The Psychology Service
Pain Disorder

What is a Pain Disorder?

In any painful condition, psychological factors are involved, in that the pain will feel more or less intense, or be more or less bearable, depending on the person’s emotional state and whether or not they have anything to distract their mind from the pain. This is a normal reaction, although the extent to which psychological factors impact upon the experience of pain varies considerably. Some people experience pain which is much more intense or more prolonged than can be explained by physical illness or injury alone, and where it is clear that psychological factors are playing a much more significant role in the person’s experience of pain. However, it is very important to understand that, whatever the causes of pain, the person feels the pain in the same way, i.e. it actually hurts and is real.

Some people have a tendency to “somatise” emotions, and, instead of feeling depressed or stressed, which may be too difficult for them to accept, they may experience pain in a part of their body. They are essentially expressing emotional distress as physical pain. It is not uncommon for some people who are suffering from Depression go to their doctor complaining about a range of physical symptoms rather than depressed mood.

The nature and role of psychological factors varies. In some cases there may be a psychological overlay to a basically physical pain problem, in that the person perhaps unnecessarily avoids activities, because of an excessive fear of hurting themselves. Others may adopt, or be encouraged by others, to adopt a “sick role” and are more dependent on others for help in daily activities than necessary.

A Pain Disorder is a psychiatric condition which recognises the impact of significant psychological factors on the experience of chronic pain. It is also commonly referred to as Chronic Pain Syndrome.

What are the symptoms?

The person mainly complains of pain, which medical specialists cannot explain in terms of physical causes alone. For example, the pain may be felt in an unusual pattern in the body, or it may be more severe or prolonged that would normally be expected given the nature and severity of an injury, or it may obviously fluctuate with mood. In very severe cases, where for example a severe Pain Disorder has been formally diagnosed, the person’s whole life, and often also that of their family, seems to revolve round their pain, with marked avoidance of normal activities, excessive use of analgesic medication, and undue reliance on others for assistance.

How long does it last?

In cases where there is a mild psychological overlay to pain, or where there is some degree of somatisation, the problem may resolve naturally once a period of stress is over. Where both physical and psychological factors are involved to an equal degree, then physical recovery will normally be accompanied by improvement in the person’s mental health. However, some people with severe Pain Disorders, if untreated, may not recover.

What is the treatment?

For many people suffering from chronic pain conditions, CBT has been found effective through a process of challenging negative thoughts about pain, and increasing levels of activity, and assisting people to live more adaptively with the pain. There can, however, be difficulties in engaging the client in the therapy, as many people resist the suggestion that psychological factors are involved, believing that people think the pain is only “in their mind”. Reassurance that the therapist believes that the pain is genuinely felt is essential, and working towards a shared understanding of how the pain interrelates with emotions is a necessary preliminary stage in therapy.

More severe and chronic cases of Pain Disorder require an intensive multidisciplinary pain management programme, with involvement of Doctors, Psychologists or other CBT Therapists, and Physiotherapists. Such programmes are normally provided on an in-patient or day-patient basis. The treatment results for more severe and chronic Pain Disorders are very variable, although some people do gain great benefit from this approach.