Pain, Thoughts and Feelings

The nervous system of a person with chronic pain is often in a state  of high reactivity, therefore producing pain that is amplified. This  condition is referred to as central sensitisation. This means something  as simple as a light touch, massage or bump could cause the brain and  nervous system to go into overdrive, producing a sensation of pain and  discomfort. Pain can also be felt without movement and by thoughts  alone.

In people with persistent pain, central sensitisation can also cause  the pain ‘memories’ to persist long after the original cause of the pain  has healed. This explains why people with chronic pain can experience  pain, despite their x-ray or scan appearing normal, or why amputees feel  phantom pain. In some instances, patients may experience both fear and  pain with a certain movement, as a result of the memory of the original  injury or event that caused the pain becoming intertwined.

Learning about pain management can help to retrain the brain and  reduce the strength of pain signals being sent to the problem area.

Even small and insignificant things can be a big deal when you live with chronic pain. Chronic pains effect on the brain can impact the way we feel. It can  leave us feeling lonely, upset, angry and frustrated. As shown in the  diagram below, chronic pain leads to reduced gray matter in the brain,  which can impair cognitive abilities (ability to process thoughts),  memory and lead to emotional problems. The way we feel can affect our  thoughts, which can negatively affect our experience with pain. As such,  it is important to have a positive mindset, which can support you to  feel more energised and encourage you to take steps towards feeling  better.

Stress can alter the balance of our system by switching on the  nervous system, hormones or immune response, forcing our body to work  extra hard to return to its original state. This can bring about a wide  range of physical and emotional reactions, which can increase pain both  in the short and long term. Stress can also affect the way we think and  behave. Changes in eating and sleeping habits, lack of motivation,  neglect, isolation or taking up smoking to cope are a few of the  behaviour changes that can result from the pressure of stress and impact  how long persistent pain lasts.

Our surroundings can have a role to play in how pain is experienced.  Family challenges and conflicts reduce resilience to pain. This also  applies in the workplace. Poor work satisfaction, physical discomfort at  work and poor peer support can result in increased pain.

Experiences from the past may impact the way chronic pain is felt and  handled. Early identification of negative past experiences of pain  assists in managing the risk of developing persistent pain. 

Pain and depression are conditions that are commonly linked. Those  suffering from pain have a 30% to 40% greater chance of developing  depression. Likewise, people with persistent pain can develop problems  with anxiety. In some cases, an underlying medical problem such as  fibromyalgia can give rise to both pain and depression. Seeking help to  manage emotional and mental health is a significant part of reducing  chronic pain. 

In chronic pain, it is important to be conscious of your thinking so  you can choose your thoughts and language more mindfully. If you choose  to actively practice techniques like mindfulness, you will be less  likely to:

• Magnify the threat of your pain
• Get stuck thinking continuously about your pain
• Feel helpless about your ability to cope with pain

A range of techniques are available to help develop healthy thinking  habits to support you in managing your pain. Below are some tips to get  you started:

• Find things that you feel able to do and that you enjoy. For  example, give a friend a call once a day, who will encourage and listen  to you. It is important to stay connected.
• Give yourself a ‘pat on the back’ and reward yourself for the good things that you do. Celebrate even the smallest efforts.
• Regularly schedule in something nice for yourself.
• Practice relaxation techniques, breathing techniques, positive affirmations and keep focused on what you can do or try next.

Another technique to develop healthy thinking habits is to tune into  your own thoughts. This can be achieved by completing the below 3 steps.

1. Notice your thoughts. When you notice a negative thought, stop it in its tracks and write it down.
2. Look at that thought and ask yourself whether it is helpful or unhelpful.
3. Choose a new, helpful thought to replace a negative one. Ask  yourself: What effect does believing this thought have on me? What might  happen if I tried to believe the healthier thought?

Being intentional about trying and doing things that make you feel  good will help you take the next positive steps in managing your chronic  pain.

Pharmacists have an important role in helping you manage your  medication related problems when dealing with chronic pain. This  includes giving you the confidence to self-manage your pain by providing  management options to help you focus on thoughts when dealing with  chronic pain, so you feel in control of your pain. Pharmacist can  provide a Medication check with a pain focus to help identify areas  where you need support or assistance and can help you work through this  plan. Below is a list of other ways your pharmacist can support you.

• Recommend natural remedies
• Provide referrals to allied health professionals
• Recommend helpful apps or websites to support you to practice relaxation techniques and breathing techniques
• Keep you focused on what you can do or try next
• Recommend local support groups for you