Persistent pain: Understanding causes and finding relief

Did you know that three in five people over the age of 50 have persistent pain? For some, this is related to an autoimmune disease like rheumatoid arthritis or to a degenerative disease like osteoarthritis. But, for many, the pain they experience is dismissed as a medically unexplained symptom.

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If you find yourself in pain and the doctors tell you that there is no physical cause for it, you not only feel your pain but you also feel disbelieved and alienated, and think that others believe you’re a fraud. You defend your ego by isolating yourself from society, becoming depressed and stressed, and this makes your experience of pain more severe. But be reassured – your pain is real!

You don't have to have an identifiable injury or observable tissue damage to be in pain. It used to be believed that pain was a sensation you experienced only when you have been injured and the amount of pain you felt was proportional to the amount or severity of the damage to your tissues. But this is not true! Depending on circumstances, a person who has extensive injuries can experience no pain and, conversely, a person who has no physical injury can suffer excruciating pain despite there being no identifiable cause.


The science of pain

People have pondered about what pain is since the days of the early Greek philosophers. But in more recent times, starting around the mid-1600s, serious thought has been given to explaining pain and how it is felt.

Theories have been put forward, refined and improved since then until studies that began in the 1950s started to unravel some of the mysteries of pain. They continued through the second half of the last century with research projects looking at how nerve endings detect tissue damage through to the way that messages about tissue damage travel to the spinal cord and onward up to the brain.

The 90s, with the invention of fMRI machines, enabled the brains of people in pain to be imaged, confirming that several different parts of the brain – which were also needed for other essential processes when not engaged in making pain – were involved in creating the sensation.

The consensus is now clear: Pain is a protector. Acute pain makes you pamper an injured part to prevent more damage from happening to it while it heals. But sometimes this useful quality of pain goes rogue. Sometimes the pain, which is so protective of injured body parts, continues to be felt despite the injury having healed, and long after there is any discernible injury, you continue to feel pain.

This is because your brain has learned to produce pain, by a complicated process known as neural plasticity, where the neurones in your brain which make pain, connect strongly with one another and become much more excitable, spontaneously firing and producing pain even when there is no warning of damage coming to your brain from your peripheral nerves. At these times, pain ceases to be a protector and becomes a tormentor – but a tormentor with the best of intentions. Your unconscious mind thinks that it is still protecting your body.

The current model of pain visualises it as a phenomenon which is influenced in part biologically, in part psychologically and in part sociologically. And because it has this makeup, we have several different ways to intervene and help a person feel their pain less intensely or, in some cases of medically unexplained pain, to cure it altogether. Because pain is a biopsychosocial phenomenon, there are three paths along which to approach the reduction of pain, which can be applied either individually or in combination.

Biological factors and their effect on pain

The medical approach attempts to deal with the biological elements which influence the perception of pain at different links in the chain: the point of peripheral detection of damage, the warning transmission system, and the brain’s decision-making process. It includes electrical stimulation, analgesics, prescription drugs, spinal blocks and possibly surgery. 

Psychological factors and their effect on pain

When we feel unsafe, our brain creates a stress reaction, and stress makes pain more painful. The more pain we feel, the less safe we feel and the stronger the stress reaction becomes – creating a vicious spiral. The converse of this is that when we feel safe, our brain reduces our level of stress with a commensurate reduction in the experience of pain.

The psychological approach to pain reduction is based on this fact, and the factors that affect our sense of safety: the thoughts we have, our beliefs, our knowledge, our predictions, our feelings and our actions. Working with a counsellor can help you to reduce the perception of pain by increasing your sense of safety and reducing your awareness of threat by changing unhelpful cognitions, correcting distorted models of your body and of the world and rectifying negative automatic ways of thinking.

Sociological factors and their effect on pain

Humans are social animals. Prehistorically, we congregated in small social groups for safety and even today, a group of close friends or an intimate relationship gives us a sense of belonging and a sense of safety – and with an increasing sense of safety reducing levels of stress, it brings about a corresponding reduction in the intensity of pain.

The social influences which contribute to our sense of safety are: family, friends, colleagues, culture, society, community, and access to care. If we have dysfunctional relationships or are socially isolated, we will feel unsafe and experience pain more intensely. Counselling can help reduce the perception of pain by helping you to live more adaptively in your relationships and with your social group and increase your sense of safety.


Neural networks and their role in pain relief

Despite the trillions of cells in the human brain, there are not enough cells for one isolated group of cells to carry out one single function. So, brain functioning is based on groups of cells in different parts of the brain operating in a distributed network – a bit like the Internet as it flashes messages around the world. All of the groups of cells in the network take part in a very large number of other, different networks.

Pain is created in the brain by specific brain cell groups working in a network. Each of these groups also works with different networks to perform other functions, and one group in the pain network is needed for vision and imagination. Making your brain work on visualisation and imagination while it is also busy making pain can disrupt the pain network to make your pain less intense. Relentlessly practising this method when you’re in pain has, in some cases, been shown to eliminate medically unexplained persistent pain, altogether.

An experienced counsellor can guide you in the use of this method. Achieving your goal will require determination and perseverance, but your counsellor will also be able to support and encourage you on this arduous journey.

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The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Manchester, Greater Manchester, M1
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Written by David Peak
location_on Manchester, Greater Manchester, M1
David Peak has over 20 years experience in the field of psychological therapy and constantly strives to improve his knowledge and skills, the better to help his clients overcome the mental distress that some life events can cause them.
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