Chronic pain: There is a way out

September 21, 2021

Expert guest blog: Gina DelGardo, Ph.D., Clinical Psychologist

Pain is a complex condition with a negative impact on functioning and sense of well being.

To better understand pain, we must define acute pain and chronic pain. Acute pain arises as a warning sign from current injury or damage to the body. It is a signal to stop and get help for a current damaging condition. This pain generally resolves as the condition improves. Chronic pain is usually defined as pain that is present for three months or more, and can be a product of an initial acute pain condition. What usually characterizes chronic pain is the duration, in that it is present long after an injury or illness has healed. For the purposes of this blog, the focus will be on chronic pain.

Chronic pain has biological, social and psychological (biopsychosocial) factors. While the origins of chronic pain are biologic, there are more complex factors at play. Chronic pain is not simply a message from a body part directly to the brain. The pain nerves in the body send messages to the brain, but travels through the hypothalamic-pituitary–adrenal axis. This means that the pain signal travels through the same areas where emotional reactions are regulated and influenced by our thoughts, which are influenced by social factors. By understanding that pain is mediated by so many factors, one can begin to understand why the most effective chronic pain treatment approach uses multiple treatments tools, and not one treatment alone.

As chronic pain continues, normal daily activities are affected. People do less of the things they enjoy and feel less productive. They can develop muscle weakness, a change in posture, and/or begin to develop pain in other areas of their body. Sleep and mood can be negatively affected. Someone with chronic pain may begin to avoid activities due to fear of causing more damage or pain. The treatment for chronic pain is most successful when addressing the multifactorial causes and the multiple areas of impact. This means the best approach involves dealing with the bidirectional interactions among the physical, psychological and social factors that maintain the pain experience.

Treatment based on a biopsychosocial model usually includes education about pain, medical interventions, effective independent use of modalities, diet, psychology (cognitive behavioral therapy) and physical conditioning. Cognitive behavioral interventions include addressing mood, communication, sleep, and beliefs about the impact of pain, with strategies such as graduated activity exposure, pacing, and stress managements. Teaching the chronic pain sufferer to rely on a variety of tools, rather than a singular approach, empowers the individual to better manage pain and restore functioning.

Learn more about the Pain Rehabilitation Program at Siskin Hospital.