Pain Depends on Context

Pain depends on context is one of Pain Revolution’s key Target Concepts – as understanding the nature of persistent pain is essential to controlling one’s pain experience. Pain is influenced by biological, social and psychological factors.

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Mary O'Keefe - Communications Committee ChairPublished on 19 January 2021

Pain depends on context

Pain depends on context is one of Pain Revolution’s key Target Concepts – as understanding the nature of persistent pain is essential to controlling one’s pain experience. Pain is influenced by biological, social and psychological factors.

Things you need to know about context and pain

• Biological, social and psychological factors influence each other and form the context of your pain.They have a powerful influence on the pain experience. • Social factors include things like other people, your work and things you see and hear. • Psychological factors are divided into cognitive and emotional aspects.

  1. Cognitive aspects include your understanding and beliefs and how you think about things. For example, your ideas about the causes of your pain, whether you believe your diagnosis is correct, how much you trust your health care professional.

  2. Emotional aspects are the feelings and emotions that accompany your injury or pain condition. For example, feeling upset, depression, stress, anxiety, anger or frustration.

  • Understanding the impact of context on your pain can help you work towards lessening that impact – understanding is power
  • Worrying all the time that something might be really wrong and interpreting increases in pain as a sign of potential catastrophe, have both been shown to make pain worse and make it last longer
  • Working on your unique contextual factors to change situations or your responses to them will help you on your road to to recovery.

Pain depends on context: perspectives from individuals with a lived experience

We asked five individuals with a lived experience of pain to comment on this target concept and what it has meant to their journey through persistent pain.

How has understanding that pain depends on context influenced your pain journey?

Overall individuals felt having an understanding of the role of context on the pain experience helped them see pain as something that can be influenced by non-physical aspects and knowing this gave them a sense of being able to exert control over their environment - and consequently the pain experience.

“Immensely. Understanding this idea was interesting, but taking the time to properly consider the environment, stresses, pressures etc. around me and being able to apply it to myself was very powerful.”

“It confirmed the suspicions I already had about the role of my own mental processes on the pain that I was feeling. I now think of myself as an active healthy person who has episodes of pain rather than as a person with osteoarthritis or a bad back (basically I now put my capabilities before my disabilities!)”

“This understanding has been crucial for my recovery. Pain does not exist in a purely physical vacuum - it is impacted by beliefs and mental states plus all of the other influences that a person navigates throughout their lives” What, if anything, do you do differently having gained an understanding that pain depends on context?

Individuals mainly expressed a confidence or change in the way they processed the pain experience. Most felt less worried about a pain-flare up and looked for things that they themselves could modify in their own unique environment to influence their pain experience – or the potential disability associated with it.

“I don’t worry as much about the pain. I put effort into changing my stress levels rather than always focussing on the pain. If I change the stress levels then my pain changes.”

“When I start experiencing pain I will look at what is happening in my life that could be causing or increasing that pain. In particular, when I am under a lot of stress my pain increases or reappears so it can be a warning to me that I'm under pressure and I need to address it. In a way that's a positive thing.”

“I have become less dispirited when I have a flare-up. I remind myself of the things I can do to help control the pain. I tell myself this is not forever - there are things I can do to help myself. I make sure I keep moving as best I can. I seek help quickly from my physio. I don't try to soldier on alone. I remember the good times when I don't have the pain. I remind myself that I will come out the other side of this episode.”

What helped facilitate a shift to understanding that pain depends on context?

Answers to this question varied significantly across individuals. All expressed the importance of different factors in helping their understanding about the role of context in pain. Some referred to certain treatments like engaging in exercise, seeing a psychologist, or learning more about pain science. Others had life events that made them reflect on the role of context.

“Actually it was the death of a close friend that really hammered it all home for me. The day of his death I had a massive spike in my pain which lasted for two weeks. I knew it was due to the stress. Nothing had changed in my body however everything had changed in my life.”

“Seeing a psychologist experienced in pain was definitely helpful. I was then able to look at times where I had a lot of pain and draw links between those times and quite traumatic experiences I had gone through. I had to do a lot of reflection on this myself, but it was useful to have someone to talk me through it. I could also identify things such as when I was less active (ie; when I went to bed and was thinking a lot about my pain) it was worse, but if I was able to keep my mind focused on other things I can lose track of the pain. This was important, but it took a while to see those indicators.”

“A better understanding of pain science, specifically, Explain Pain and Explain Pain Supercharged helped me to take a step back when in pain and apply principles taught in those books.”

What was challenging about shifting your understanding to pain being dependent on context?

Many individuals felt that it was difficult to move on from a purely physical or medical model of viewing their pain. Others felt the realisation that one can self-manage their own pain through controlling their environment and context can be scary as it means less reliance on other people for help.

“Existing belief structures are often difficult to work through.We all have a natural resistance to new ideas that challenge core beliefs that we had previously accepted as self evident, such as pain and how we should cope with it. The more I thought about this the more sense this new understanding made to me and the more it helped me.”

“Getting your head around the fact emotional factors can influence how your body is feeling. We are so use to operating within a medical model and many of the healthcare professionals we see do this, so its important to find a patient health care provider who can bring this new model of pain to our attention in a way that not offensive or beyond our reach. It can take time to change that thinking, like any sort of cultural change, it doesn't happen overnight.”

“Realising that I was able to change the context was daunting but also very liberating. Stopping my quest for the right therapist, drug or doctor was scary. Taking control of my pain meant that I had to do the real hard yards to change my pain experience and not rely on someone else to do it for me.”

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Mary O'KeefeJanuary 19 2021

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