Illustration by Clara Nicoll

Mindful life: “I believe in my patients’ pain completely and don’t need any proof of it”

As a psychiatrist who works in a pain clinic, I see how debilitating chronic pain can be
November 3, 2022

I am a psychiatrist but I also work in a pain clinic, which might seem odd. When I meet patients for the first time, I often worry that my job title might seem to imply that chronic pain is all in their heads. This is the opposite of what I think—I believe in my patients’ pain completely and don’t need any proof of it. 

Most of us feel pain on a regular basis; it’s a warning sign that stops us from getting injured and unwell. The unlucky people who cannot experience it—usually due to a genetic condition—can end up doing significant damage to their bodies without realising it. However, my own experience with back pain a couple of years ago illustrated to me how horrible it is when pain goes beyond this helpful preventative function and becomes constant. Some research suggests that the experience of pain itself can make the nervous system more sensitive, so we begin to feel pain in situations where the body isn’t actually at risk of damage.

Chronic pain is common: over a fifth of us experience it and, usually, it’s likely to get worse as we age. It can lower a sufferer’s mood and quality of life, especially when coupled with the fear it will never end. To count as “chronic” the pain must last for at least three months, which can feel like a very long time. For some people, their debilitating chronic pain has a clear physical cause—like rheumatoid arthritis—but for others there isn’t an obvious cause, or at least not one that accounts for just how bad it is, which can make matters feel worse.

Pain without end is one of our most ancient and enduring fears, so we make considerable efforts to get rid of it or avoid it altogether. Some people become so frightened of hurting themselves that they avoid their usual activities, leading to a cycle of muscle wasting that makes them even more susceptible to pain. Some of the medications that are often used to treat pain, like opioids, can make us more sensitive to it in the long run. Some people end up taking far too much in a desperate but understandable attempt to feel better.

My role in the clinic is to treat the symptoms and sometimes the depression that often comes with chronic pain. Sometimes this can be helpful to patients—how you feel does actually help how you feel, physically. Even more interestingly, some antidepressants can actually reduce nerve pain, which does make one wonder about the connections between our mood and the pain we experience on a deeper level in the nervous system. 

I can understand why chronic pain causes such distress: I was appalled when I developed back pain. I’m used to being the psychiatrist with a mental illness—I know how to cope with that—but, despite years working in chronic pain, it came as a horrible shock. 

So, what did I do? First, I tried to ignore it, which didn’t really work. Then I just tried to keep going, which partially worked. (It was better than avoiding my daily activities, at least.) I also complained a lot, so that my family would know how bad it was—interestingly I found this easier than talking about my mental illness. I avoided medication other than paracetamol and ibuprofen, and I think this was a good thing for me. I didn’t use alcohol or illicit drugs either—this would have been a slippery slope. Finally, I went to see a physiotherapist, and I’ve had no pain since (after several years). I always recommended physiotherapy before; now, I recommend it from the heart. I was probably lucky, but it was a good lesson.

No single piece of advice will be right for everyone suffering chronic pain, but in general try to keep moving and keep warm. Keeping warm is likely to be a problem for many people faced with rising energy bills and the cost-of-living crisis. Yet, like other conditions that are seen as less acute or life threatening, people with chronic pain are often overlooked. I worry for them in the long winter ahead.