Chronic Pain

What is Chronic Pain

Chronic pain is defined by pain which persists beyond the expected healing time.

This is different from acute pain, pain driven by tissue damage from an injury, where we would expect rest, gentle movement, or surgical intervention to ease pain over time. In many cases of chronic pain, the nervous system becomes sensitised to activities, movements, or sensations, driving the pain response. While ongoing tissue damage may not fully explain the intensity or persistence of the pain, the nervous system can continue to generate pain signals.

Chronic pain is extremely common. A 2019 NHS Digital Survey found that around one in three adults in the UK were living with chronic pain. 

How Chronic Pain Becomes Persistent

Most people are familiar with acute pain. For example, go for a run and twist your ankle, your body detects an injury and generates pain as a protective signal, encouraging you to rest. Therefore, you take a few weeks off running and the injury begins to heal. You can now gradually return to running as the pain eases.

Now imagine the same injury, but the pain doesn’t ease. After a while the pain begins to show up during walking, household tasks, and work. You begin to anticipate pain during these activities and avoid them, making life feel like it’s shrinking. This pattern is often referred to as the “pain-fear cycle”.

Although this response can feel frustrating, our nervous system is hard-wired to prioritise protection. Therefore, when we begin to associate certain movements, activities, and sensations with danger, it can generate stronger pain signals in order to protect us, making us fear or avoid this movement or activity even more. While at this point, a scan may show no structural damage severe enough to fully explain the pain response, the nervous system has become overprotective, causing pain to persist.

How We Assess Chronic Pain

Assessment starts in the first session, where your therapist may discuss the onset of your pain, any medical investigations, diagnoses, or treatments you have received, and the impact pain has had on different areas of your life. 

Assessment is an ongoing process, and you and your therapist will continue to gather information about your symptoms throughout treatment. This may include learning more about factors that influence your pain, how you respond to symptoms, any changes you have made to your daily activities, and the thoughts and emotions that can arise in response to pain.

The aim of assessment is not to question whether your pain is real. It is to develop a shared understanding of all the factors that may be contributing to your experience. This ensures that treatment is appropriate for your current situation and helps you work towards your goals.

How Psychological Therapy Can Help

Psychological therapy for chronic pain doesn’t imply that pain is “imagined”. Rather, it works on the understanding that pain is amplified by the nervous system. Psychological therapy aims to target the pain-fear cycle.

Psychological therapy aims to provide understanding and practical strategies that help break this cycle, allowing you to respond to pain in a calmer way and helping the brain interpret sensations and movements as safe rather than dangerous

What Therapies We Offer

Pain Reprocessing Therapy (PRT):

PRT is aimed at helping the brain reinterpret painful sensations as safe through pain education, somatic exercises, and a gradual return to avoided activities. This allows the nervous system to reduce its protection, dampening the pain response.

For more information, please see our Pain Reprocessing Therapy page.

Cognitive Behavioural Therapy (CBT):

CBT looks at the relationship between thoughts, emotions, physical symptoms, and behaviours.

It helps you identify and challenge catastrophic thinking, for example, “I’ll never be able to exercise again!” which can increase nervous system activation and contribute to the pain-fear cycle.

CBT for chronic pain also works on the boom-bust cycle, where you may overdo it on good days, causing pain to flare up, followed by a drastic reduction in activity. CBT uses pacing to help you find a manageable baseline, followed by a gradual progression of activity. Helping you build back towards a meaningful life.

CBT also involves relaxation techniques such as breathing exercises, mindfulness, and muscle relaxation to help you calm your nervous system in response to pain.

For extra information on chronic pain please see the following blogs as well as the resources page on our website:

Chronic Pain

Pain Reprocessing Therapy (PRT)