Managing Pain: The Case for Compassion

For most of my career I have worked as a Clinical Psychologist in Pain Management, trying to help people with long term pain to respond in a way that allows them to live as well as they can. This is rewarding, challenging and at times very difficult work, because long-term pain would challenge every one of us. One of the problems is that long-term pain is different from the kind of short-term pain that most of us are familiar with. A lot of strategies that work for short-term pain, like resting or taking medication are not helpful when the pain persists over time, and can even make things worse. The problem in general is not well understood so it can be very hard for people with long term pain and their family and friends to know what is happening and how to respond.

Most of the people I have seen professionally have worked extremely hard to try not to let their pain get the better of them. Yet often it can seem that the harder they try, the harder it gets. The problem is that the logical way to respond to pain is often not a helpful way to respond to long-term pain. Many of the people I have worked with have reached a point of blaming themselves when their efforts to control their pain and it's impact don't work, thinking that they should somehow be able to try harder, do better. Patients have also often reported feeling disconnected and distancing themselves from others, even those who are trying to support them.

People with long-term pain are often given a bad press, labelled as lazy, scroungers, not wanting to get better. My experience is that more often the opposite is true. Whatever the problem, it is not lack of effort on the part of the patients I work with. More likely is that often the experience of pain can pull us into ways of responding that are not a good fit with long-term pain.

A relatively new therapy, compassion-focused therapy (Paul Gilbert, 2009) may offer a promising way of understanding the problem. The therapy was developed to help people with depression who also experienced high levels of shame and self-criticism, and has since been applied successfully to many different mental health conditions. Compassion focused therapy teaches us that, because of the way that our minds evolved, with new competencies added to brains that were built for old motivations like safety and dominance, we can often experience difficulty with our responses to modern life. This can mean that we respond to events automatically in powerfully programmed ways that we would not necessarily choose. Our new brain abilities mean that we have a high level of self-awareness and can be very critical of ourselves for these instinctual responses.

In my work with people living with pain the compassion focused model has seemed to fit very well with the experiences that people have talked about. Often they have found themselves pulled into habitual ways of responding to their pain and other difficulties that have been unhelpful, and that they have blamed themselves for. Compassion focused therapy describes three main emotional systems that we have, focused on dealing with threat, activating motivation and drive and soothing and healing ourselves. Based on a CFT focused understanding, trying to fight against an unpleasant experience like pain is likely to activate our emotional threat system which will also activate our drive system to look for a solution. In the absence of a solution the two systems will continue to fuel each other leading to the release of a range of inflammatory hormones which can cause further pain and health problems over time. The harder somebody tries to fight pain, the more this loop can be reinforced. At the same time the activity of the soothing system, which has access to powerful natural painkillers, is suppressed by this activity, leading to feelings of disconnection and the absence of a person's natural ability to soothe and heal themselves and connect socially with others.

I found in my work that many people found it helpful to think about their responses to pain in this way, and that it provided a powerful, non-blaming way of helping them to examine and gradually change some of their habitual responses to pain. As part of an MSc that I undertook in Mindfulness Studies I developed a group based intervention based on this understanding of pain, which was well received and showed early promising results. A link to the research can be found here or here.

I was privileged in these groups to hear people, one by one talk about their own habits of coping, many of which they had thought were stupid, a sign of weakness or not good enough, only to find that others also acknowledged these same habits and thoughts. Compassion focused therapy explains patterns like this in terms of 'our tricky human brains'. For some, once they felt that their experience was part of a shared human experience rather than a personal weakness, they were able to dare to look in detail at the way that they were responding to their pain and to make personally demanding changes that changed their lives for the better.

This intervention did not help everybody, and as an inexperienced researcher I certainly made a lot of mistakes. Despite this I felt that the intervention showed real promise and I hope that others will pick up the challenge of looking in more detail at the potential of compassion focused therapy for working with people with long-term pain.

Gilbert P. Introducing compassion-focused therapy. Advances in psychiatric treatment. 2009 May 1;15(3):199-208.

#mindfulness #compassio #ResilientMind #pai #painmanagement

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