Viewpoint - Rethinking chronic pain

Georgie Oldfield explains how psychological factors affecting chronic pain are not just becoming more widely accepted, but providing answers too

We’ve known for long known that not all chronic pain has a physical cause.

Recently there’s been an increasing interest in how psychosocial factors affect pain.

The result is that the ‘medical model’ is being stretched to include more than just the physical and biological aspects of specific conditions.

Meanwhile, cognitive behaviour therapy (CBT) and mindfulness are becoming used more widely in pain management clinics.

Physios are well placed to help patients recognise and resolve the real causes of their chronic pain.

My experience over the past five years has shown that the environment, stressors and the resulting emotions don’t just affect pain - they often cause it.

Once a diagnosis of a psychophysiological disorder has been made and accepted by the patient, full recovery is possible.  

Past and current stress, including childhood traumas, can all trigger pain and pain pathways can become conditioned. When triggers are missed, symptoms can persist.

One patient hadn’t written for months because his arm became ‘dead’ after he wrote a few words. He had no other problem with his arm and remembered he had been writing when he had collapsed and needed urgent heart surgery. The ‘dead’ arm was ‘protecting’ him.

A woman, who always had back pain while travelling by car, realised arguments with her husband only occurred there, away from the children.

Another patient’s back pain had persisted for seven years despite three ‘failed’ operations for two slipped discs. Recovery only came when he realised the pain had begun a month after his sister died.

Looking beyond the physical cause can provide the answer to chronic pain. Even just asking our patients what was going on when their pain began could be life-changing for some.

Georgie Oldfield is a physiotherapist and pain specialist at the Pain Relief Centre, Huddersfield

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