• Anxiety - in a survey of those with fibromyalgia up to 51% reported anxiety, mainly related to the meaning of their symptoms and the future. This can result in fear and fear-induced behaviours to avoid the pain, which ultimately leads to further disability.
• Depression - there is a strong association between chronic pain and depression, with up to 50% of those with chronic pain suffering from a depressive disorder. Depression is the strongest predictor of low back pain occurring and persisting.
• Anger - up to 98% of patients with chronic pain report experiencing feelings of anger.

Other factors associated with chronic pain:

• Beliefs - negative or threatening beliefs about pain have been shown to increase the severity of pain the individual feels.
• Attitude and expectation - a negative attitude/expectation is associated with increased pain severity and disability.
• Coping mechanisms - taking an active approach to managing chronic pain is associated with improved levels of pain severity and improved function.

Some of this distress is exacerbated by the lengthy time and complicated process it usually takes to get diagnosed. Those experiencing chronic pain often feel dejected by the healthcare system and medical professionals. They usually see numerous healthcare professionals and undergo a multitude of different tests, all of which are inconclusive. This can lead to the individual receiving mixed messages about their pain, resulting in confusion, frustration and a feeling of hopelessness like nobody can get to the bottom of this pain.

As treatments may not provide the expected relief, this can cause further distress, irritation, frustration and a loss of faith in the healthcare system. Alongside this, as pain persists, it may result in a lack of ability to do everyday tasks, reduced ability to work, social withdrawal, sleep disturbance and feelings of anxiety, depression and anger. Fear of increasing the pain can lead to reduced activity levels which in turn causes muscle disuse and further disability.

This chronic pain cycle needs to be broken!

Chronic pain cannot be cured but it can be managed. Research has shown that approaching chronic pain using the biopsychosocial model rather than the traditional biomedical model is the most effective form of management.

This biopsychosocial model takes in the account:

• Bio - biological factors, physiological pathology etc
• Psychological - beliefs, attitudes, thoughts, mood, feelings, coping mechanisms, behaviours etc
• Social - personal relationships, work issues, family circumstances, support systems etc

Optimal management involves a multidisciplinary approach (a team of healthcare professionals) and a multimodal approach (using different treatments). For example the team may consist of:

• Doctor (who can prescribe and review appropriate medication)
• Physiotherapist (who can provide graded exercises and education)
• Psychologist (who can address the psychological distress associated with chronic pain)

Management techniques will be different for each individual. An example of some evidence-based techniques are:

• Pain neuroscience education
• Graded exercise programmes
• Lifestyle modification
• Certain medications
• Cognitive Behavioural Therapy
• Acceptance and Commitment Therapy
• Pacing
• Goat setting

Of course there are many other options available, those are just a few examples.

If you would like to learn about what chronic pain is and why it persists click here.

For further information:

www.iasp-pain.org

www.chronicpain.ie

www.irishpainsociety.ie

www.britishpainsociety.org

Information based on:

Gatchel, R.J., Peng, Y.B., Peters, M.L., Fuchs, P.N. and Turk, D.C., 2007. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological bulletin, 133(4), p.581.

International Association for the Study of Pain, 2018. Chronic Pain has arrived in the ICD-11.