ACT and chronic pain

By Benjamin Schoendorff

Pain hurts. 

And when it hurts, it’s only natural to want to stop the pain. For most of us, pain is temporary. It signals that something threatens our physical integrity and it helps us take action to move away from danger. In this sense, pain is useful and folks who can’t feel pain rarely live very long. But pain can also come to stay and never leave. Close to 10% of all Canadians live with some form of chronic pain. Medicine can sometimes help, but often medical treatments aren’t sufficient to make the pain go away and painkillers become a last resort, with their well-known problematic side effects and significant risks of addiction.

Pain is real and the fact that it is real can lead us to consider the problem as purely medical. But whatever doctors can or cannot do to alleviate it, the way we receive our experience of pain can also have a significant impact. Pain represents afferent information flowing from our nerves up to our brain. Once received, the brain processes the information. Then we behave in a way congruent with that processing. Instinctively, when pain arises, the normal reaction is to move away from the source of pain. This works well for acute pain, less so for chronic pain.

Experience the pain

With treatment-resistant chronic pain, we can’t just focus on its source, especially as that source is often hard to identify. Just as important is the impact the pain has on our functioning and our lives. We can seek to refuse the experience of pain and see it as an obstacle that needs to be gotten rid of before doing anything else. In this case, we risk letting pain control us and see our life reduce to those activities that elicit the less pain. But we can also seek to learn to live our life beyond the pain so as to continue living a vital and meaningful life.

Folks who suffer from chronic pain, whether they see it or not, all face such a choice. Acceptance and Commitment Therapy (ACT) is the psychotherapeutic approach best validated for all forms of chronic pain. ACT can help people gently face up to that choice and to move toward the persons and things that are important to them, even in the presence of their pain. This is done by learning to progressively change one’s relationship with pain. In so doing, we can retrain the way our brain processes the information that will continue to feed in from our nerves, so as to minimize the impact on our life and well-being.

Noticing feelings, making space for them, gaining some distance from unhelpful or catastrophizing thoughts, reconnecting with one’s values and gently but resolutely moving in their direction through our action. At first, the ACT approach can often seem counterintuitive. But there is a growing wealth of resources that can help folks living with chronic pain pain live just as vital a life as anyone, in accordance with their most deeply held personal values. We recommend the workbook Living Beyond your Pain from our friends Joanne Dahl and Tobias Lundgren.