Suffering from chronic pain? You might be managing it wrong.

Chronic pain is awful. It can be debilitating and often leads to mental health and relationship problems.

Around 23% of people have significant persistent pain — from back and joint pain and rheumatoid arthritis to chronic headaches and sciatica. That’s 15.5 million people in the UK alone, including over 60% of those aged 75 and over reportedly suffering from chronic pain.

Many of these 15.5 million people — including, quite possibly, you — are trying to manage chronic pain in ways that might not work or, more problematically, ways that might be making it worse.

That’s because chronic pain is fundamentally different to acute, short-term pain. And because it’s fundamentally different, it requires a different treatment plan.

‍A new strategy for managing long-term pain

We manage acute pain by treating the injury until our body returns to its pre-injured state. For example, you take paracetamol for a headache. When you break your arm, you put it in a sling or cast. You put a plaster on a cut.

Chronic pain is more complex because your brain doesn’t respond as if your body has healed, even once the original injury is no longer a problem. Your brain doesn’t stop the pain response. It’s as if the fire has gone out, but the smoke alarm is still ringing, and you can’t stop it — not even by taking out the batteries.

Put simply; you’re not going to best manage your chronic pain by treating the original injury.

So, how should you manage chronic pain?

Good management of chronic pain rests on three fundamental principles:  

• You aren’t seeking to eliminate pain.
• You’re working on accepting the pain (and its genuine impact).
• You want to become more active in managing the impact of your pain so it dominates your life less and you feel more content and in control of your life.

This approach is based on elements of Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT). It’s widely considered the gold-standard method recommended for treating chronic pain by the National Institute for Health and Care Excellence (NICE): the body that provides evidence-based guidance for healthcare in the UK. 

The link between pain management and mindset

Following this recommended approach to chronic pain management doesn’t mean giving in to your pain. Instead, the evidence shows that the best mindset is less related to what you think and feel and more to how you relate to what you think and feel.

A critical aspect of chronic pain management is to learn to step back from what you’re thinking and feeling, notice it, and open up to what you are experiencing. In doing so, you avoid the trap of trying to control your thoughts or feelings, allowing you to focus on taking positive actions to improve your life.

By stepping back, you might notice that you’ve learned to respond to your pain with the thought ‘pain is always bad’ or by avoiding any exercise — including mild stretching — that leads to muscle aches.

This strategy would work if you were suffering from acute pain. But with chronic pain, you aren’t seeking to eliminate discomfort. You need to work to accept that pain is part of your life. Ideally, you’ll be working at the edges, ensuring you’re doing a range of physical and social activities that push you but don’t exhaust you every day.

This activity is more likely to happen on ‘good pain’ days than on ‘bad pain’ days. Finding the right pacing for you and setting yourself realistic goals — with help from a good support team (therapist, personal trainer, physical therapy, GP etc.) — is crucial.

Here are eight tools and techniques you can try to help manage your chronic pain.   

1. Make exercise easy and something to enjoy.

Studies have shown that if you reduce the distance to your gym by just two miles, you go up to five times more often.

2. Keep an activity diary.

Find out what works for you, what makes you most tired and what reduces your pain. Learn from it, and tweak your daily and weekly schedules correspondingly.

3. Use a thought journal.

Putting your thoughts to paper can help you notice how you think about your pain and reframe any ‘black and white’ thinking. Develop a new relationship to your pain by bringing shades of grey and nuance into the way you think about it.

4. Focus on mindfulness.

Work on staying present and resisting the temptation to avoid or control your pain.

5. Practice grounding techniques.

Deep breathing and body scan techniques can be beneficial when your pain is overwhelming.

6. Set realistic but stretching goals.

It’s crucial to set social and professional targets and work towards them. After all, suffering from a chronic pain condition doesn’t mean you have to stop living a fulfilling life.  

7. Get back to your treatment plan.

Prepare and plan for setbacks, but don’t give up just because you had one bad day or experience.

8. Remember that you’re not alone.

There’s a vast array of resources available from organisations like The British Pain Society, and a wide variety of support groups are available online and in person.

The London Centre for Applied Psychology (LCAP) is a small group of therapists, educators and academics that left successful, senior careers in other fields to pursue a passion for using the science of psychology to improve the lives of others. Discover LCAP’s online course on managing chronic pain to learn how to build a treatment plan specific to your needs.

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