My Chronic Pain is Real! Why Would I Need a Therapist?

Today we welcome a guest blog post from our colleague and friend, Dr. Beverly Thorn (https://www.drbeverlythorn.com). Dr. Thorn is a licensed clinical psychologist who is board certified in Clinical Health Psychology. A professor at The University of Alabama for 30 years, she specialized in treating patients with chronic illness and chronic pain. She formally retired in 2016 to serve as a dementia caregiver for her husband, but has remained professionally active in writing, speaking, and giving workshops. In 2022, she received additional training and certification as an end-of-life doula and is currently publishing a book for dementia caregivers, titled Before I Lose My Own Mind: Dementia Caregiver Survival, due out in May 2025. Her website has several free resources for patients with chronic illness, including caregivers.

If you have chronic pain, have you ever felt like others didn’t think that your pain was real, or was “all in your head?” You’re not alone! Because chronic pain is mostly invisible to others, you may feel that family or friends think you are exaggerating the pain or making it up. Physicians may have told you that “you just have to learn to live with it,” but did they give you any skills to do that? Perhaps they gave you pain pills for a while, but many times, they made you feel “out of it,” and had other side effects. By now, we all know the very real dangers of addiction and potential overdose from opiates and other pain medications. Surgery, if offered, carried some real risks and may not have worked. If you were referred to a therapist for pain management therapy, did you feel like your doctor was telling you your pain wasn’t real, was psychological, or you were just a drug-seeker? A referral to a therapist for pain management therapy doesn’t mean any of those things.

When people have chronic pain, they don’t typically think of psychological therapy as a treatment option. They may think that therapists only treat people with “mental disorders,” or “psychological pain” - not real pain. Nothing could be further from the truth! Therapists have become a crucial part of a multi-disciplinary team approach that may include medical interventions, psychological pain management therapy, and physical therapy. A multi-disciplinary approach to chronic pain management has been found to be superior to using medication and/or surgery (traditional medical approaches) alone. Here are several things that pain management therapists contribute to the team approach.

Therapists know that chronic pain is real pain, and they know it is stress-related. Stress makes all things worse, including chronic pain and other chronic illnesses. So, it makes sense that therapists, who teach people to manage stress, can help people reduce the burden of having a chronic illness such as chronic pain. Many stress management skills, like learning and practicing relaxation and/or meditation exercises, are not specific to treating chronic pain and can be used for a variety of stressors in our lives, including such wide-ranging life challenges as chronic illness, the pressures of child-rearing, and even stress associated with being a caregiver for a loved one with a chronic or life-limiting illness, such as dementia. (See, for example, https://drbeverlythorn.com/resources/, to download free audio guidance for meditation and relaxation.) Relaxation and meditation exercises, when practiced on a regular basis, have been shown to decrease stress, increase health, and raise one’s overall quality of life.

An important psychological treatment specific to chronic pain involves learning how the brain processes pain and harnessing the power of the brain to quiet down pain signals. The brain is like a huge filter sorting pain signals coming from the body. That filter can either amp up pain signals – making your overall experience of pain much worse, or the filter can dampen down the pain signals coming from the body. It’s like the filter in the brain can open or narrow a pain gate going to the place in the brain where you feel pain. For example, pain signals travel through areas of the brain responsible for our emotions. If the emotions-centers of the brain are overactivated from anxiety, depression, and yes, even stress, this over-activation will worsen the experience of pain. Conversely, if you can learn how to better manage negative emotions before they run away with you, this can have the effect of reducing the experience of pain. Pain signals also travel through the thinking centers of the brain, and if your thoughts about the pain are negative and catastrophic (e.g., “this pain is killing me – I can’t live with this pain!”), your overall experience of pain will be worse. Therapists teach people to recognize the presence of negative thoughts and emotions, label them for what they are, and rework them to be more realistic and less damaging. These skills harness the power of the brain to combat some of the effects of chronic pain and in the process, enhance quality of life. You can get a sense of how this works by looking at a patient workbook designed to be used with a pain therapist to help you learn these and other pain management skills. https://drbeverlythorn.com/pain-workbooks/. The illustration below comes from the workbook.

Pain management therapists also help people live more fully despite pain by helping them re-engage with meaningful and enjoyable activities. Often, when people have experienced severe or recurrent pain, they become fearful of activities that might bring on a pain episode or make the pain worse. They consequently withdraw and do less and less as time goes on, including activities that once gave them pleasure. Withdrawing from pleasurable activities leads to depression, more withdrawal, and even more pain! And as we withdraw from physical activity our bodies can lose the ability to use our muscles to support our joints – another big factor that increases pain. Using activity-rest plans, pain management therapists teach people to gradually re-introduce physical activities (gentle movement) to strengthen the body without causing pain flare-ups. They also help people re-engage with activities that are meaningful to them, so that life is worth living again.

Finally, we know that traumatic events in childhood or adulthood can make chronic pain worse. Trauma-informed psychological therapy takes that into account for those individuals who may benefit from this additional approach to pain management.

The support you need and the skills you acquire through a cognitive-behavioral treatment program such as this can be learned in face-to-face in person therapy, group therapy, or via telehealth. Research has shown that these three treatment modalities are equally effective, and for many of us, making time for a telehealth appointment is far easier to fit in than traveling to an office, parking, and driving back. Upward Behavioral Health provides in-person and telehealth services throughout the state, including, but not limited to Birmingham, Mobile, Huntsville, Tuscaloosa, and Montgomery. A major advantage of telehealth is that you don’t even have to be near a city, yet you have access to pain management therapists.

With all these potential benefits to help you better manage chronic pain, why hesitate? Contact your pain management therapist today and see how your life can improve.