Clinical psychologist Amanda William of University College London advocates for psychological interventions such as CBT or ACT to be used as front-line treatments, rather than as a last resort.
"Psychological methods tend to be tried only when everything else has failed," says Williams. "People only get exposed to these kinds of ways of understanding their pain later on, and they often say, 'Why wasn't I given this help earlier?'"
People with conditions such as nerve pain, arthritis or other forms of chronic pain are often offered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids. But long-term use of NSAIDs can come with severe side effects, while the impact of opioid addiction has been well documented. Data from the Priory Group indicates that opioid overdoses in the UK have increased by 87 per cent in the past year alone.
Pain is a highly complex phenomenon that sits at the intersection of biology and psychology, but the extent to which we perceive pain depends on many things, from our brain circuitry to our thoughts, emotions and personality.
Psychologists have long known the brain can learn to become hyper-sensitised to pain, but it can also learn to dull and diminish it. Andrea Furlan, a pain researcher at the University of Toronto, believes that in some cases of chronic pain, the discomfort stems from an initial illness or injury and that the brain's pain processing system has learnt to become hyper-responsive to normal sensations from nerves, meaning the pain still persists long after the body has healed.
Our thinking and state of mind can also play a major role in how we perceive pain. In one famous study, a construction worker had a six-inch nail impaled through his shoe, with the pain requiring him to be sedated with strong opioids. When the shoe was removed, it turned out the nail had passed between his toes, causing no obvious injury.
Furlan refers to 'catastrophising - imagining the worst possible outcomes - causing more intense pain, and a greater likelihood of the person developing chronic pain. Brain imaging studies suggest patients who ruminate on their discomfort experience amplified pain processing.
The goal of CBT and ACT is to enable patients to come to a new understanding about how dangerous their chronic pain is, how long it will last, and to see certain patterns of thought can make pain worse.
"It's learning to understand that pain does not always mean that damage has happened or is happening," says Williams. "CBT is about helping them realise that it is not the end of the world and helping them work out their tolerances for doing different activities."
Another psychological approach is pain reprocessing therapy (PRT), which uses a technique called somatic tracking whereby patients notice the feelings in their body and determine whether to fear them. A recent clinical trial at the University of Colorado Boulder found two thirds of patients with chronic back pain saw their symptoms go away after a four-week course of PRT. Intriguingly, imaging scans showed changes in pain-generating brain regions following therapy, indicating that it is possible for some patients to unlearn their pain.
Pain may not be all in the mind, but the mind can at least manage it - offering welcome relief to many.
