Psychological Therapeutic Solutions

Psychological Approaches for Pain and Pain Management

By Dr Deborah Kingston

By Dr Deborah Kingston

Psychosomatic pain, somatic pain, and visceral pain are terms that refer to different aspects of pain experiences, and they have distinct characteristics and origins:

Somatic Pain:

Source: Somatic pain arises from the musculoskeletal system, such as muscles, bones, joints, skin, or connective tissues.

Characteristics: It is often described as a sharp, localised, and well-defined pain. Individuals can typically pinpoint the specific location of somatic pain.

Example: Pain from a muscle strain, joint inflammation, or a cut on the skin.

Visceral Pain:

Source: Visceral pain originates from internal organs, such as the heart, liver, intestines, or kidneys.

Characteristics: It is often described as a dull, aching, or squeezing sensation. Identifying the precise location of visceral pain can be challenging as the brain interprets the signals less precisely.

Example: Pain from organ-related issues, such as inflammation or dysfunction.

Psychosomatic Pain:

Concept: Psychosomatic pain refers to physical symptoms, including pain, that are believed to have a psychological origin or be influenced by emotional factors. This does not mean the pain is not real or just “in your head”.

Characteristics: The pain is real, but it may be influenced or exacerbated by psychological or emotional factors. Stress, anxiety, or unresolved emotional issues may contribute to the perception and experience of pain.

Example: A person experiencing headaches or stomach aches in response to stress or emotional distress.

Psychological Treatment for Pain Management:

Acceptance and Commitment Therapy (ACT) is a therapeutic approach that can be valuable for pain management, particularly for individuals dealing with chronic pain. ACT is rooted in the principles of mindfulness and acceptance and focuses on enhancing psychological flexibility. Here’s how ACT can be useful for pain management:

1. Mindfulness and Acceptance:

Mindfulness Skills: ACT incorporates mindfulness techniques to help individuals become more aware of their thoughts and emotions in the present moment. Mindfulness can be applied to pain, allowing individuals to observe their sensations without judgment.

Acceptance: ACT encourages acceptance of pain rather than struggling against it. By acknowledging and accepting pain as part of the present experience, individuals can reduce the emotional suffering associated with resistance.

2. Values Clarification:

Identifying Values: ACT emphasises the importance of clarifying one’s values and connecting actions to those values. This process helps individuals focus on what truly matters to them in life, even in the presence of pain.

Commitment to Values: By committing to actions aligned with their values, individuals can lead a more meaningful and fulfilling life despite the challenges posed by chronic pain.

3. Cognitive Defusion:

Dealing with Thoughts: ACT employs cognitive defusion techniques to help individuals distance themselves from unhelpful thoughts or beliefs about pain. Rather than being overwhelmed by negative thoughts, individuals learn to observe and let go of them, reducing their impact on emotions and behaviours.

4. Present Moment Awareness:

Staying Present: ACT encourages staying present in the moment, allowing individuals to respond effectively to their current experiences. This can be particularly beneficial for managing pain-related distress and preventing the mind from dwelling on fears or worries about the future.

5. Committed Action:

Behavioural Activation: ACT involves taking committed action toward one’s values, even when experiencing pain. This can include engaging in activities that bring joy, connection, and a sense of accomplishment, promoting a more fulfilling life.

6. Self-Compassion:

Cultivating Compassion: ACT incorporates self-compassion practices, helping individuals develop a kind and accepting attitude toward themselves in the face of pain. This can reduce feelings of shame or frustration often associated with chronic pain.

7. Pain as a Contextual Experience:

Contextualising Pain: ACT encourages individuals to view pain as a contextual experience rather than a defining characteristic. By recognising that pain is just one aspect of their life, individuals can create a broader context for their experiences.

Overall, ACT provides a framework for individuals to develop a more flexible and adaptive relationship with pain. It helps them focus on what they can control (e.g., their actions, values) rather than attempting to control the pain directly, which can be empowering and conducive to improved emotional well-being. It’s important to note that ACT is often delivered by mental health professionals, and its application should be tailored to individual needs in collaboration with healthcare providers.

EMDR (Eye Movement Desensitisation and Reprocessing):

Application: EMDR is primarily known for treating trauma-related conditions, but its potential role in pain management is an area of ongoing research.

Mechanism: EMDR may help individuals process traumatic or emotionally charged memories that could contribute to psychosomatic aspects of pain. By reducing the emotional impact of such memories, it may indirectly impact pain perception.

Effectiveness: The evidence for EMDR in pain management is still evolving, and its application is not universally accepted. Research in this area is ongoing.

It’s important to note that pain is a complex experience influenced by biological, psychological, and social factors. Treatment plans for pain should be comprehensive and may involve collaboration between medical professionals, pain specialists, and mental health professionals to address all aspects of an individual’s pain experience. As with any medical or psychological intervention, the suitability of these approaches should be determined in consultation with healthcare professionals.