The Mental Game of Chronic Pain / Mamaena Roa

Chronic pain doesn’t just hurt—it can take over your life. No matter the cause, the impact is deep, affecting both body and mind. This article dives into how pain affects your nervous system and why a psychologist might just be the key to managing it better. Let’s explore how to take back control!

So What Is Chronic Pain / Mamaenga Roa?

It’s important to talk about acute pain before we talk about chronic pain. Acute pain occurs due to an injury or illness. Think about touching a hot stovetop – the pain causes you to pull your hand away to prevent further injury. The pain sets off an “alarm” of sorts – your nervous system – which causes the movement away, and reminds you not to do that again in the future. Acute pain is short term, lasting from seconds to weeks, and resolves when the injury or illness heals.

Chronic pain is defined as “pain that lasts longer than three months.” It can range from mild to severe, and it can be present 24/7 or come and go. Chronic pain can be caused by an injury, an inflammatory disease, nerve damage, or changes to the nervous system's processing of sensory information. Often, but not always, the initial injury has healed, but the pain persists. In these cases, there can be both physical changes and changes in how your nervous system and brain process pain.

When you experience chronic pain without a clear cause (or if the cause has resolved), the alarm (your nervous system) may become overly sensitive or even faulty. The pain pathways may become overly activated, even though there’s no actual danger to your body. This is what can happen when for example you’ve had endometriosis removed surgically, but you’re still experiencing chronic pelvic pain.

If you’re following The Cyclist, you are probably experiencing chronic pelvic pain. The underlying cause may be a condition like endometriosis, fibroids, vulvodynia, or polycystic ovary syndrome (PCOS). You might experience severe pain during your cycle, pain between periods, painful sex, and other symptoms like irritable bowel issues and irregular periods. It’s likely that the pain is affecting your quality of life. You may feel frustrated and want to find better ways to manage your pain. In some cases, you might be unable to live your life normally due to the pain.

Chronic pain is complex. A core treatment team for chronic pelvic pain typically includes:

• GP: Handles day-to-day care and pain medications.

• Gynecologist: Diagnoses and treats physical causes of pain, like removing endometriosis or fibroids.

• Pelvic physiotherapist: Helps with muscle-related issues, like hypertonic pelvic floor (I’ll let Caitlin explain that one).

So Why is a Psychologist Talking About Pain?

The first question people have when referred to a psychologist for chronic pain is “so are you telling me it’s all in my head?” I want to clarify: this is not why a psychologist gets involved! Your pain is real, whether or not there is a clear physical cause. Pain pathways are activated, and your brain processes that as pain. The reasons for this and how your brain processes it are more complex, which is where psychologists come in.

Let’s talk about the relationship between mental states and pain experience.

We’ve all been in acute pain at some point – whether childbirth, an inflamed appendix, a sprain or broken limb, or post-surgery. When you’re in acute pain, hyperventilating, crying, and focusing on how much it hurts, it feels unbearable. You might think, “I can’t cope with this.” You’re in “fight or flight” mode, with your nervous system on edge. Now, imagine if you take calming breaths, are comforted, or distracted by something you enjoy. Your pain might not disappear, but it becomes more manageable.

Pain is both a physical and emotional experience. Your emotional state affects your nervous system’s functioning, which can influence your pain. When we experience pain that lasts longer than a few minutes or hours, we find it hard to focus on anything else. Emotional capacity to cope is diminished – you might snap at loved ones when you normally wouldn’t. You might become anxious, wondering if the pain will ever stop or if you can cope. If the pain lasts longer than a few weeks, you might start feeling hopeless, or angry about missing out on things because of the pain.

As the pain persists, you might rely on painkillers to get through the day. You might struggle with sleep, and the lack of sleep further reduces your ability to cope. Over time, chronic pain can lead to:

• Relationship difficulties

• Depression and anxiety

• Lower work functioning

• Social isolation

All these factors reduce your capacity to deal with the pain, creating a cycle that can feel impossible to break.

This is where a psychologist can help. A psychologist can provide strategies to reduce anxiety, improve sleep, and improve mood. By improving these factors, your nervous system becomes more regulated, which can actually reduce pain.

Another factor contributing to chronic pain is trauma. Trauma often causes people to remain in “fight or flight” mode, keeping their nervous system in a heightened state. This makes transitioning into a chronic pain state more likely. Additionally, individuals who have experienced sexual trauma often have a stronger physical and emotional response to pelvic pain, which results in pelvic guarding (tight pelvic floor muscles) and increased emotional reactions to pain. We know that big emotions can worsen pain.

So What Will a Psychologist Help Me With if I Experience Chronic Pain?

A psychologist will first get to know you and your history. If you’re experiencing chronic pelvic pain, they’ll ask about your periods, how painful they were, and how things have been more recently. They’ll want to understand how the pain is impacting your life and what you’ve been doing to manage it. They’ll also ask about past pain experiences, emotional states, low mood, anxiety, neurodivergence, and any diagnoses you have, as these can be linked to your pain. They will gently inquire about trauma, though you won’t be expected to discuss it unless you’re comfortable.

Based on this, the psychologist will create a “formulation,” explaining what’s happening and why. You’ll then work together to create a treatment plan. This might include:

• Education on chronic pain and treatment strategies.

• Grounding and relaxation techniques to reduce stress.

• Radical acceptance of pain, helping you reduce emotional struggles with it.

• Addressing trauma, including medical trauma and past experiences of medical gaslighting.

• Helping loved ones understand and support you better.

• Collaborating with your GP, gynecologist, and pelvic physiotherapist.

The Takeaway

Chronic pain can feel overwhelming, and no chronic pain professional will promise you’ll be pain-free. However, psychologists can provide support by improving your mental state, helping to calm your nervous system, and potentially reducing pain. With a holistic treatment approach that includes psychological strategies, alongside medical and physical interventions, you can regain control over your life and manage your pain more effectively.