Mind your body

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience.”

Yet, the emotional impact it has on sufferers — and how psychology can help — remains very much misunderstood.

While it’s natural for patients to expect their pain to go away with treatment, the complexities of the condition can be life-changing and frustrating.

“There’s a lot of blaming on pain, that pain is a cause of this, pain is a cause of me being frustrated, pain is a cause of me being snappy, pain is a cause of me having to miss work or missing my promotion or not being given a good appraisal or being asked to leave work,” says Dr Yang Su-yin, clinical lead for pain psychology at TTSH.

It’s a vicious circle, the pain psychologist adds, that compounds and aggravates over time — sufferers become hypervigilant, and avoid activities they think lead to pain.

“I’ve had patients that stop dancing, they stop exercise even though that is something that they enjoy,” Dr Yang adds. “I have patients that choose not to go out with family and friends because they are fearful of a flare up, so they become more and more socially isolated.”

Many sufferers find that their whole lifestyle has to change because of pain, she says. This is where pain psychology comes in — reducing the amount of interference pain brings to a sufferer.

Pain psychology is mainly centred on self-management, to help sufferers become more functional despite pain, and to change their expectation of treatment outcomes through cognitive behavioural therapy.

Treatment includes reducing behaviour like fear avoidance, positively reinforcing healthy behaviour, and encouraging sufferers to reframe their thinking and understand the effects of thoughts and emotions.

“As much as we provide support, it’s really about asking patients to be more active, to do things for themselves,” Dr Yang adds.

A separate part of this process also involves managing sufferers’ complaints about a lack of understanding. Psychologists often spend more time in session with patients, compared to a surgeon, physician or pain doctor, and they educate patients on what doctors may mean, she adds.

Despite being a readily available option, cultural differences may pose a barrier towards psychological treatment for pain.

Another qualitative study of eight Singaporean sufferers found a lack of understanding between the need for psychological treatment and pain, with some querying why they had paid “just to talk”.

Sufferers in the study, published in the journal Pain Medicine, thought there was no relevance between psychology and pain, and wondered if it meant that their pain was not real.

The public has a limited understanding of psychology, often associating it with mental health issues, says Dr Yang, who was the lead author for the study. “There’s also stigma that stems from this understanding, hence an avoidant behaviour,” she adds.

“A lot of people will hesitate to ask for help because it seems as if you’re not self-sufficient, you’re not strong enough, and there’s a sign of weakness,” says Asst Prof Andy Ho, who researches community health psychology at NTU.

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