A novel approach to reducing chronic pain

Jenny Graves
May 27
5 min read

An open birdcage held in two hands containing a shining heart

About 45% of cancer patients experience pain at some point, either before treatment, during it or afterwards. About 1/3 experience moderate to severe levels, particularly if their cancer is in the advanced stages (1).

Causes of cancer pain

Before diagnosis, the pressure of the tumour on bones, nerves or organs in the body can result in pain.

Sometimes, the tests used to make a diagnosis can cause pain, such as injection sites or biopsies, but this is usually fairly short-lived.

Some treatments can be painful. One example is radiation, which can cause skin burns. Luckily, this is usually treatable and heals easily. Immunotherapy injection sites can also be sore.

In advanced cancers, tumour pressure often causes intense pain.

Post-treatment, there are several causes for pain:

Neuropathy, caused by damage to the nerves during treatment
Surgical scarring
Phantom pain results from surgically removed body parts
Lymphoedema.

Sometimes these after effects of treatment can last for years and are difficult to resolve, causing chronic pain.

How do we feel pain?

The sensation of pain happens when sensory receptors that detect pain send messages via neurons to the brain. So, we feel pain in the brain, rather than in the receptors. Experiencing phantom pain from a missing body part proves this (2).

Pain is unique amongst the senses because it’s subjective and it’s influenced by past or present experiences. Say, for example, that you are frightened of the dentist, any pain you feel, perhaps from an injection, will be greater. Or an athlete who injures themselves during an event may block pain from the injury during the competition (2).

Chronic pain can happen long after the initial injury occurred. Here, we feel pain because of abnormal signalling somewhere between the sensory receptor and the brain. It happens when the neurons, brain cells or immune cells release cellular messengers that are supposed to be helpful: for example, by promoting healing after an injury or improving the speed of pain transmission. It makes the neurons overly sensitive and they send pain signals even though the injury itself has healed (2).

Many people who suffer from chronic pain have experienced trauma in their lives and there is a common link between post-traumatic stress disorder (PTSD) and chronic pain. Some researchers have suggested that the link arises from the role that avoidance of pain, emotions or other triggers appear to play in both PTSD and chronic pain (4). I suggest that most cancer patients have PTSD to some extent.

The power of the mind

In a previous article, I talked about the effects of optimism on cancer pain and how cognitive behavioural therapy (CBT) can reduce cancer pain. In a recent study, researchers compared the effects of CBT with Emotional Awareness and Expression Therapy (EAET) on chronic pain (3).

The participants in the study were US veterans who had suffered at least 3 months of chronic musculoskeletal pain. Each of them received one individual treatment lasting 90 minutes of whichever arm of the trial they were in, followed by 8 group-based sessions, also of 90 minutes over 4 years.

They were measuring effectiveness on achieving a pain reduction of at least 30%. The results showed EAET was vastly superior to CBT, with 63% of EAET participants achieving that level of pain reduction, compared with 17% for CBT. In fact, 35% of the EAET arm of the study got a 50% reduction in pain, compared with 7% in the CBT group.

The results on anxiety levels, depression, PTSD and general life satisfaction were also better in the EAET group.

How does Emotional Awareness and Expression Therapy differ from CBT?

CBT focuses on changing how people think about pain and on changing their behaviour. For example, all or nothing thinking and catastrophising are unhelpful ways of thinking about pain. Therapists encourage patients to look at different ways of perceiving it. They might also teach patients to use relaxation techniques and encourage them to try activities that they have been avoiding because of pain (4).

EAET practitioners help people to change their relationships and emotions, which can reverse the centralised pain (5). This is the process:

First, instructors educate them about the role of emotions and stress in their perception of pain, using examples from their lives.
Therapists then encourage them to write or talk about the psychological conflicts and traumas that seem to drive their pain.
They receive help to express the emotions that they appear to have been avoiding. These emotions include anger, but also sometimes guilt, sadness, self-compassion and love.
Finally, patients learn how to better communicate how they feel in their relationships.

When they complete these steps, very often the intensity of the pain reduces (5).

Where can you access EAET?

EAET is a fairly new therapy and there are few providers specifically trained to offer it. This website has a directory of practitioners worldwide. https://www.symptomatic.me/practitioner-directory.

However, many psychologists and mental health providers offer trauma-focused therapies. They may provide a similar service.

You can also find self-help books that can help. These include:

Unlearn Your Pain by Dr Howard Schubiner https://unlearnyourpain.com/unlearn-your-pain-book/
The Mindbody Prescription: Healing the Body, Healing the Pain by Dr John E Sarno https://www.goodreads.com/book/show/361775.The_Mindbody_Prescription
Think Away Your Pain: Your Brain is the Solution to Your Pain by Dr David L Shechter https://www.goodreads.com/book/show/23964731-think-away-your-pain

And these websites may help you too:

Conclusion

Healing your mind to heal your body is not new. I wrote an article about Emotional Freedom Technique (EFT or Tapping), which is another method. Both can address PTSD and both have research showing that they are effective in combating pain.

If you prefer more conventional techniques, this article on treating neuropathy, this one on using PEA for pain, and this one on acupuncture for pain may be more helpful for you.

I also have multiple other suggestions in my book, along with dealing with other side effects besides pain, and how to prevent cancer from starting or returning. The button below has links to all the online stores that stock my book.