Pain Psychology - Identifying With Pain

As I continue into my practice as an Athletic Therapist, it fascinates me on how much of a mind-game rehab is; not simply a body one alone. It's not as easy as rubbing a client's sore muscle and telling them to exercise. If it was, my job would be way too easy.

Pain has a large impact on our physical as well as psychological state. Inversely, both physical and psychological factors play a role in its onset, frequency, severity, and more. Over multiple posts, I plan on discussing just a few of the many psychosocial factors that influence pain and some of the tools that I use to help clients past them.

One major phenomenon that all therapists run into with clients, especially those who live with chronic pain, is the circumstance of individuals who identify with that pain. In the same way that a person can identify as - and revolve their life and their psyche around - being an athlete, a mother, or an academic, it's equally possible to do the same with pain.

To my understanding, this occurrence is one that allows people to turn the situation around and, in their minds, making the existence of their pain "ok". Patients have been observed using this principle to keep the blame and ownership for their own pain away from themselves, potentially treating it as simply a "fact of life" in order to cope and make the sensation easier to handle. To complicate the matter, it's suggested that patients can end up relying on their pain for self-identity, creating a crisis if pain is, in fact, remedied.

So here's the challenge. When clients who come in who are so used to and accustomed to pain that it's a part of their entire identity and if taking their pain away risks causing an identity crisis, what do I, as the clinician, do?

A lot of the process comes down to classic first-year psychology class methods, believe it or not. Visualization and imagery is crucial, as pain-sufferers need to be able to envision a future outcome that involves an improved condition (even if it's not a complete recovery). Doing so prepares them for what could be considered their "new identity", creating a pathway for the transition after pain is gone. Following the creation of that long-term end result, shorter-term goals need to be established in order to make the process of reaching the outcome seem plausible. (Sound familiar, everyone who went to college ever?)

We'll never use any of this stuff.

Past that, there are too many other skills and methods used to assist clients along their recovery process to fit into one post, but what I've written here offers a good start. For all of what I've said, this is the reason why my appointments tend to be so chatty, but those psychological barriers need to be addressed if there's to be any hope of treatment success.

When it comes to treatment, exercise, and rehab, "just do it" doesn't quite cut it. Sorry, Nike.

This topic was written with consult and collaboration with Alison Quinlan, a Sports Behavioural Consultant in Victoria, BC who is also pursuing continued education in dietetics. Follow her on Twitter and visit her website and blog to see some of her own authored articles. 

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