“Invisible Pain Requires Visible Support: Rethinking Functional Pain Management”

Often when we consider pain, we imagine something clearly broken, torn, inflamed and generally visible. However, for millions of people living with chronic pain entails hidden pain and tests which come back normal despite enduring pain. This can lead to a harmful and common misconception that pain, which is not visible, is made up.

The truth is simple and crucial; pain does not require visible damage to be valid.  

Pain can sometimes be described as functional. That is, where the nervous system is not functioning as it should. The brain and nerves become overly sensitive, sending pain signals even when there is no ongoing injury. Despite nothing being “broken” the area responsible for sensing danger is in high alert. Thus, pain is not imaginary, it is felt and often disabling.

Why does nothing show up on tests?

Medical tests are sensitive to detecting structural problems, an excellent method for organic conditions. Although far less effective at measuring how the nervous system processes pain. A normal scan simply means, the cause is not structural and not that the pain is exaggerated or a person seeking attention, nor that the pain is all in their head. However, pain which lacks a visible cause can sometimes be dismissed, even by the person experiencing the pain. This dismissal can lead to stress, worsen symptoms and delay effective treatment.

Impact on Mental Health

There is a strong link between pain and a decline in mental health. Not surprising given the dismissal in symptoms, lack of understanding whilst living a life with enduring pain. For most, it’s a daily struggle and this connection between the mind-body impacts profoundly on our mental health.  

Essentially, validation matters. Being believed and supported does not create pain, it helps reduce it.

Understanding pain as functional changes how it’s treated.

A multidisciplinary approach is important. This means, support from a small team of different professionals, each bringing their own expertise. This might include a pain specialist, your GP, and sometimes a physiotherapist or occupational therapist, alongside mental health professionals such as a counsellor, psychotherapist, or psychologist. Everyone’s needs are different, so this isn’t a fixed or complete list. Care is tailored to what feels right for you, and the aim is to improve quality of life.

As my area is mental health, let’s focus on the psychological support.

The Role of Psychological Support in Chronic Pain

Effective psychological support entails working with the brain and nervous system and not excluding the physical experience of pain.  

Pain is produced by the brain. This makes us human, it’s not fake, nor a sign of weakness. In that case, the brain is an important organ to consider in therapy. The brain can be likened to the operational system software, controlling all that we do. It decides whether the body is safe or in danger and in chronic pain this software can become overly protective. That is, signals which should be neutral such as movement, touch, fatigue are in fact interpreted as threats and pain is triggered as a warning.

So how can therapy help?

• Calm an overactive nervous system

• Reduce fear around movement or symptoms

• Break cycles of pain, stress, and avoidance

• Restore confidence in the body

This is not about “thinking positively” or ignoring pain. It’s about changing how you respond to pain thus reducing how the nervous system responds.

What Psychological Support Actually Looks Like

Psychological approaches to pain are practical and skills based. They may include:

• Pain education: Understanding how pain works can reduce fear and intensity.

• Cognitive strategies: Identifying thought patterns that increase tension or threat (like ‘catastrophising’, or ‘black and white’ thinking or ‘compare and despair’ thinking) and gently reshaping these. Being more flexible with our thoughts and making space for these can help to minimise the unhelpful emotional responses connected to these thoughts. This inevitably helps us to feel more balanced.

• Emotional processing: Chronic pain is exhausting and frustrating. Support helps people cope with grief, anger, and loss of identity that often come with it. Making space for our emotions is important. Likewise, being able to show ourselves compassion. Allowing ourselves kindness and compassion can be tough for several reasons. Sometimes we do not feel deserving of kindness or are juggling too many demands to be able to make time for ourselves.     

• Stress regulation: Teaching the body how to exit constant “fight or flight” mode through relaxation, breathing, and grounding techniques. A thorough understanding of what goes on in the body physiologically when we are anxious can equip you with the skills to manage these fight or flight symptoms when they appear.  

• Behavioural pacing: Learning how to balance activity and rest without triggering flare-ups. Setting realistic and achievable goals which do not set you up to fail. Exploring values in therapy can help you to consider and problem solve what is important to you and how you can take steps to integrate this into your life. 

These tools don’t erase pain overnight, but they often reduce its grip.

Psychological Support is Not a Last Resort for Pain Management

Too often, psychological care is offered only after everything else has failed. This reinforces the idea that it’s not real pain. In truth, psychological support works best when it’s part of treatment from the start, alongside physical and medical care; the multidisciplinary approach discussed above.

When we stop separating “physical” and “psychological” pain, we start helping people more effectively. Treating only the body ignores half the problem.  

In essence, therapy needs to be functional, that is, tailored to you, person-centred and considers the whole person. Providing safety and compassion in the therapy room, reduces that sense of threat on the nervous system and welcomes safety promoting wellbeing. With this in mind, I encourage you to consider one thing you can do for yourself today which welcomes kindness and compassion, reducing that sense of threat on your nervous system.

As always, if you would like to learn more about my approach and how psychological therapy can help you please get in contact. I offer a free 15-minute telephone consultation.

Your Wellbeing in Mind.

The Functional Therapist.