accidentally cutting yourself on the fingertip can hurt a lot, even though the injury is far from life-threatening.
Another example of when pain signals may be misaligned is the condition chronic pain.
Some people are in constant pain even though they are not suffering from any serious injury or they have a serious injury or illness, which the body is unable to heal. In both cases, the pain can become chronic (permanent): it does not go away, but becomes part of everyday life for the sufferer.
Causes of chronic pain
Our bodies produce substances called opioids (not to be confused with opiates, which are supplied from outside, such as morphine).
One type of opioid are endorphins, which are often described for their analgesic properties. In order for them to do their job, the nerve cells must have enough receptors, so that the pain-relieving signals are properly registered.
People with high pain sensitivity, for example those who suffer from chronic pain, often have fewer opioid receptors than average. This means that the body’s attempts to alleviate the pain do not succeed, because the message does not reach the nerve cells.
How we interpret and value our pain also plays a big role in how we experience it.
The parts of the brain that are responsible for the most advanced thinking are connected to an interesting area called PAG (periaqueductal gray). This region has many opioid receptors, and also has the ability to send pain-relieving signals into the body.
When researchers stimulate this area electrically, the subject feels less pain. Since PAG is linked to our brain functions, it seems reasonable that humans can to some extent train their consciousness to relieve pain on their own (something that so-called fakirs – who walk on broken glass or glowing coals – seem to have learned).
Treatment of chronic pain
Treatment options can involve exercise, physiotherapy, medication and psychotherapy.
Medication for chronic pain
Somatic (physical) healthcare can offer many painkillers. Unfortunately, the strongest drugs in this category are often addictive, and therefore not a good long-term solution.
Medical cannabis can in some parts of the world be prescribed for chronic pain, but is currently not an established treatment in UK healthcare.
Psychotherapy for chronic pain
The experience of pain thus has several components: physical, biological, cultural, cognitive and emotional.
Sometimes we can not influence all these factors. A broken bone is a broken bone. But it is almost always possible to work with the mental pieces, that is, our thoughts and feelings. CBT, cognitive behavioral therapy, can be helpful here. Traditional CBT has many established techniques for managing pain.
Among other things, they try to reduce the experience of learned helplessness, an attitude that makes us feel like passive victims when something difficult happens. If we can shift focus and realize that we partly have the power to influence our own experiences, we will have better conditions for dealing with pain.
The patient also receives homework, which can include writing down thoughts and feelings that affect the pain experience. In this way, you can identify the behaviors that reduce the pain, and make sure to perform them more often.
ACT (Acceptance and Commitment Therapy) is a modern form of CBT (“third wave CBT”).
ACT has many elements of mindfulness and places more emphasis on accepting inevitable suffering, such as pain, than traditional CBT. It is believed that efforts to turn off or think about the pain can actually make the experience worse.
ACT also encourages the patient to continue doing what gives him or her joy and meaning, even though the pain may seem limiting.
The treatment examines which life values and personal goals are most important to the patient. Then he or she makes a commitment to do their best to follow these intentions, even if there are obstacles, such as chronic pain.
How do CBT and ACT differ in the treatment of chronic pain?
A very simple summary can sound like this:
The goal in CBT is primarily to reduce the pain, so that life works better. ACT thinks the opposite: they try to improve the quality of life, so that the pain experience has less space.
Both methods have good scientific support.