Thoughts and emotions

Living with chronic pain can be a challenging experience and very different to the experience of living with acute pain. Many people report feeling more pain when they are feeling down or more anxious or worried.

Relationship between pain, thoughts and emotions

• Pain and emotion are closely linked. It is almost impossible to have pain without there being an emotional impact.
• Recognising the emotional impact of chronic pain can be a first step towards being able to manage both pain and emotions better.
• Emotions people experience when they feel pain include: sadness, anxiety, frustration, anger, guilt, disappointment, shame, stress, a sense of loss.
• These emotions can affect how someone thinks and feels.

 

Relationship between pain, thoughts and emotions

 

Potential strategies:

• Acknowledge that the experience of living with chronic pain is different from acute pain
  • Acute pain:
    • Medication relieves pain
    • Short-term disruption to usual routine and activities
    • May bring short-term frustration and stress
    • Expectation of return to normal in weeks or months
    • Family and friends often provide support
  • Chronic pain:
    • Limited benefit from medication
    • Lasting changes to activities, routines and roles
    • May feel low, exhausted, overwhelmed
    • Likely to feel uncertain about the future, hopeless
    • Family and friends may not understand and may become frustrated
• It is vital to spend time and actively listen to the whole person’s experience, with genuine warmth and empathy. This validates the individual’s experience
• Emotional reactions to pain (and other everyday life events) are normal and don’t necessarily mean that people are developing or have a mental health condition. Although normal, these reactions should be acknowledged and considered when we look to help those with chronic pain
• If able, it may be helpful for individuals to discuss their emotions with an appropriate clinician
• Consider other aspects of the pain management jigsaw which can support negative thoughts/emotions, e.g. activity, communication, social connection/relationships, mindfulness/relaxation

Resources:

• Chronic pain learning toolkit (practice level 2) on Turas
• Managing emotions with chronic pain
• Ten footsteps to living well with pai
• Discussing emotions can be challenging for both the individual and the clinician, and resources to support this include e-learning modules for clinicians:
  • Emotion Matters e-learning module on Turas Learn which supports healthcare professionals to consider how to evaluate and assist with the emotional impact of a person's long-term condition, such as chronic pain. 
  • Building a shared understanding e-learning module on Turas Learn which helps develop cognitive behaviourally informed principles to help those with pain manage it effectively.
  • Mental health improvement, and prevention of self-harm and suicide learning resources on Turas Learn can improve confidence and ability to support and signpost for the appropriate assistance.

 

Psychological therapies

Psychological therapies (cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) should be considered for adults experiencing chronic pain, depending on individual preference²⁹.   These should be delivered by appropriately trained professionals³⁰. 

All GP practices in Scotland can refer patients to Silvercloud CBT for chronic pain.