The Role of Psychotherapy in the Treatment of Chronic Pain

Pain appearing in the body can, at times, become chronic. As well, a causal relationship can often be easily established - such as in the case of injuries resulting from a fall, a car accident, the result of an illness, and the like. However, at times the origin is unknown.

What is physical pain?

Physical pain is a sensory and subjective perception located in a part of the body. It is the result of abnormal stimulation of nerve endings. Physical pain can be acute and disappear after its cause has been treated or it can become chronic, even after its cause appears to have been successfully treated.

Physical pain and the resistance to it

Physical pain is a common life experience that tends to trigger resistance due to the immense stress that can result, especially when it becomes chronic. Since physical pain is a conscious sensory perception, the contact with it could be potentially disruptive. The individual who suffers from chronic pain often tries not to experience the unpleasant sensation by resisting the contact with the pain and this mechanism becomes, in and of itself, an important part of his/her life.

Physical pain as a magnet

By definition, a magnet cannot exist without creating a magnetic field from which it will attract or repel objects.When an individual pays attention to his/her pain, even with the intention of resisting the feeling associated with it, just the attention to it can create an expansion of the undesirable sensation. The experience itself may then trigger thoughts related to fear, for example, that the individual may try to reject. Attraction or rejection can potentially magnify the experience of physical pain as a result of this attention to the object (pain).

This experience then creates a “magnetic field” that tends to perpetuate itself.

Reasonable interpretations of physical pain

Pain, fortunately, serves the purpose of making the individual aware that something is not well and often a response to this experience leads to an appointment with a physician which is, for obvious reasons, highly recommended.

The subjectivity of pain

Often, the physician can diagnose the cause of the pain, while at other times a diagnosis may not be established. If the cause is not ascertained, then a cure may not be possible. Regardless of these circumstances, the experience of this physical pain can often be subjective, personal and unique. This unique experience can be based on many variables, among them the level of success or failure that the individual may have had in the past regarding the solution or lack thereof, of previous health issues. The individual may trust his/her body’s natural ways to heal or not. Based on these past experiences or those from significant others around them, the person may create ”adhesions”. These adhesions or interpretations of the physical pain may result in what the individual experiences in its uniqueness. At times these interpretations regarding the physical pain unfortunately could potentially augment the sensation, amplifying the pain due to its negative or pessimistic component. The uniqueness of the experience of the physical pain is not in the medical domain, but rather is in the psychotherapy domain.

Can psychotherapy help individuals who suffer physical pain?

The answer to this question is yes, the psychotherapist working in conjunction with a medical doctor (if possible) is recommended in order to treat physical pain, especially chronic pain. The medical doctor is the expert regarding the “medical body” while the psychotherapist is knowledgeable about issues such as body image, interpretations and especially, emotionally built resistance. At times, the physical pain involves emotional experiences that are not easy to let go of or even at times, to identify. For example, at times the grieving process is silently being experienced and yet is held by the body as  pain.

Traumatic experiences never exist in the potentially traumatizing event but rather in the body that carries the unique impact of it. Physical pain and its interpretations can coexist, creating habits and the attention to them may contribute to their chronic nature.

How would your life look like if you did not suffer from chronic physical pain?

This is the first question I ask new clients who consult for chronic physical pain. The answer, which at times is not always easy to say, may point to the meaning of the pain and its subjective/objective interpretations. That is, the sore body part may represent something related to, for example, unfinished grieving which may perpetuate the pain due to psychological resistance in connection to the loss.

Can chronic pain lose its intensity or even disappear?

Yes, most definitely. In my 35 years experience as a psychotherapist, I can confirm that chronic pain can be effectively treated with psychotherapy. However, it is strongly suggested that the therapist in charge has to be familiar with the approach of considering “adhesions” and resistance as part of the treatment. This is not about a “miraculous cure” but rather of a process where the individual with chronic pain learns, with guidance by the psychotherapist, what to observe and how to identify and transform what keeps the pain strongly present.

This unique exploration takes the client into a different self observation. As a result, clients with chronic pain may find

themselves in a transformative process of discovering the energy that was trapped in the previous experience, releasing it, and transitioning toward finding him/herself having their attention instead focused on a more creative and joyful way of living.

Laura Coogan