MHM Magazine

Issue 1 | 2025 | MENTAL HEALTH MATTERS | 17 MHM Persistent pain – which persists or recurs for longer than three months affects about a fifth of the world’s adult population, and as much as a quarter of children and young people. Pain can be secondary to other conditions where pain is a symptom. It can be ‘primary pain’ which means the pain itself is the disorder – and usually occurs without an identified cause. Chronic pain has an impact on all aspects of a person’s wellbeing, affecting their occupational and social functioning, having broader effects on immediate family, community and wider society. It can lead to depression, difficulty sleeping and anxiety, and increases risk of suicide. Up to 16% of people with persistent pain wish to end their life due to pain at some point. Once pain becomes persistent, there are changes in the structure and function of the central nervous system which becomes sensitised to repeated pain messages. These can include alterations in both behavioural and central responses to unpleasant stimuli, and this neuroplasticity leads to changes in brain structure. The hypothalamic– pituitary–adrenal (HPA) axis and autonomic nervous system (ANS) are designed to respond to threat signals, for example by releasing cortisol. As the stress (pain) continues, these systems don’t down-regulate, leading to lowered immune responses, increased inflammation and further pain. These factors together mean that once a person is experiencing chronic pain, it becomes a vicious circle of increased sensitivity and prolonged pain. The most effective treatments address the impact of the pain on the person’s life, improving function and promoting pain self-management, and living according to important personal values. These interventions are based on cognitive-behavioural psychotherapies (CBT), including approaches such as Acceptance and Commitment Therapy (ACT). One of the key mechanisms for positive change is increased psychological flexibility. Medicines for pain relief are often of limited value, either because they’re not effective in reducing the pain, or because of side effects, tolerance, interactions, withdrawal issues and other problems of long-term use. A careful assessment of the impact of pain on all aspects of the person’s life, taking into account their life circumstances, physical symptoms, feelings, thoughts and behaviours (what they do or avoid doing), will identify targets for treatment and point to interventions which will help. By Helen Macdonald, MSc RMN Accredited Cognitive-Behavioural Psychotherapist, Registered Practitioner Psychologist in Health, Helen.macdonald@babcp.com PERSISTENT PAIN AND SELF-MANAGEMENT MHM | 2025 | Volume 12 | Issue 1 | Persistent Pain Management MHM