Mind matters in chronic pain management

Making long term pain more bearable

Tuesday, November 29 2022

Being in constant pain can rob a person of their quality of life and seeing a loved one suffer is agonising for their families too. A psychologist and psychiatrist offer their insights for making life a little more bearable for individuals with chronic pain.

“Chronic pain has been identified as a leading cause of disability worldwide, and irrespective of the root cause, chronic pain can be debilitating for sufferers,” says Dr Shazia Mungly, a psychiatrist who practises at Netcare Akeso Milnerton.

“Pain works as a protective mechanism, like an alarm system in the brain, that is meant to allow an injury to heal. However chronic pain occurs when pain lasts longer than three months after the recovery of an injury. With chronic pain, the alarm keeps going off even after there is no danger of further damage,” she explains.

Dr Graham Lindegger, a clinical psychologist practising at Netcare Akeso Pietermaritzburg, notes that the daily burden of living with chronic pain almost invariably has consequences for a person’s mental wellbeing, with irritability, depression, and anxiety being common symptoms of chronic pain that has not responded to treatment.

“A few theories have been put forward regarding how the body processes pain, and how a person’s emotional state may influence their experience of pain. One of the most widely accepted is the Gate Control Theory. This theory suggests that when pain signals travel up the spinal cord to the brain, whether the pain signal gets through to the brain depends on whether the ‘gate’ is open or closed. It is suggested that psychological states and emotion may influence whether the gate is open or closed, and hence whether the pain is transmitted,” Dr Lindegger says.

“As with depression, pain often changes a person’s behaviour. In trying to avoid pain people often plan their lives around the expectation that they will be in pain. Eventually, it is easy for pain to become your whole world – especially if you give up your job, your hobbies and daily activities and isolate yourself, but it need not be this way.”

Dr Mungly points out that the shared neural mechanisms between chronic pain and mental health disorders are reflected in the fact that between 20% and 50% of patients with chronic pain also have depression. “This can create a vicious cycle in which pain worsens the symptoms of depression, and the resulting depression in turn makes the pain feel worse. Chronic pain can also worsen anxiety, and people who are more fearful of pain are more likely to develop chronic pain.

“Pain can deprive sufferers of quality sleep, which in turn can worsen chronic pain, and may influence cognitive functions, such as a person’s ability to concentrate, plan and prioritise, their thought processing speed and their memory function.

“The goal of treatment is to improve social, emotional, and physical functioning in people with chronic pain. Pain management is most effective when using multiple modalities such as rehabilitative therapy, cognitive and behavioural therapy, as well as lifestyle changes and prescribed medications,” Dr Mungly notes.

The general consensus is that chronic pain is best treated by a multidisciplinary team, including medical specialists, physiotherapists and psychologists. Occupational therapists may also play a role in recommending environmental changes at work and home because being active helps to distract attention from the pain.

“Psychosocial treatments can help to enhance a person’s resilience to pain and distress while relaxation training helps to reduce the distress of pain,” Dr Mungly says.

Cognitive behavioural therapy helps a person to change the way they think about pain, helping to reduce the suffering in their body and mind. Another useful tool for self-managing chronic pain is acceptance and commitment therapy, where a person develops the ability to focus on more positive and productive goals rather than the negative experience of pain controlling the person’s thoughts and behaviour constantly.  

“For people with chronic pain, a fixed schedule for treatment usually yields the best results. This includes resting, taking medication or other interventions at fixed times, rather than waiting for the pain to develop and then trying to treat it. This makes it easier for the person to switch their attention so that they are not constantly focusing on their pain,” Dr Lindegger says.

“The partner and family of a person with chronic pain often also require psychological support, as it is extremely distressing to see a loved one in pain. Soon other people may be planning their lives around the individual’s pain, which can create tensions in family relationships that are not helpful to the situation,” he says.

“It may not always be possible to cure chronic pain, however with professional multidisciplinary treatment, a pain management programme and social support, it is often possible to considerably improve a person’s quality of life so that pain no longer defines their existence.”

For information about mental health and services, and accessing care, or for help in an emotional crisis, Netcare Akeso is here to help. In the event of a psychological crisis, individuals can phone the Netcare Akeso crisis line on 0861 435 787, 24 hours a day, to talk to an experienced counsellor.

About Netcare Akeso
Netcare Akeso operates a network of private inpatient mental health facilities and is part of the Netcare Group. Netcare Akeso provides individual, integrated and family oriented treatment in specialised inpatient treatment facilities, as well as certain outpatient services, for a range of psychiatric, psychological and substance use conditions. Please visit or contact [email protected] for further information.
In the event of a psychological crisis, call 0861 435 787, 24 hours a day for emergency support. Psychiatrist consultations can be made through Netcare appointmed™, online at or by calling 0861 555 565.

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