Positive Pain Management: How to Better Manage Chronic Pain

Chronic pain is a condition that causes widespread, constant pain and distress and fills both sufferers and the health care professionals who treat them with dread.

There is often no clear cause, and treatment and traditional pain management efforts are often less than successful. This can cause great distress and a sense of hopelessness.

“When pain is no longer useful as a symptom, identity is challenged, weakened and at risk for both chronic pain patients and pain professionals.”

Eccleston et al., 1997, p. 699

Recent research and a shift toward a more comprehensive pain management approach, however, bring hope. By combining traditional and psychosocial interventions, practitioners are now able to help their clients better navigate their experience of chronic pain.

Find out more about the latest evidence-based research below.

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Navigating Chronic Pain Management

Chronic pain is a difficult topic to navigate. It is fraught with fear, misunderstandings, and a whole myriad of negative connotations and expectations. There are, however, significant breakthroughs that are being made across various fields. These allow us to understand this phenomenon and therefore manage it better.

What is chronic pain?

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Raja et al., 2020, p. 1976).

In simpler terms, pain is the sensation that we feel when our body is hurt or under threat of being hurt. From this, we can assume that there is usually an obvious cause for pain, and when the damage or threat of damage is healed or removed, the pain should go away. But what if it doesn’t? Or, what if there is no obvious cause? Or the cause can’t be removed?

This is when we start to talk about chronic pain (Raffaeli et al., 2021). This type of pain doesn’t necessarily have an obvious cause that can be treated or resolved. It can last for months or even years. It affects the sufferer’s quality of life and often comes with multiple associated conditions. As you can imagine, this can lead to a cycle of pain, stress, and depression (Blackburn-Munro & Blackburn-Munro, 2001).

Johns Hopkins Medicine refers to this cycle as the terrible triad of chronic pain: suffering, sadness, and sleeplessness (Koffel et al., 2015). The diagram below illustrates how the triad involves a cyclical cause-and-effect process where pain and worry about pain cause sleeplessness, which causes more pain and depression. The depression in turn exacerbates the pain and sleeplessness, starting the cycle all over again.

What causes chronic pain?

The causes of chronic pain are varied and elusive (Wang et al., 2020). It can result from a wide range of underlying conditions, injuries, diseases, or syndromes, and it often involves a combination of physiological, psychological, and social factors.

Some common causes of chronic pain include the following (Johns Hopkins Medicine, n.d.):

• Injury or trauma can fail to heal properly or lead to persistent pain even after the injury has healed.
• Degenerative conditions like osteoarthritis, rheumatoid arthritis, and degenerative disc disease cause inflammation.
• Neurological disorders such as neuropathy, multiple sclerosis, or fibromyalgia cause abnormalities in nerve function or processing of pain signals.
• Chronic illnesses like cancer, autoimmune diseases, inflammatory bowel disease, or endometriosis cause inflammation, tissue damage, or nerve involvement.
• Musculoskeletal issues related to muscular tension, myofascial trigger points, or imbalances in muscle strength and flexibility lead to conditions like chronic back pain or tension headaches.
• Psychological factors such as emotional stress, anxiety, depression, or past trauma may cause central sensitization, amplification of pain signals, or altered pain perception.
• Genetic predisposition to chronic pain conditions or certain inherited pain-related traits can increase susceptibility to developing chronic pain.
• Lifestyle factors such as poor posture, sedentary lifestyle, improper ergonomics, obesity, smoking, or unhealthy dietary habits contribute to musculoskeletal pain or exacerbate existing pain conditions.

And sometimes there may be no clinical reason for chronic pain at all. How then can there be pain with no cause?

It would seem that this type of chronic pain occurs as a result of faulty neural circuitry (Wess, 2008). Your brain’s circuits don’t work the way they’re supposed to. Either they’re too sensitive or they’re misreading the signals the body is sending, causing your body to experience pain when there is no physical stimulus for the pain.

Intriguing Psychological Research Findings on Pain Management

Psychological research on pain management has highlighted several intriguing findings that are helpful when it comes to managing chronic pain. Some particularly interesting findings include the following.

Pain catastrophizing

Pain catastrophizing refers to our tendency to magnify the threat value of pain and to feel helpless in the face of pain. Consistent research findings indicate that if you engage in pain catastrophizing, you experience greater pain intensity, disability, and psychological distress (Petrini & Arendt-Nielsen, 2020).

Psychological interventions that target pain catastrophizing have been shown to be effective in reducing pain and improving functioning in individuals with chronic pain (De Boer et al., 2014).

The placebo effect

This is a phenomenon that occurs when you experience a reduction in pain or improvement in symptoms after receiving an inactive treatment that you believe to be real (Macedo et al., 2003).

Psychological research has explained some of the mechanisms underlying the placebo effect, including the role of expectations, conditioning, and the release of endogenous opioids in the brain that help with pain management (Perfitt et al., 2020).

Neuroscience

Neuroscience and the study of neuroplasticity have revealed that the brain has a remarkable ability to reorganize and adapt in response to pain (Wess, 2008).

Interventions such as physical therapy, cognitive training, and mindfulness meditation can cause structural and functional changes in the brain that may reduce pain perception and improve pain management outcomes (Wess, 2008).

Mindfulness-based interventions

These interventions have been shown to reduce pain intensity and improve quality of life by altering brain activity and enhancing coping skills (Garmon et al., 2014).

Changes in brain activity associated with practicing mindfulness can improve psychological factors that influence how pain is experienced, such as pain acceptance, self-efficacy, and emotional regulation (Majeed et al., 2018).

These findings highlight the significance of psychological factors in pain perception and the potential of psychological interventions to complement traditional treatments. In fact, one could argue that, considering the above research findings, psychological interventions are an integral part of successful pain management.

Combining Traditional Approaches and Psychology for Pain Relief

A combined approach to managing chronic pain is fast becoming the gold standard (Jensen, 2011). This is unsurprising given that it is a systemic problem that requires a holistic and systemic approach. Combining traditional approaches with psychology allows for a more comprehensive approach to pain relief (Shi & Wu, 2023). Let’s look at why this is so.

Traditional methods such as medication and physical therapy address the physiological aspects of pain, while psychological interventions target the emotional and cognitive components.

Including psychological interventions in pain management strategies will help clients develop coping strategies, manage pain-related distress, and reframe negative thoughts about their condition. This integrated approach not only reduces pain intensity, but also improves overall wellbeing and quality of life for individuals living with chronic pain.

8 Proven Chronic Pain Treatments Using Positive Psychology

Various positive psychology interventions are effective for managing chronic pain (Flink et al., 2015). These chronic pain interventions aim to improve resilience, wellbeing, and quality of life in individuals living with chronic pain.

Mindfulness

Mindfulness-based interventions teach skills to manage pain-related distress, enhance pain acceptance, and improve overall wellbeing (Garmon et al., 2014). By cultivating mindfulness, clients develop a different relationship with their pain and reduce their emotional reactivity and suffering.

Self-compassion

Although there is still a need for more large-scale randomized controlled studies, self-compassion is recognized as a key positive psychology intervention for managing chronic pain (Mistretta et al., 2022).

By cultivating self-compassion, clients with chronic pain can reduce self-criticism and feelings of inadequacy (Edwards et al., 2019). This will improve their ability to navigate the challenges of living with chronic pain with greater ease and acceptance.

Resilience

Researched resilience-based interventions for chronic pain management involve (Goubert & Trompetter, 2017):

• Strengths identification
• Optimism cultivation
• Mindfulness
• Social support enhancement
• Meaning making
• Goal setting

All these interventions will build resilience, reduce emotional distress, and enhance overall wellbeing.

Humor

Using humor as a positive psychology intervention for chronic pain can offer numerous benefits (Ruch & Hofmann, 2017).

Humor shifts the focus away from pain, and it is a natural coping mechanism that provides emotional relief (Pérez-Aranda et al., 2019). Humor further assists with the management of chronic pain in that it fosters social connection, strengthens relationships, and provides emotional support (Finlay et al., 2022).

Gratitude

Practicing gratitude involves intentionally expressing appreciation for what you have, despite the presence of pain. Research suggests that cultivating gratitude can enhance psychological wellbeing, reduce stress, and improve coping with adversity, including chronic pain (Shah, 2021).

By making use of gratitude interventions, such as keeping a gratitude journal or writing letters of appreciation, attention is shifted away from pain and positive emotions are promoted (Boggiss et al., 2020).

Strengths identification

Identifying personal strengths and resources can empower individuals to leverage their strengths in managing pain and face challenges more effectively (Graziosi et al., 2020).

Strengths-based assessments and interventions can assist clients in identifying their own strengths and using them to better cope with chronic pain.

Social connection

Strengthening social connections and seeking support from friends, family, or support groups can provide emotional comfort and practical assistance in coping with pain (Sturgeon & Zautra, 2016). Positive psychology interventions that encourage social interaction and support lead to the development of stronger social support networks and improve wellbeing and quality of life (Farr et al., 2021).

Psychological capital

Psychological capital, comprising hope, optimism, resilience, and self-efficacy, may offer an effective positive psychology intervention for chronic pain management (Luthans & Youssef-Morgan, 2017).

Interventions that promote psychological capital aim to improve psychological wellbeing, enhance coping skills, and increase clients’ ability to thrive despite their pain.

It’s important to note that while these interventions are an integral part of a comprehensive pain management plan, they may not directly alleviate physical pain. They may improve psychological wellbeing and coping skills, ultimately enhancing the overall quality of life for individuals living with pain.

Pros & Cons of Positive Psychology Treatments for Pain

Positive psychology interventions offer several benefits for chronic pain management, but there are also potential drawbacks to consider. The following is a selection of advantages and disadvantages.

Pros

The advantages of positive psychology being used for pain management include:

• Enhanced coping skills and agency
  Positive psychology interventions can equip clients with tools that help them feel more in control of their own pain (Müller, 2016).
• Improved wellbeing
  These interventions can promote psychological wellbeing, reduce stress, and enhance clients’ overall quality of life.
• Complementary approach
  By offering additional strategies to address the emotional and psychological aspects of pain, these interventions complement traditional medical treatments.
• Empowerment
  By focusing on strengths, positive emotions, and personal resources, clients take an active role in managing their pain and improving their quality of life (Hansen et al., 2023).

Cons

The potential disadvantages associated with using positive psychology interventions to manage chronic pain may include:

• Individual variability
  Not everybody will respond equally to mental health interventions (Garmon et al., 2014). Taking a collaborative and person-centered approach will help you devise the best plan for your client.
• Time and commitment
  Engaging in interventions often requires time, effort, and consistent practice. Clients may need ongoing support and motivation to maintain these practices (Farr et al., 2021).
• Potential overemphasis on positivity
  There’s a risk of overemphasizing positivity and neglecting the realities of the client’s experience. Avoid this by reminding the client of the importance of acknowledging and addressing negative emotions and experiences associated with chronic pain.

While positive psychology interventions can offer valuable tools for individuals living with chronic pain, it’s essential to approach them as part of a holistic and individualized treatment plan that addresses the multifaceted nature of pain and its impact on physical, emotional, and social wellbeing.

6 PositivePsychology.com Interventions to Help With Pain

PositivePsychology.com has several tried-and-tested interventions that may be helpful as you support clients’ chronic pain management. In particular, the following worksheets can be helpful.

• The Coping With Stress worksheet is a two-part plan that aims to help identify what life situations make you experience stress and recognize their impact. Doing so will help you identify triggers associated with chronic pain and link them to more adaptive and effective coping strategies.
• The Decatastrophizing Worksheet provides five progressive questions to deconstruct chronic pain-related “catastrophes.” This prevents thoughts of “What if …?” from taking over.
• The Resilience and Change Worksheet provides a means to identify the psychological capital available to clients and to support them through the changes caused by their chronic pain.
• The Gratitude Journal Worksheet acts as a good prompt for those new to journaling. Keeping a gratitude journal creates perspective around the chronic pain experienced.
• The Radical Acceptance Worksheet is a Dialectical Behavior Therapy exercise to deal with intense negative emotions and experiences related to chronic pain.

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A Take-Home Message

Chronic pain presents a daunting challenge, marked by persistent discomfort and limited treatment success.

Recent research suggests that a holistic approach integrating traditional and psychosocial interventions offers hope. This more comprehensive approach acknowledges the complexities of pain management and leverages diverse strategies to improve quality of life.

Integrating traditional and psychosocial approaches offers a promising path forward in chronic pain management, fostering empowerment and reclaiming the potential to flourish despite challenges.

By balancing the benefits of positive psychology with the realities of chronic pain, you can empower clients to navigate their experiences with resilience and optimism.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.