Pain and the psyche: 4 myths about chronic pain and the truth behind them

Today, we’re here to debunk some myths about chronic pain. We also want to offer some approaches for those suffering on how to deal with chronic pain and thus, lead happier lives. To this end, we say down with Constanze Pfefferle, a Caspar Clinic doctor focused on psychosomatic medicine and psychotherapy to discuss the role the mind plays in chronic pain — and what can be done to treat it.

Constanze offers chronic pain patients – of whom there are many – constant support so that they don’t become resigned to their pain. Three key terms define her approach: activation, motivation, and support.

But first thing’s first: what exactly is chronic pain? In general, pain is described as chronic when it has lasted at least three months and/or surpasses the normal pain period of a given illness (source). The Deutsche Schmerzgesellschaft (Pain Society) defines the term even more openly. The important thing is that, through the clinical recognition of chronic pain, those afflicted can get the professional support and help they need.

Myth #1: Chronic pain always has a physical cause

This is clearly false. There are so-called “somatoform” pain disorders. Here, patients complain of pain that occurs in either one area or in different areas of the body — and for which no physical cause can be identified. In these cases, research shows that conventional medicine’s diagnostic tools (such as MRI of the lumbar spine) can’t pinpoint any definitive physical causes of the pain. In these cases, a psychological component is taken into consideration.

Often, however, there is a preceding incident. This could be an accident, wear and tear of the spinal cord, or the after-effects of a surgery. The side-effects of this incident can persist, causing pain in the effected area. Psycho-social stressors also play a role here, such as family or financial burdens, general stress, or social circumstances. Traumatic stress, a genetic predisposition to chronic pain, or even psychological or psychosomatic pre-existing conditions — all these are risk factors for pain to become chronic.

Myth #2: All chronic pain patients will eventually become depressed

This is also false. It is true, however, that some who suffer from chronic pain may also exhibit symptoms of depression. However, it’s often not possible to clearly differentiate whether the chronic pain is the cause, or whether the patient was already experiencing psychological difficulties. Pain patients often suffer for a long time because they cannot always be helped ad hoc  – and researching the pain’s cause can be time intensive. This means it often takes awhile before a concrete therapy can be initiated.

Furthermore, many patients don’t have a clear understanding of how their body and psyche interact, and may not initially see the benefit of addressing accompanying psychological and social issues along with their chronic pain. Here’s where so-called “pain therapists” can be especially helpful. These specialists come from a wide range of disciplines – such as anesthesiology, neurology, or psychosomatics – with additional training in pain therapy. Pain therapists can take patients’ psychosocial factors into account when making a diagnosis. In many cases, the pain that patients are experiencing also has to do with the lack of connection to to themselves – and their own bodies. This can promote depressive moods, adding an additional burden when they’re already suffering. To make matters worse, there is no real avoidance strategy for pain. You can usually hold your nose when confronted with unpleasant smells, or plug your ears to avoid loud noises. But with recurring or persistent pain, patients really find themselves at the mercy of it –– and a kind of powerlessness sets in. The anger at this lack of control may lead sufferers to simply give up hope that things might change – and constant anger can, in turn, increase existing pain. As therapists, we see our task as counteracting this attitude by motivating patients and helping them discover alternative methods to address their issues. We accompany our patients through rehabilitation or aftercare, and make sure that we’re always available for them when they need us.

In the Caspar Clinic team, Constanze Pfefferle assists patients who need individual support. Here, her wide medical expertise as well as her psychotherapeutic and psychological knowledge is particularly useful. Her interest also extends to supplementary medicine – she likes to get to the bottom of things.

Myth #3: Only medicinal treatment is helpful when it comes to chronic pain

From my experience with my pain patients, I can say with full confidence that this is not the case! Many sufferers believe that only prescription drugs can and will make a difference. What's more, they expect their doctor to do something that will offer them a pain-free life. So, often, we say that we can do something, but medication is not always the right solution – even if hoping for a quick fix is totally understandable.

Other approaches require a certain amount of initiative on the patients’ side. From relaxation techniques like autogenous training and progressive muscle relaxation to supplementary treatment like traditional Chinese medicine (TCM) and acupuncture to mindfulness training, hypnosis, or yoga – these are all things patients can try which can offer them some relief, depending on the intensity of the pain and their situation at the outset. Overall, a personalized, catered approach is extremely important. I always tell my patients not to give up, or to give in to their pain. I offer them tips on what they can do on their own or take them by the hand when they need extra support. As soon as they’ve had their first success or found something that really works, self motivation often comes on its own.

Myth #4: Chronic pain is a vicious circle that’s impossible to get out of

Yes, this vicious circle does exist, but there are countless ways out of it. With chronic pain, we’re taking about a clinical picture that’s extremely complex, because many factors act together to influence the pain. For example, the patient might experience sleep issues, mobility struggles, or even social isolation. The biggest advantage here is that this variety of factors offers multiple starting points on how to improve the overall constellation. This includes finding relaxation methods for restful sleep, ensuring regular physical activity to prevent muscle degeneration and tension, and loads of other methods to ensure that there’s no feeling of defeat or resigning themselves to chronic pain.

Even if it feels at first as if there is nothing patients can do about their pain, on closer inspection, there are many different ways to actively improve the situation, without relying fully on medication. It’s important for those with chronic pain to take an inventory of their medical history so that, together with their treatment therapists, they can learn how to alleviate their pain, improve their general well-being improved, and regain a better quality of life.

Thanks so much, Constanze Pfefferle, for this fantastic interview!