A Nation in Pain
Scientific advances open the door to CBT and mindfulness for chronic pain.
Posted Sep 02, 2016
I could not be more pleased to introduce my first guest blogger, Aria Campbell-Danesh, who kindly agreed to share his knowledge, experience, and compassion in working with men and women who deal with chronic pain. Recipient of the prestigious Principal's Medal when he was at the University of St. Andrews, Aria lives in the UK where he provides cognitive-behavioral and mindfulness-based therapy.
Pain is a fundamental aspect of being human. Although a very unpleasant experience that we generally try to avoid, from an evolutionary perspective pain has played an essential role in our survival: It grabs our attention, motivates action (for instance, to escape from whatever may be triggering the pain), and teaches us to avoid similar situations in the future. A child touching fire for the first time highlights this very quickly. In fact, the inability to feel pain is a serious disorder (albeit one occasionally used for rogue purposes by villains in James Bond or superhero movies).
Acute pain generally has a clear cause, goes away with healing, and responds well to treatment. However, even modest estimates suggest that at least 25 million Americans suffer daily from chronic pain, typically defined as persisting for at least 3 months. Common areas include back pain, joint pain, and headaches, with sensations ranging from shooting pain to burning or aching. The underlying cause can be unknown and medication, surgery or physical therapy may provide little or no relief.
The use and addiction of opioids (including prescription painkillers, morphine and heroin) in the US is a grave concern, highlighted tragically this summer with the death of the artist Prince. On average, 78 Americans die each day from opioid overdoses.
Some of my clients have lived with their pain for more than 30 or 40 years. Understandably chronic pain can become overwhelming, spilling over into many areas of life, from sleep to relationships, and contributing to depression, anxiety, and social isolation.
Recently there has been an eruption of research in this area that has led to important scientific advances in our understanding and treatment of chronic pain.
Traditionally, the field of medicine viewed the mind and body as functioning separately. However, it is now recognized that pain is affected not only by physical but by psychological factors. Pain itself is an interpretation of signals that are sent to the brain through nerves in the body. Returning to the child that touches a fire, in this case pain signals will be sent from the site of injury (i.e., the fingertips) to the brain, where various signals will be interpreted and the experience of pain will be produced.
Fascinatingly, research shows that this complex process is actually influenced by our beliefs, expectations, memories, thoughts and emotions. For instance in one study from Oxford University, researchers fired a laser at participants’ feet while enclosed in a scanner (a little like Bond villains except this was in the name of science). In one condition participants were told that the laser was entirely safe, and in the other that the laser was potentially harmful. The researchers were therefore manipulating the "‘threat level," with the latter group anticipating a higher threat.
As you can imagine, the "high threat" individuals reported being more anxious than those in the "low threat" group! Despite the laser stimulation intensity being the same, those in the high threat group were more likely to classify the laser stimulation as painful, and perceived it as more painful than the other group. This was characterized by higher activation in brain regions associated with pain processing. The anxiety and fearful anticipation actually increased the experience of pain and activity in the brain, like turning up the volume on an amplifier.
So if you are anxious, depressed, stressed, constantly on the lookout for pain, overestimating the personal consequences or underestimating your ability to cope with it, then you will actually feel more pain than you would if you were relaxed and less threat-focused. Over time, the brain can also become highly attuned to pain, seeking out triggers and creating more pain with less provocation. Ordinary touch can become painful. The brain is then like a sensitive burglar alarm, even setting off when a spider crawls in the corner of the room. On top of this, the meaning that we attach to these experiences of pain, whether having thoughts about being a burden on the family or thoughts about the pain getting worse in the future, can create an additional layer of emotional suffering.
The Road to Recovery
Now before you fall into a deep pit of despair, help is at hand! Understanding how pain is created allows scientists and clinicians to develop more effective treatments. Cognitive-behavioral therapy applies this understanding to a client’s own specific circumstances to alleviate pain and reduce its disabling effects. Unhelpful beliefs and behaviors that maintain and exacerbate pain can be identified and changed. Furthermore, the number of studies demonstrating the benefits of “third wave” cognitive-behavioral therapies for treating chronic pain, known as acceptance-and mindfulness-based interventions, is rapidly growing.
Hospitals and specialist pain clinics now refer patients to mindfulness courses adapted for chronic pain. As you may know, mindfulness is based on paying attention to our experiences in the present moment, compassionately acknowledging and accepting our thoughts, feelings and bodily sensations. In my clinical practice, when I start to discuss mindfulness my clients often give me a confused or alarmed look at this stage and say something along the lines of: “When I’m in pain, it’s all I can think about. How on earth can mindfulness help? I don’t want to focus on the pain even more, it’ll just make it worse!”
The Mindful Path
When we’re in pain, our mind is often consumed by it: Our thoughts automatically jump from one worry to the next, conjuring up catastrophic interpretations and fearful future scenarios. As we know, this serves to worsen pain. Through mindfulness practices we can start to tease apart different layers of suffering. Rather than fall into habitual patterns of thinking, feeling and acting that turn up the volume of the pain, we can start to distinguish between the physical sensations and the thoughts, emotions and actions that intensify the pain.
As strange as it sounds, with curiosity and friendliness we can approach the pain, observing it and watching as it comes and goes. Mindfulness meditation has been found to decrease pain intensity by 40%. My clients often find that through this process mindfulness reduces the pain and suffering. For others, the pain is still there, but it no longer dominates or interferes with their lives as it did before.
We can arrive at the understanding that pain does not have to define or rule the way that we live each day: it is just one aspect of our experience and it is still possible to live the life that we want to the full. For each individual this will be unique, whether it’s finding meaning and enjoyment through relationships and work, or overcoming Bond and finally achieving world domination.
Aria Campbell-Danesh, M.A. (Hons)
For health, weight loss and mindfulness, follow my Instagram, @ariacampbelldanesh