Chronic Pain Management: Techniques and Therapies

Introduction

Chronic (persistent or long-term) pain lasts longer than twelve weeks or beyond the natural healing time (NHS inform). It can also refer to pain because of another health condition or despite investigations and treatment.

According to NICE, chronic pain affects between one-third and one-half of the UK population (just under 28 million adults). It tends to be more common in women than men, and the three most common types of pain are back pain, headache and joint pain. In England alone, around 15.5 million people (34% of the population) have chronic pain (Versus Arthritis).

Chronic pain can significantly and negatively impact the physical, emotional and mental health and well-being of those living with the condition. It can affect their daily lives, and they may struggle with day-to-day activities such as work, self-care, household chores, hobbies and socialising. Overall, it can lead to poor mental health, social isolation, financial difficulties and a reduced quality of life.

Understanding and managing chronic pain effectively is vitally important to improve the lives of those with the condition and enhance their physical and mental health and well-being. Whether you are suffering from chronic pain or are caring for someone with the condition, this blog post will offer a variety of techniques, strategies and therapies to help manage pain effectively.

Please note: this blog is for information purposes only and should not be taken as medical advice. Always see a healthcare professional where needed.

Understanding Chronic Pain

Everyone feels pain at some point, whether short-term (acute), such as a sprained ankle, or recurrent/intermittent pain, e.g. a toothache. However, some individuals suffer from persistent and long-term pain, which is chronic pain.

People experience chronic pain differently; some may have mild pain, and others severe and excruciating. They may also have ‘flares’ where their pain increases in intensity at certain times, e.g. when stressed or in certain weather conditions.

There are varying types of chronic pain with different causes and triggers, but what all types have in common is the psychological impacts and mental anguish of living with these conditions.

Types of Chronic Pain

There are various types of chronic pain with different causes. Some conditions can affect the whole body (systemic) or parts (localised).

Chronic pain is typically classified into several types based on its characteristics and underlying causes, and there are two main categories:

• Chronic primary pain – is not directly related to any other underlying condition, e.g. chronic primary headache.
• Chronic secondary pain – is associated with an underlying condition, e.g. arthritis.

Some examples of types of chronic pain include:

Head pain

• It occurs when a person has a headache every day for fifteen days of the month or more (The London Clinic).
• They have migraine-like, cluster-like or tension-like features.
• The pain can occur in various parts of the head.
• Symptoms include head pain, tenderness and a feeling of pressure.

Inflammatory pain

• Inflammation occurs because of substances released in the body in response to injuries, disease, germs, allergens or toxic chemicals.
• Symptoms include swelling, sensitivity, pain and stiffness.
• An example of inflammatory pain is rheumatoid arthritis.

Musculoskeletal pain

• ‘Musculoskeletal’ refers to the muscles and skeleton.
• This chronic pain affects a person’s bones, muscles, joints, tendons and ligaments.
• It is caused by overuse, injuries, poor posture or conditions, e.g. osteoarthritis.
• An example is fibromyalgia, which is a complex condition characterised by widespread pain, fatigue, and tender points.

Neuropathic pain

• This type of chronic pain affects a person’s nervous system.
• It is caused by nerve damage or dysfunction.
• Symptoms can include pain that is shooting, burning or feeling like electric shocks.
• Some examples include sciatica and diabetic neuropathy.

Causes and Triggers

Chronic pain is complex and can arise from various causes, such as:

• Injury – some may suffer from chronic pain after an injury, even after healing, such as a back sprain or pulled muscle.
• Surgery – some individuals can face complications after surgery, such as chronic post-surgical pain (CPSP).
• Chronic conditions – people living with long-term health conditions can suffer from chronic pain, e.g. arthritis, fibromyalgia, endometriosis and lupus.
• Diseases – those with certain diseases, such as advanced cancer, can experience ongoing pain.
• Idiopathic causes – unfortunately, in some cases, the causes of chronic pain are not always obvious, e.g. complex regional pain syndrome.
• Psychological factors – this is sometimes known as psychogenic pain caused by stress, anxiety and depression.

Risk factors can increase the likelihood of developing a chronic pain condition. According to NICE, risk factors for chronic pain can include (this list is not exhaustive):

• Age – over 45 years old.
• Sex – female.
• Employment – manual work and unemployment.
• Lifestyle – smoking, alcohol and inactive.
• Clinical – obesity, sleep disorders, surgery and trauma.
• Family history – migraine and fibromyalgia.

‘Triggers’ can exacerbate pain and worsen symptoms. Individuals can have specific ones, depending on their condition. For example:

Stress – “is the body’s reaction to feeling threatened or under pressure ” (NHS). It can worsen pain because of:

• An increase in the stress hormone cortisol, which can cause inflammation and pain.
• It causes muscle tension and spasms.

Insufficient/poor quality sleep – those with chronic pain can find it difficult to sleep. It can make their pain worse as they are not getting adequate rest, and their body cannot repair and recover effectively.

Weather changes – some people can experience increased pain in specific weather conditions, e.g. arthritis in cold and wet weather.

Certain foods – some people may find that certain foods trigger inflammation and worsen pain, e.g. processed foods and sugary snacks.

Over-exertion – if a person pushes themselves too hard physically, it can cause flare-ups and an increase in pain.

Psychological Impact

Alleviate compares chronic pain to an iceberg, i.e. people only see a small part of what a person is going through on the surface – but there is a lot more going on underneath, such as the impacts on their life and their pain experiences. One thing is for sure – it can have significant psychological impacts.

Living with chronic pain can take a significant toll on a person’s mental and emotional health and well-being. Experiencing relentless pain day in and day out can be exhausting, and they may have persistent discomfort, thus limiting their daily activities. They may also have consistently disrupted sleep patterns, which can exacerbate pain and impact their mental health.

Chronic pain can also put significant constraints on a person’s life. It makes it more difficult for them to work, pursue their hobbies, have positive relationships with others and uphold social commitments. They may also become more irritable with others, which can lead to loneliness and social isolation.

Physical, mental and emotional health and well-being are closely linked. Therefore, if a person has chronic pain, it can result in psychological and emotional issues. Individuals are more likely to develop mental health conditions, such as anxiety, depression, and even post-traumatic stress disorder (PTSD). In fact, one study found that 60.8% of people with chronic pain have severe depression (Circle Health Group).

According to the Mental Health Foundation:

“Research shows that people with long-term physical conditions are more than twice as likely to develop mental ill-health. Mental health problems can then make it harder for you to cope with your physical health condition.”

Traditional Pain Management Techniques

People living with chronic pain need to know there is help and support available. One approach is traditional pain management techniques, such as medications, physical therapy and surgical interventions.

Medications

The medications healthcare professionals will prescribe will depend on the type of chronic pain condition. Some examples of commonly prescribed medications include:

• Acetaminophen (paracetamol) – is a common non-opioid painkiller, typically used for mild to moderate pain. Most types are available to purchase in supermarkets or pharmacies, but some are prescription-only.
• Anticonvulsants (antiepileptic drugs, anti-seizure drugs, or anti-seizure medications (ASM)) – can help relieve pain caused by damaged nerves. Some examples include gabapentin and pregabalin.
• Antidepressants – may help manage chronic pain, as they can affect pain signals and influence neurotransmitters in the brain. Commonly prescribed antidepressants for chronic pain include amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, and sertraline. They may also be prescribed to manage mental health symptoms, such as depression.
• Non-steroidal anti-inflammatory drugs (NSAIDs) – are used to reduce inflammation and relieve pain, e.g. ibuprofen and naproxen. They can cause side effects, e.g. gastrointestinal, in some people and may not be suitable for everyone.
• Opiate-based medications – work by blocking or reducing the transmission of pain signals along the nerves to the brain. These medications tend to be used for severe pain. Some examples include codeine, tramadol, oxycodone and morphine. They are highly addictive and are usually prescribed for short-term use.
• Topical treatments – these are applied to the skin and can be effective for localised pain, such as capsaicin cream, topical NSAIDs and lidocaine patches.

Whatever the type of medication prescribed, they can have benefits and risks, especially when taking them long-term.

Benefits

• It provides consistent pain relief, thus improving a person’s quality of life.
• It improves mobility, enabling the person to be more physically active.
• It can lead to better sleep, which can help physically, cognitively and psychologically.
• It can improve a person’s mental health and well-being when their pain is alleviated.
• It empowers a person and enables them to take control of their condition and life.

Risks

• It can cause side effects, e.g. long-term use of NSAIDs can cause stomach, heart and kidney issues.
• It can increase the risk of dependency and addiction, e.g. opioids.
• It can lead to accidental overdose with addiction and incorrect dosages.
• The body can become tolerant to certain medications over time, meaning higher doses are needed, which can increase side effects.
• It can interact with other medications and other things, such as herbal remedies or alcohol, leading to adverse effects.

If any medication is prescribed for chronic pain, it must be taken as instructed by a doctor and pharmacist. It is also important to be aware of any side effects and anything that could affect medications, such as alcohol and herbal remedies.

Working with healthcare professionals in managing medication for chronic pain is vitally important, as it:

• Ensures it is suitable, considering family and medical histories.
• Ensures dosages are correct.
• Reduces side effects and avoids interactions and adverse reactions.
• Allows it to be reviewed and changed if there are any issues.

Overall, it ensures that patients are kept safe and the treatment effectively manages their chronic pain.

Physical Therapy

Physical therapy, typically known as physiotherapy, for persistent pain can involve manipulation, stretching and pain-relief exercises (NHS). It has a crucial role in managing chronic pain, as it helps to:

• Improve movement.
• Relieve pain.
• Make day-to-day activities easier.

Various healthcare professionals may deliver physical therapy, including physiotherapists, chiropractors, osteopaths or occupational therapists. They will use a range of exercises and techniques, and some examples include:

• Range of motion (ROM) exercises – used where there is decreased movement and flexibility in a specific joint and aims to improve it. The exercises an individual will undertake will depend on the part of the body affected.
• Strengthening exercises – involves building muscle strength to support and stabilise joints and reduce pain. Exercises may include squats, lunges, and resistance band exercises.
• Stretching exercises – help improve flexibility and reduce muscle tension. It involves stretching particular parts of the body. Exercises may include shoulder, neck, back, hamstring, and calf stretches.

People living with chronic pain also have an important role to play and will usually be given various exercises to do at home. While it can be extremely difficult for someone living with chronic pain to even think about exercising and physical activity, it has many benefits for pain management, such as:

Benefits mental health

• The release of endorphins and serotonin during exercise can improve mood and reduce stress, anxiety and depression.
• It can enhance mental health and well-being, helping manage pain more effectively.

Reducing pain intensity

• Regular exercise releases endorphins, which can help reduce pain and stress.

Enhances blood circulation

• Exercise gets the heart pumping and blood circulating, which can reduce inflammation, promote healing, and help manage pain.

Improves flexibility and strength

• Enhancing joint flexibility and muscle strength can alleviate pain.
• It can help prevent joint stiffness and muscle tightness.
• It is helpful for those living with arthritis.

Improves sleep quality

• Regular exercise can help a person sleep better, which can help the body to heal and aid effective recovery, which can contribute to pain management.

Choose a fun exercise that will not cause too much strain, such as walking, yoga, pilates, swimming, etc. There are also various exercise videos on YouTube. Always check with a healthcare professional first if they are safe.

Surgical Interventions

If chronic pain is untreatable with medications and physical therapy, healthcare professionals may recommend surgical interventions. However, it will depend on the part of the body affected. Some examples of surgical procedures for pain relief include (this list is not exhaustive):

• Joint replacement surgery – involves replacing a specific joint, such as those in the hip or knee, to treat chronic pain caused by joint issues. Some types of replacement surgery are invasive, while others are minimally invasive. An example is here, where the NHS describes knee replacement surgery.
• Nerve decompression surgery – treats compressed nerves, e.g. in the lower (lumbar) spine. Various procedures are involved, such as spinal fusion, where they join two or more vertebrae with a bone graft. The NHS has an example here.
• Spinal cord stimulation – relieves pain intensity but will not resolve it completely. It typically involves sending electrical impulses to the spinal cord by implanting a specific device. The aim is to reduce pain signals transmitted to the brain.

As with any treatment, there are risks and benefits of surgical options.

Benefits

• It can alleviate a person’s pain, discomfort or dysfunction.
• It may enhance a person’s mobility.
• It can significantly improve a person’s quality of life.
• It can be life-saving, e.g. removing tumours, which can also help reduce pain.
• It can prevent worsening pain.

Risks

• It can take time to recover, which can affect mobility and work.
• There is a risk of complications during surgery, such as:
• Infection.
• Blood loss.
• Reactions to anaesthesia.
• Nerve or blood vessel damage.
• Blood clots.
• It may not be successful in treating a person’s pain.
• Pain experienced after surgery can be severe.

It is vital to consider the potential benefits and risks when considering surgery. Patients should have full information about the procedure and be involved in shared decision-making with healthcare professionals and loved ones.

Alternative and Complementary Therapies

There are other options for people with chronic pain, such as alternative and complementary therapies. The former is used instead of traditional pain management techniques, and the latter complements them.

There are various therapies, including acupuncture, chiropractic care, massage and mind-body therapies.

Acupuncture

A treatment based on ancient Chinese medicine where a professional acupuncturist inserts fine needles into specific parts of the body (‘acupoints’). Western medical acupuncture, known as dry needling, involves stimulating the sensory nerves under the skin and into the muscles (NHS).

Acupuncture can relieve chronic pain, as it causes the body to release endorphins, which are pain-relieving natural substances and may block pain signals from the nerves. It can also boost a brain chemical, serotonin, associated with mood and pain relief.

There is evidence to support the effectiveness of acupuncture. A review by the National Institute for Health and Care Research found that acupuncture has been shown to have benefits for the treatment of some chronic pain conditions. In fact, NICE recommends it alongside exercise programs, psychological therapies and antidepressant drugs (British Acupuncture Council).

The NHS has further information on acupuncture here.

Chiropractic Care

Chiropractic care involves a skilled practitioner, known as a chiropractor, using their hands to manipulate various parts of the body and applying controlled pressure or force to help relieve bone, muscle and joint issues. It may also be referred to as chiropractic adjustment or spinal manipulation.

According to the NHS, chiropractic care can help with muscle and joint pain in the back, neck, shoulder, elbow and from osteoarthritis. It can also treat pinched nerves and headaches arising from the neck.

Benefits

• It can help manage pain by realigning the spine and easing muscle tension.
• It can reduce the need for medications, such as opioids, and some surgeries if effective.
• It can enhance posture and joint mobility.

Risks

• It can cause side effects in some people, e.g. aches and pains, stiffness and tiredness.
• It can cause serious health issues, e.g. stroke, in some cases.
• It may not be suitable for people with certain conditions, such as cancer or severe osteoporosis.

It is not widely available on the NHS, and many have to pay for it privately, which can be costly. It is always essential to seek advice from a GP to ensure its suitability for the specific chronic pain condition.

The Royal College of Chiropractors has FAQs on chiropractic care for patients and the public here.

Massage Therapy

Massage therapy involves a trained professional manipulating the body’s soft tissues using various techniques and their hands, fingers, elbows, knees, forearms, feet, or a device. It can help alleviate chronic pain in several ways:

• Relaxing the muscles, joints and tendons – bringing relief.
• Relieving stress and anxiety – helps with pain perception.
• Stimulating nerve fibres – can reduce pain signals going to and from the brain.

There are various techniques used in massage therapy, such as:

• Deep tissue massage – uses firm pressure to target lower muscle layers and connective tissue. It aims to address specific tension areas, break up knots and ease pain.
• Swedish massage – involves long, gliding strokes (effleurage) to improve blood circulation and promote relaxation.
• Trigger point – focuses on areas of muscle spasms and tension. It targets painful “knots” (trigger points) to provide relief. It is also known as neuromuscular massage therapy.
• Myofascial release – aims to release tension in the fascia (connective tissue) surrounding muscles. It can be effective for chronic pain caused by tight fascia.
• Acupressure – applies pressure to specific points on the body to promote energy flow and alleviate pain. It is similar to acupuncture but without needles.
• Hot stone massage – involves placing heated stones on the body to enhance muscle relaxation and blood flow, which can be beneficial for chronic pain management.

Benefits

• It can be used for various types of pain, such as back, neck and shoulder.
• It can improve joint flexibility and mobility, allowing increased movement – despite pain.
• It can reduce stress, anxiety and depression, improves overall well-being and can alleviate pain.
• It can target specific muscle groups to ease tightness and discomfort associated with chronic pain.

Risks

• It can cause side effects in some people if gels or oils are used on the skin.
• It can be painful if heavy pressure is used during massage.
• It can exacerbate inflamed and infected skin and also injuries.
• It may not be appropriate for certain existing health conditions, such as bleeding disorders, severe osteoporosis, burns or thrombosis.

Mind-Body Therapies

The mind and body are interconnected, and some therapies look to promote these connections positively. Some of the approaches used for chronic pain can include meditation, mindfulness and yoga.

Meditation

An ancient practice that involves training attention and awareness while creating a calm, focused, and relaxed mental state. It can help lower stress levels, ease anxiety, promote better sleep and reduce pain.

Regular practice can help to retrain the brain to better cope with pain and make it less pain-sensitive. It can also release pain-reducing chemicals.

There are numerous types of meditation, including:

• Bodyscan – involves focusing on various parts of the body and bringing attention to any feelings and sensations.
• Guided imagery/visualisation – involves picturing something in the mind, e.g. imagining yourself on a beach.
• Transcendental meditation – involves sitting comfortably for 20 minutes twice a day and repeating a mantra, such as a phrase, word or sound.

The NHS has further information on meditating for beginners here. There is also free pain management meditation from Meditainment here.

Mindfulness

This approach requires:

• Directing attention and awareness to the present moment and feelings and surroundings
• Not judging or reacting and letting go of any thoughts and sensations that arise.

It can help with chronic pain by reducing negative thoughts, reconnecting with the body and sensations, and helping with any sleep and mental health issues.

The NHS has further information on mindfulness here.

Yoga

This practice is an ancient Indian practice that involves physical postures (asanas) and movements that strengthen the body, improve flexibility, and promote overall well-being. It also helps to relieve tension and can reduce pain symptoms.

Some examples of yoga exercise videos for specific pain and problems are on the NHS.

There are other practices, such as Tai Chi and Qi Gong, which those with chronic pain may also find helpful.

Lifestyle and Self-Management Strategies

Diet and Nutrition

Think about food like a car. If you put poor-quality fuel into a vehicle, it will not perform optimally and can break down if you put the wrong fuel in. This analogy can be used when looking at the role of diet and nutrition in health, well-being and pain management.

Diet plays a crucial role in managing chronic pain, and some foods and drinks can reduce inflammation (anti-inflammatory foods), for example:

• Fruits, e.g. berries, pomegranates, cherries, etc.
• Vegetables, e.g. peppers, leafy greens, tomatoes, onions, garlic, broccoli, Brussels sprouts, and cauliflower.
• Wholegrains, e.g. wholegrain bread, oats, brown rice, barley, quinoa, couscous and wholewheat pasta.
• Lean poultry, e.g. chicken and turkey.
• Healthy fats, e.g. unsaturated, such as olive oil, nuts, avocados and oily fish.
• Water – maintains joint function and reduces discomfort.
• Beans, nuts, and seeds, e.g. black beans, kidney beans, chickpeas, walnuts, almonds, sunflower seeds, pumpkin seeds, etc.

Certain foods can worsen inflammation and exacerbate pain, for example:

• Ultra-processed foods.
• Foods high in sugar, salt or saturated fat.
• Animal fats.
• Fried foods.
• Sugary drinks, including fruit juices.
• Refined carbohydrates.
• Alcoholic and caffeinated drinks.

Supplements may also help to reduce pain, such as:

• Glucosamine and chondroitin – help with joint-related issues.
• Omega-3 fatty acids – those found in fish oils can reduce inflammation.
• Rosehip extract (GOPO) – research is still ongoing, but it may relieve arthritis pain.
• Vitamin B12 – plays a role in neurological processes related to pain.
• Vitamin D – helps muscle fatigue and overall health.
• Magnesium – important for muscle function.

These should not be taken instead of eating a healthy and balanced diet but should be used to complement it. Individuals with chronic pain should check with a doctor, dietician or nutritionist about diet and nutrition specific to their condition.

It is also crucial to manage weight, as carrying excess weight can put additional strain on the joints and exacerbate pain. Eating a healthy, balanced diet with nutrient-dense foods and being mindful of portions is essential for weight management.

Exercise and Movement

It may feel like an impossible task, staying active with chronic pain, but it is essential for the following reasons:

• Being inactive can worsen the pain.
• It helps lubricate the joints and improves flexibility
• It can increase resilience to pain.
• It promotes blood flow, reducing pain and promoting healing. It is also beneficial for cardiovascular health.
• It can help strengthen muscles and improve joint stability, thus alleviating pain.
• It improves mood and overall well-being.

Finding a way to exercise safely that does not cause too much strain and chronic pain flare-ups is vital. Some low-impact exercises may be suitable for chronic pain sufferers, such as:

• Dancing.
• Pilates.
• Stretching.
• Swimming.
• Tai chi.
• Walking.
• Yoga.

Staying active every day and incorporating various activities into daily routines is crucial. Rather than concentrating on intensity, focus on consistency, as it can help reduce pain.

It is useful to have a personalised exercise plan tailored to a person’s needs and preferences. It contains bespoke exercises that consider the specific chronic pain condition, pain levels and a person’s overall fitness level. Plans are typically completed with a physiotherapist or a pain specialist, and may include:

• Gentle exercises, such as pilates, swimming, walking and stretching.
• Strength training, e.g. light weights, resistance bands or bodyweight exercises.
• Mind-body techniques, such as yoga or Tai Chi.
• Progress monitoring, e.g. pain levels and physical improvements.

Exercise plans should be modified where required, e.g. how the body responds. It is important to be consistent and avoid overdoing it on good days.

Sleep Hygiene

Chronic pain and sleep disturbances are closely connected. When a person is in pain, it can disrupt their natural sleep cycle. Poor quality sleep can make pain feel worse, as it can make the nervous system more reactive, amplifying pain signals.

People with chronic pain may also have other conditions that can affect their sleep, such as restless leg syndrome, sleep apnoea and mental health conditions, e.g. anxiety and depression. Having comorbidities can complicate sleeping issues and exacerbate pain.

Good sleep hygiene is essential for chronic pain management, and it:

“Is the term used to describe healthy habits that you can practice during the day to help you get a good night’s sleep” (NHS).

Those with chronic pain should adopt good sleep hygiene practices, which can often be challenging, but here are some tips for improving sleep quality:

• Pain medication – take medication as prescribed, e.g. before bed to ease pain in the night.
• Consistent sleep schedule – go to bed and wake up at the same time every day, as this will help to regulate the body’s internal clock.
• Comfortable sleep environment – make the sleeping room dark, quiet, and cool.
• Relaxation techniques – undertake practices, such as deep breathing exercises, mindfulness and meditation to promote sleep, which can help ease pain.
• Avoid stimulants close to bedtime – caffeine, nicotine, and alcohol can interfere with sleep.
• Comfortable sleep positions – adopt the best position for the pain location and consider using specific mattresses and pillows.
• Regular exercise – daily gentle exercise can help reduce pain and promote sleep.
• Limit screen time – avoid screens, such as laptops, tablets and phones, at least one hour before bedtime, as the blue light can disrupt the sleep cycle.

Stress Management

When a person feels stressed, their brain triggers the release of stress hormones, such as adrenaline and cortisol. These chemicals result in increased heart rate, faster breathing and muscle tension. Over time, this can have long-term effects on their physical and mental health and well-being.

Stress can have an impact on chronic pain, usually exacerbating it. Tense muscles can increase pain, especially in the back, neck and shoulders, and cortisol can lead to inflammation, worsening pain over time. It can also make individuals more sensitive to pain due to stress-altering brain processes and disrupted sleep patterns.

Those living with chronic pain need to reduce stress, and some stress management techniques can include:

• Relaxation exercises, such as meditation, mindfulness, progressive muscle relaxation and deep breathing.
• Self-care, e.g. eating healthily, exercising regularly, avoiding unhealthy habits, sufficient sleep, connecting with others and engaging in enjoyable activities and hobbies.
• Effective time management, including planning tasks, delegating to others, prioritising, breaking tasks into smaller, manageable chunks and learning to say no.

If a person with chronic pain overexerts themselves and does not get sufficient rest, they may find they may overwhelm their body and have a ‘flare’. Their body will also be unable to recover and heal, which can cause inflammation. On the other hand, if they do not engage in regular physical activity, it can cause stiffness and limit their range of motion. Therefore, it is vital to find a balance between activity and rest, listen to the body and not push beyond individual limits.

Psychological and Cognitive Approaches

Psychological and cognitive approaches are also important in managing chronic pain, as they help patients cope with pain and improve their overall quality of life. Some approaches include cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT) and biofeedback.

Cognitive Behavioural Therapy (CBT)

CBT is a talking therapy that aims to change the way people think and behave, which can help them manage various problems, including chronic pain. It can help them develop coping strategies to deal with their pain and is also used to treat associated mental health problems, such as anxiety and depression.

CBT uses many techniques, and some examples include (this list is not exhaustive):

• Cognitive restructuring or reframing – challenging negative thought patterns and behaviours that can worsen pain and replacing them with more positive ones.
• Journaling and thought records – writing down pain-related thoughts and feelings to identify patterns and triggers.
• Exposure therapy – learning to face fears of pain gradually to help overcome anxiety.
• Relaxation and stress reduction techniques – including deep breathing, progressive muscle relaxation and visualisation to manage stress.
• Behavioural activation – looks at engagement in certain activities, e.g. hobbies and socialising, and ways of increasing enjoyment and achievement.

The CBT techniques used are tailored to the individual’s needs and goals. It is important to note it does not cure pain symptoms, but it can help people with chronic pain cope better.

There is a wealth of research and reviews on the effectiveness of CBT for pain management. There is a consensus that CBT can improve the quality of life for those living with chronic pain (NICE).

The NHS has further information on CBT here. There are also online self-help CBT techniques here.

Acceptance and Commitment Therapy (ACT)

ACT is a form of CBT that encourages patients to accept pain rather than fight it and commit to actions that align with their values despite the presence of pain. It uses various strategies, such as:

• Acceptance – accepting distressing thoughts and feelings about pain rather than trying to eliminate them.
• Mindfulness – being in the present moment without judgment.
• Cognitive defusion – distancing from thoughts by repeating a thought vocally or using visualisation.
• Values clarification – identifying what is truly important, which can lead to meaningful behavioural changes.
• Committed action – taking actual steps to live as per values, even with difficult feelings and thoughts.
• Self-as-context – separating oneself from thoughts and feelings, i.e. they are more than their pain experiences.

ACT can have many benefits for individuals with chronic pain, such as:

• Reducing the impact of pain on day-to-day activities and overall functioning.
• Enabling them to adapt to stress and pain – increasing flexibility and resilience.
• Decreasing mental health issues, such as anxiety and depression.
• Enhancing well-being and overall quality of life through acceptance.
• Reducing emotional distress and encouraging better-coping strategies.

According to a research review by McCracken, et al. (2022), ACT produces benefits for people with chronic pain, including improvement in pain interference, disability, depression, and quality of life.

Biofeedback

Biofeedback is a technique that involves using electronic devices, such as sensors, to monitor physiological functions, such as heart rate, muscle tension, breathing, or brain waves. It teaches patients how to control these functions using various techniques, which can help reduce pain and improve relaxation. For example, a person can be taught to relax their muscles by practising progressive muscle relaxation.

Various techniques are used in biofeedback, including:

• Electromyography (EMG) – measures muscle activity.
• Thermal biofeedback – monitors skin temperature.
• Neurofeedback (EEG) – tracks brain wave patterns.
• Heart rate variability (HRV) – measures the variation in time between heartbeats.

People with chronic pain often feel helpless due to feeling they have no control over their own bodies. Biofeedback is beneficial, as it empowers them to regain control, which can give them significant relief. It can also improve physical functioning, reduce stress and anxiety and enhance emotional well-being.

Building a Comprehensive Pain Management Plan

A person diagnosed with chronic pain is likely to be given a personalised pain management plan, and it is also important for them to have appropriate support systems.

Personalised Pain Management Plans

It is important to create a comprehensive plan that combines multiple approaches for many reasons, such as:

• It addresses various aspects that can affect someone’s pain experiences, such as physical, psychological and emotional, and promotes a more holistic approach.
• It increases the likelihood of finding effective pain relief and better overall outcomes when various methods are combined, different techniques are integrated, and they are tailored to a person’s needs and preferences.
• It reduces side effects and reliance on medications by incorporating non-pharmacological approaches.
• It can improve physical function, mental and emotional well-being and quality of life.

A pain management plan should be:

• Based on an assessment of a person’s pain, type, intensity and impact on their life.
• Holistic, i.e. looking at the whole person and not just their pain.
• Person-centred, i.e. tailored to a person’s condition, health and well-being needs and preferences.
• Developed in collaboration with various healthcare professionals (a multidisciplinary team) – it will require different experts to ensure it is safe and personalised.
• Regularly reviewed and adjusted based on progress and changing symptoms and needs.

A pain management plan may include details on the following:

• Medications.
• Physical therapy.
• Psychological support.
• Lifestyle modifications and self-help.
• Pain level and treatment effectiveness monitoring.
• Further support, i.e. networks.

It is vital for patients to actively participate in their treatment plans to help them effectively manage their pain and empower them to take control of their condition.

Support Systems

Often, people with chronic pain can feel isolated and lonely, affecting their mental health and well-being. Therefore, family, friends, and support groups are crucial in chronic pain management.

Family and friends

• Provide vital emotional support and reduce feelings of isolation and loneliness.
• Assist in practical activities, such as daily tasks, medication management and attending appointments.
• Give motivation and encouragement to help individuals adhere to treatment plans and make lifestyle modifications.

Support groups

• Provide a sense of community and understanding – enabling people in similar situations to share their experiences and coping strategies.
• Provide important information about pain management techniques and new treatments.
• Provide significant emotional relief to know others are going through similar experiences.

Those with chronic pain must know they are not alone and that there is plenty of support to help them, such as support groups, online resources and communities. Here are some examples:

• Action On Pain – a charity with advice and support and a painline.
• NHS – has information on how to get help with pain.
• Pain Association – a Scottish charity that has various resources and online pain management videos.
• Pain Concern – a charity that has information and resources, a helpline, local support groups and an online community.
• Pain UK CIO – an alliance of charities and a signposting organisation. It has details of various charities where people in chronic pain can seek support.
• The British Pain Society – a charity that has various information and resources for people in pain.

There are also charities for specific health conditions that can cause pain, such as Fibromyalgia Action UK and Arthritis Action, and those for mental health problems, e.g. Mental Health Foundation, Mental Health UK and Mind.

People with chronic pain may also find local and online groups on social media, such as Facebook and X.

Conclusion

Chronic pain can be debilitating and have physical, psychological and emotional impacts on a person. It can also affect their family, caregivers, friends, and society if it affects their ability to work and socialise. It can negatively impact their overall quality of life.

There are many techniques, therapies and strategies that may help reduce pain and deal with its impacts. As covered in this blog, there are traditional pain techniques, various alternative and complementary therapies, and psychological and cognitive approaches that individuals could try.

A healthy lifestyle and self-help are crucial in chronic pain management. Eating a balanced diet, adopting good sleep hygiene, exercising regularly, and practising stress management and relaxation techniques can make a significant difference to people’s pain, how they perceive it and their well-being.

A combination of approaches is likely to be more effective in reducing pain, and individuals should explore different pain management strategies and find what works best for them. However, it is always important to consult with healthcare professionals for a comprehensive pain management plan, as they will work with the person to ensure that any treatments and strategies are safe and are tailored to their condition, needs and preferences.

It is vital to seek support from family, friends and support groups to reduce isolation and loneliness. There is also a wealth of information, resources and advice online for learning more about chronic pain management, such as:

• British Pain Society – People living with Pain.
• CPD Online College – What is Pain Management?
• Live Well with Pain – Resources for people with pain.
• NHS – Pain.
• NHS inform – Chronic pain self-help guide.
• Pain Concern – Self-Management Navigator Tool.
• Pain Toolkit – 12 Practical Pain Self-management Tools.
• The Chartered Society of Physiotherapy – Chronic pain.