Taking control of pain

Psychology

It can be described as Australia's "silent epidemic": thousands of people suffering from chronic pain and being unable to fully control their lives as a result.

New research from the University of Adelaide is casting light on the impact chronic pain has, particularly its association with depression.

For her PhD with the University's Department of Psychology, Dr Della Steen studied a group of more than 100 people with chronic back pain who had not been involved with a pain-clinic treatment program.

She examined her subjects from a cognitive-behavioural approach: that is, how people's beliefs and thoughts might shape the impact chronic pain can have on their lives.

For example, people who "adjust" and learn to live with the pain, rather than waiting until it goes, are much more successful in living relatively normal lives and are also much less likely to suffer from depression.

"Chronic pain is a huge problem across the world, and Australia is no exception," Dr Steen said. "For example, in the US alone, nearly half a million work days are lost every year as a result of chronic pain, at a cost of approximately US$150 billion in related health care. It is estimated that the impact of chronic pain in Australia and other Western nations is on a similar scale.

"I was interested in how people adjust to chronic pain - why do some people adjust, and others don't?

"I also wanted to explore the link between chronic pain and depression, and whether suffering from one condition led to suffering from the other."

Dr Steen found that there may be high levels of depression among people with chronic pain, and that health professionals need to continue to be more aware of the psychological consequences of chronic pain.

"One in three people with chronic pain that I studied had symptoms of depression - but it is difficult to say conclusively whether the chronic pain led to the depression, or vice-versa," she said.

"The depressed people reported significantly more pain, and significantly less feelings of control both over the pain and their everyday lives.

"They were also more likely to feel that external forces, such as other people or even fate, were responsible for their situation - whereas chronic pain sufferers who didn't suffer from depression were more likely to believe that they could help themselves and adjust to the pain being a part of their lives."

In Dr Steen's study, there were also differences between the way men and women perceived and reacted to chronic pain.

Men with chronic pain were more likely to suffer from depression if their pain impacted to a significant degree on their daily lives, such as their ability to work or conduct social activities. Women with chronic pain, on the other hand, were more likely to suffer from depression if they perceived the pain level was high and the amount of control they had over it, and their life, was low.

"This is not to say that women are less tolerant to pain, far from it," Dr Steen said. "The levels of pain experienced by men and women in my study were about the same, and what my study showed was that because men and women can react differently to chronic pain, diagnosis and treatment may need to be different accordingly.

"For men, they may benefit more from education and how to reduce the interference chronic pain presents to everyday life. Women may benefit from more information about pain relief, not just pharmacological but other measures like massage, physiotherapy or heat treatment."

Story by Ben Osborne