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Persistent Pain

By Emma McNulty, Registered Psychologist

Persistent pain, typically defined as pain lasting for more than three to six months, affects one in five Australians, and represents a tremendous burden on the healthcare system. Although pain research has made incredible progress in recent decades, community understanding of pain is often biomedically-focused, leading to a desire for interventions – such as prescription opioid medications – that are now understood to be inappropriate for (and may actually worsen) long-term pain.

From a psychological perspective, low mood, social and occupational withdrawal, anxiety, and hypervigilance – common psychiatric symptoms – can all contribute to sensitisation of the pain system. Likewise, persistent pain can make people anxious, hypervigilant, withdrawn, and depressed. It’s a nuanced and multifactorial cycle that is best addressed from a multidisciplinary perspective.

Pain can perhaps be best understood as a threat detection system rather than a threat response. Tactile and nociceptive information from the periphery is integrated with input from other sensory systems, attention and emotion networks, as well as previous knowledge and learning about pain, movement, and the environment. David Butler and Lorimer Mosely, authors of Explain Pain, have this simple explanation:

Pain will result whenever the brain concludes that there is more credible evidence of danger than there is of safety.

Current evidence supports a number of psychological approaches as effective treatments for persistent pain. Cognitive Behavioural Therapy, Acceptance and Commitment Therapy, and Mindfulness-Based Interventions have all been shown to improve pain severity, pain interference, depression, anxiety, and overall quality of life.

Although based on different theoretical models, these approaches have several commonalities:

  • Reduced avoidance;

  • Increased awareness and acceptance of the present moment;

  • Relaxation training;

  • Strategies to target catastrophic thinking; and

  • Increased engagement in valued activity.

For some additional resources on persistent pain, check out:


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