People with chronic pain face a number of challenges that may seem insurmountable. With the right tools, however, chronic pain can be managed to minimize the detrimental impact it has on the person’s life. Melissa Geraghty, Psy.D., presented a webinar with Mental Health America (MHA) on Living Mentally Well with Chronic Pain Conditions to help equip chronic pain patients with strategies to improve their quality of life and mental health.
Among the variety of challenges chronic pain poses is the complexity of the pain itself. Managing symptoms is not always a straightforward process even when a patient only has one condition, but patients with chronic pain usually have several comorbid conditions. As an example, Geraghty said, “There are so many migraine comorbidities other than ‘just pain.’ There’s IBS issues, gynecological issues, all of this, and, of course, the mental health piece. How could we, as people with such complex medical conditions, not have difficulties with mental health?”
Because chronic pain impacts so many parts of a person’s life, it is also a powerful cause of psychological suffering. “If a person in pain continues to miss out on opportunities to connect with others due to their pain, they may think that they’re controlling the pain by staying at home,” Geraghty said. “And yet, the pain will just remain.” By removing themself from their activities and friendships, the person isolates themself, leaving them to deal with relentless pain alone. Avoiding activities to manage the pain can, itself, contribute to the cycle. “If I’m having a ton of pain and I’m frustrated about it, I can easily get really frustrated by that and tense up, and then have more pain.”
Chronic pain affects relationships, employment, and self-care through this self-perpetuating cycle. Consequently, people with chronic pain have an elevated risk of distress and depression. Geraghty stressed that although mental health has a bidirectional relationship with chronic pain, it does not cause the chronic pain. “I have actually never met a pain patient who was ‘faking’ because of a mental health condition. It’s not all in your head.”
A 2019 MHA analysis of well over 30,000 screeners demonstrated a heavy overlap of pain and both PTSD and depression. In light of this connection between chronic pain and mental health, chronic pain patients should be screened for commonly co-occurring mental health conditions, such as depression, anxiety disorders, substance abuse disorders, PTSD, and bipolar disorder — but most are not.
In this analysis, 36% of those screened reported never receiving treatment, even though 80% reported wanting to take the next steps to manage their health conditions. Nearly half were receiving treatment but still being screened, which indicates that they needed more than the treatment they were receiving for their physical and mental health needs. Patients often do not receive the care they need not only due to the common factors associated with social determinants of health, such as high costs, insufficient insurance, limited options, long waiting periods, and lack of access — 25% of Americans reported having to choose between mental health care and paying for daily necessities — but also because chronic pain and the exhaustion it causes make overcoming these obstacles even more difficult.
Living a healthy life with chronic pain requires balance and compassion, especially with the frustration that comorbidities can cause. If you or a loved one is experiencing chronic pain, be aware of warning signs which may indicate that mental health assistance is necessary. Even without warning signs, mental health assistance can be a benefit. “It’s a lot for us to have to figure out which condition needs our attention at the moment, what’s going to flare if I attend that condition, or what’s going to be helped,” Dr. Geraghty said. “It’s a lot.” Critical warning signs include:
- Having suicidal thoughts, talking about wanting to die, or having a plan.
- Giving items away.
- Feeling hopeless and not seeing a future.
- No longer caring for basic hygiene.
- Isolating from friends and loved ones.
- Not finding pleasure in hobbies anymore.
- Feeling constant anxiety.
- Having racing or repetitive thoughts.
- Feeling down or depressed.
If they do not have a psychologist or a counselor, people should report these mental health concerns to their primary care provider, who may refer them to a therapist. In the event that the person does not feel heard by their doctor, there are other resources available to help connect them to a therapist, such as MHA, the Association for Contextual Behavioral Science, and Psychology Today, in addition to asking their insurance company for a list of in-network therapists. Report concerns by being clear and concise, which can be easier with a written list of concerns brought along to the appointment. If the person is experiencing a crisis, they should go to their local emergency room or call or text the crisis hotline, 988.
Living Well with Chronic Pain
Geraghty acknowledged that chronic pain often makes patients reluctant to pursue treatment, especially after unsuccessful attempts. Previous failures, however, may simply be the result of trying strategies that weren’t right for the person. “You won’t know what helps until you give it a try. I’ve heard everything when people want to bring up excuses of why they won’t want to try, and I’ve said some of these myself, too,” Geraghty said. “Whatever your thoughts are, that’s okay. Carry them with you and try anyway. Because chronic pain impacts every portion of our lives, how we cope often takes many different approaches. It’s not just one thing that works, and that’s all I do. It’s a lot of different things.”
Finding support groups and peer support is often helpful. Some peer-led support groups can feel like more of a “complaint fest,” so it may take some searching to find one that feels right. Similar options include mental health professional-led support groups and virtual groups, such as online forums. All of these different types of groups can be disease-specific, or general to chronic pain. Places offering these support groups include MHA and the U.S. Pain Foundation.
Staying active, which Geraghty calls ‘movement’ instead of exercise, is another useful tactic. “Movement really does benefit our mental and physical health,” she said. “If my chronic fatigue is in a flare, I’m not going to be able to go on my recumbent bike, but I may be able to just do some stretching, roll my shoulders, some gentle yoga positions, and that’s still moving.”
It can be easy to think that not moving will avoid triggering the pain, but “a lot of us will find that actually not moving will make things worse for us in the long run, and we end up getting more pain.” Having patience and compassion for whatever is possible today is important to keep a healthy mindset. Your medical professional may be able to determine what kind of movement could be best for you.
Another powerful means of managing chronic pain is mindfulness. “Mindfulness means paying attention, on purpose, in the present moment, and without judgment,” Geraghty said. “It’s not psychobabble hippie stuff.” Mindfulness is the practice of paying attention to, and staying grounded in, the present moment.
For people like chronic pain patients who may have a tendency to disassociate, mindfulness is about participating in life, rather than allowing life to happen to and around them. “I describe it as if a lot of us with chronic pain walk around just like we’re like a head. We walk around with a little part of our body, and we want to disassociate with everything else, and then we’re not really living. We’re not able to meet the needs of our body if we’re just trying to ignore it all the time.”
Mindfulness is something to strive for, not something to immediately achieve, and it’s not a Band-Aid fix or a cure-all. It is, however, an especially effective strategy. Studies have shown through MRI scans that long-term mindfulness practice appears to shrink the amygdala, a region of the brain associated with fear and stress, while causing the prefrontal cortex, which is responsible for concentration, impulse control, and planning, to become thicker.
Geraghty shared her four pillars of mindfulness of PAIN:
- Present moment: breathe slowly and deeply. Ground yourself in your surroundings.
- Allow yourself to lean into your pain. Make room for it and acknowledge it. “If we try to ignore it, maybe that will work for a little bit, but that’s not going to help forever.”
- Interview your experience. Observe what you’re feeling, physically and mentally.
- Now act on values, which are what Geraghty calls the things we care most about in life, such as relationships, self-care, and creativity.
Find ways to work with whatever is happening in the moment without giving up on being an active participant in life. If a person with chronic pain can’t meet up with their friend, maybe a video call or texting could be an option, for example.
There are many other options for people with chronic pain seeking tools to manage and work with it. The most important part is to start trying them. “A lot of our experience is waiting,” Geraghty said. “We’re waiting for a pain flare to lessen, waiting for meds to kick in, waiting for doctor’s appointments, waiting to pick up medications, waiting for tests, waiting to be well enough to meet up with our friends.”
Don’t wait to start finding new ways to reclaim your priorities and agency in your life. To hear more from Geraghty about living well with chronic pain, watch the webinar available here. For more information about managing chronic pain, visit the U.S. Pain Foundation’s website here.