Melissa Day - Psychologist


 A clinical psychologist and researcher at the University of Queensland, Melissa is focused on research to advance our understanding of the experience of pain as well as conducting trials to evaluate the benefit and mechanisms of psychosocial treatments for pain.

Is your pain the cause of anxiety?

The findings from the 2017 Global Pain Index show that Australians are worried (55% of people for body pain and 50% for head pain) and anxious (29% of people for body pain and 26% for head pain) about our pain.[1],[2] This supports research that shows a high correlation between people suffering pain and experiencing conditions such as anxiety.[3]

There are any number of reasons why we may experience anxiety due to pain. For example, feelings of anxiety can arise when medical tests have failed to identify a definitive diagnosis or “cause” for the pain, which leaves you feeling anxious and not knowing why you have pain and therefore worrying about what certain symptoms might mean. Many of us also fear that the pain will become worse, and have anxiety-related fear of the pain as well as fear of movement or re-injury – fear which, over time, has been shown to be particularly debilitating in terms of worsening pain outcomes.[4] Anxiety can also surface in the face of financial problems related to the pain –interfering with the ability to continue gainful employment, and medical care in and of itself can add an additional financial burden.[5]

Research has shown that anxiety often arises on the heels of judgments about the pain as representing a threat, and as something that impacts our resources or ability to cope, and this triggers a stress response and feelings of anxiety emerge.[6] Our judgments, and a tendency to catastrophise or continuously reflect and worry about the pain fuels the anxiety. A key way to managing anxiety is to manage our head space and to this end, there are a number of proven ways that have been shown to be particularly effective. Exposure-based or virtual reality programs have been successfully used to help people work through phobias, including fear of movement or re-injury. [7],[8] Cognitive-behavioral therapy, mindfulness- and acceptance-based approaches have also consistently been shown to improve both pain and related anxiety.[9] The other good news about these psychosocial approaches is that the side effects are often positive, including not only improved pain and anxiety levels, but also improved sleep, mood, and functioning across a number of domains. [8]

3 Simple Anxiety Busters

  1. Take 5 deep breaths: close your eyes, breathe in deeply through your nostrils and out through your mouth. Letting go of any thoughts that arise and guiding your attention to be focused on the movements of your breath. Repeat regularly throughout the day.
  2. Exercise! It’s nature’s anti-anxiety remedy. It helps clear the mind, fires up endorphins and helps you sleep soundly.
  3. Get a good night’s sleep: sleep deprivation is a huge anxiety culprit, make sure you get your shut-eye by engaging in good sleep hygiene habits.

 

References


[1] Q18. Which of the below best describe how your pain makes you feel when you are suffering from the following types of pain? [NET worried OR anxious] // Base: Those with head/body pain DATA REF: AUSTRALIA TABLES

[2] Q18. Which of the below best describe how your pain makes you feel when you are suffering from the following types of pain? [NET worried OR anxious] // Base: Those with head/body pain DATA REF: AUSTRALIA TABLES

[3] Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin. 2007;133(4):581-624.

[4] Vlaeyan JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art review. Pain. 2000;85:317-32

[5] Guest GH and Drummond PD. Effect of compensation on emotional state and disability in chronic back pain. Pain. 1992 Feb;48(2):125-30.

[6] Crombez G, Van Ryckeghem DML, Eccleston C, van Damme S. Attentional bias to pain-related information: a meta-analysis. Pain. 2013;154:497-510.

[7] Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G. Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Behaviour Research and Therapy. 2001;39(2):151-66

[8] Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. Journal of Behavioral Medicine. 2007;30:77-94.

[9] Day MA. Pain and its optimal management. In: Dorrian J, Thorsteinsson E, Di Benedetto M, Lane-Krebs K, Day MA, Hutchinson A, et al., editors. Health psychology in Australia. Melbourne, Australia: Cambridge University Press; 2017. p. 262-82.

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The impact of pain on relationships

Pain not only has a physical impact, it also affects our wellbeing and relationships. The 2017 Global Pain Index found that half of Australians surveyed say pain negatively impacts their mood (50% for head pain and 56% for body pain).[1] And pain is impacting our relationships: 45% of us say pain is impacting our ability to interact with others,[2] 50% say they have trouble enjoying family time because of pain[3] and 64% say they could be a better parent without pain.[4] 

Although the reasons pain affects relationships varies from person to person, many people report that pain is an isolating experience that is not well understood by others, which often results in withdrawal, frustration and low mood, which then in turn also negatively impacts relationships.[5] Further, partners might tend to respond to expressions of pain in what they consider to be a caring and helpful way, such as by taking over their baby’s bath time and household tasks, and this might lead to mixed emotional responses on behalf of the person with pain who might feel appreciation, but also might feel guilty and a sense of being a burden, or being a “bad mother/father”.[6],[7] Pain also commonly interferes with sexual interest, activity, and satisfaction, which is often perceived as a loss of closeness or affection in the relationship, which adds further to the relationship strain.[8] 

Good communication is critical to limiting the impact pain has on our relationships, and communication is a skill so like any skill, it can be learned. A key aspect in many cognitive-behavioural pain management approaches (a psychotherapy that helps change unhealthy or unhelpful habits or feelings) is assertive communication training to learn how to better communicate feelings about pain, express our emotions and needs, come to a shared understanding, as well as to establish mutually agreeable goals. Some pain treatment programs will also include the social support system – such as a partner and family members – as part of the treatment approach, and research has shown that this leads to increased adaptive coping efforts and results in improved pain outcomes.[9]

Also recognising that the middle ground is a very big place – we can often get trapped in “either/or” thinking. When you are experiencing pain, shared hobbies and family activities can’t always be done in the same way as they once were, but that does not mean that they can’t be done at all and so activity modification and planning can play an important role in continuing our participation in family and broader social activities. 

3 Simple Strategies to Prevent Pain from Impacting your Relationships

  1. Strike a balance in communication: it is important to communicate how you feel to keep openness in the relationship, and on the other hand, if pain is the constant topic of conversation it can cause others to feel overwhelmed – finding a balance is key!
  2. Don’t let pain be the dictator: Make plans to do paced activities with your friends and family that are manageable, and as best you can, don’t cancel those plans – stick to it.
  3. Doing chores gives us a sense of mastery: If you are unable to do your typical household chores, replace those with new tasks that you can manage, this will make you feel you are actively contributing to the family.

 

References


[1] Q22. Can you tell us which, if any, of the following aspects of everyday life are negatively impacted by the different types of pain? // Base: Those with head/body pain DATA REF: AUSTRALIA TABLES

[2] Q34. Thinking about the impact your pain can have on your social life, do you agree with these statements? // Base: All respondents DATA REF: AUSTRALIA TABLES

[3] Q31. Thinking about the impact your pain can have on your family life, do you agree with these statements? // Base: All respondents DATA REF: AUSTRALIA TABLES

[4] Q32. Now thinking about the impact your pain can have on your family life with your children, do you agree with these statements? // Base: Parents with children under 12 living at home DATA REF: AUSTRALIA TABLES

[5] Day MA, Thorn BE, Kapoor S. A qualitative analysis of a randomized controlled trial comparing a cognitive-behavioral treatment with education. Journal of Pain. 2011;12(9):941-52.

[6] Turk DC, Kerns RD, Rosenberg R. Effects of marital interaction on chronic pain and disability: Examining the down side of social support. Rehabilitation Psychology. 1992;37:259-74.

[7] Newton-John TR and Williams AC. Chronic pain couples: perceived marital interactions and pain behaviours. Pain. 2006 Jul;123(1-2):53-63. Epub 2006 Mar 24.

[8] Ambler N, de C Williams AC, Hill P, Gunary R, Cratchley G. Sexual difficulties of chronic pain patients. The Clinical Journal of Pain. 2001;17:138-45.

[9] Keefe FJ, Somers TJ. Psychological approaches to understanding and treating arthritis pain. Nature Reviews Rheumatology. 2010;6:210-6.

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Getting your head in the game: Pain and your career

We know that pain often negatively impacts our capacity to return to work, as well as our performance and productivity when at work.[1],[2]

Findings from the 2017 Global Pain Index further confirm this association. One in four workers feel their pain is negatively impacting their career progression (24% for body pain, 28% for head pain).[3],[4] On average, workers are taking between 1 and 3 days off per year due to pain (1.4 of head pain and 3.3 for body pain).[5] And when we are at work 1 in 3 of us find pain makes it difficult to concentrate (30%) and the same proportion regularly lose motivation.[6],[7] 

Research has consistently shown that pain negatively affects our concentration, and interferes with learning new skills and memory performance.[8] Pain calls for and indeed demands our attention and consumes our mental energy, meaning we then have less attentional resources to devote to the job at hand.8 Adding further to this load that pain places on our mental energy is our natural reaction in these circumstances to feel frustrated at being slower than we were previously, and at the same time, also we might also feel potential added stress and anxiety around looming work deadlines – anxiety which is only made worse by fear of a pain flare-up or a migraine, for example. All of these factors “load up” the burden of pain, absorb further mental resources, and interfere with our career goals, progression, and aspirations.

Part of managing the whole landscape of the impact of pain on our careers and well-being in the workplace is learning skills to “unload the pain” to optimise our mental function and job performance. The pain is here, but stress, anxiety, fear, depression… all these aspects add to the load of the pain, consume large amounts of energy, and are a burden that it is not necessary to carry.

 

Pain is here, but the rest is added extra that with training in pain management skills we can learn to let go of, and in the process, free up precious mental resources and energy that can then be devoted to moving us in the direction of valued life goals.

 

Proven psychosocial pain management skills – such as behavioral pacing (scheduling activity interspersed with fixed rest periods to avoid over- or under-doing), mindfulness, acceptance, and stress reduction techniques, as well as other mental and behavioral strategies targeted toward the individual’s needs and context – have been shown to not only improve pain, but also result in meaningful improvements in a range of related areas, including mental and physical function, motivation, mood, perceived stress, and quality of life.[9] These approaches provide tools that people living with pain can personally use to self-manage the pain and let go of the “added extra”, and to take back control of their career as well as life more broadly.

 

Top 3 Behavioural Pain Management Skills to Keep Your Head in the Game

 

  1. Pace yourself: Avoid “pushing through” and take regular breaks to stand up from your work station (ideally that is ergonomically designed), and to spend a few minutes doing what you know helps your pain, stress and fatigue – perhaps some gentle stretches, a walk outside, or a brief mindfulness meditation period. It can help to set reminders on your phone to take these breaks.

  2. Know thyself: Know those times during the day when you feel “most alert” (i.e., the timing of medication often affects this) and prioritize work activities that you need you to be “on your game” for to occur at those times.

  3. Top up your resources: Healthy habits both on and off the job replenish us mentally, emotionally and physically and keep stress at bay – eating well, exercising, getting enough sleep, and engaging in valued and meaningful activities do wonders for our energy level!

 

References


[1] van Leeuwen MT, Blyth FM, March LM, Nicholas MK, Cousins MJ. Chronic pain and reduced work effectiveness: The hidden cost to Australian employers. European Journal of Pain. 2006;10:161-6

[2] Patel AS, Farquharson R, Carroll D, Moore A, Phillips CJ, Taylor RS, et al. The impact and buden of chronic pain in the workplace: A qualitative systematic review. Pain Practice. 2012;12(7):578-89.

[3] Q41.1 And do you agree or disagree with the following statement? - Body pain - My pain has had a negative impact on my career progression // Base: All who work and have body pain DATA REF: AUSTRALIA TABLES

[4] Q41.2 And do you agree or disagree with the following statement? - Head pain - My pain has had a negative impact on my career progression // Base: All who work and have head pain DATA REF: AUSTRALIA TABLES

[5] Q39. Can you now estimate the number of sick days or ‘forced holidays’ you have had to take off, in the past year, due to the following types of pain? - Number of sick days - Your own body/head pain. [Mean number of days off] // Base: Workers DATA REF: SICK LEAVE – Q39 - REBASED

[6] Q40. A) Thinking about the impact your body pain can have on your professional life, how regularly do any of the following situations occur? // Base: All who work and have body pain DATA REF: AUSTRALIA TABLES

[7] Q40. A) Thinking about the impact your body pain can have on your professional life, how regularly do any of the following situations occur? // Base: All who work and have body pain DATA REF: AUSTRALIA TABLES

[8] Eccleston C, Crombez G. Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychological Bulletin. 1999;125(3):356-66.

[9] Day MA. Pain and its optimal management. In: Dorrian J, Thorsteinsson E, Di Benedetto M, Lane-Krebs K, Day MA, Hutchinson A, et al., editors. Health psychology in Australia. Melbourne, Australia: Cambridge University Press; 2017. p. 262-82.

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