Updated August 7, 2023
An estimated 50 million Americans, or one in five adults, live with chronic pain, according to 2021 data published in the journal Pain. It is a serious medical condition that like other medical issues requires treatment. Sometimes, though, stigmas around chronic pain can make life worse for people who live with it. They can hurt mental health and adversely impact quality of life.
These stigmas or stereotypes “may contain some truth about at least some people, but for others do not apply at all,” according to Dr. Beau A. Nelson, DBH, LCSW. Dr. Nelson is Chief Clinical Officer at FHE Health and has worked extensively with chronic pain patients. In a recent interview, he addressed some of the unhelpful stereotypes and misconceptions that can end up stigmatizing people with chronic pain and hurting their mental health.
The Addiction Stereotype
One of the common stigmas about chronic pain—given the current painkiller epidemic and raging rates of addiction and overdose—is the stereotype of the addict who complains about their pain to get drugs. While this stereotype may pertain to some people who “abuse the system because they enjoy pain meds,” Dr. Nelson said, it does not accurately describe “people who have certifiable pain that interferes with basic living” or “people who have pain and don’t want to take anything for it.”
More Common Stigmas and Harmful Beliefs About Chronic Pain
In addition to “the addict” stereotype, here are some more common stigmas about chronic pain.
Chronic Pain Is Not a Real Medical Condition
Another form of stigma is judging a person with chronic pain for having their condition— as if it were their choice to be in pain, when in fact it is a medical problem. Dr. Nelson compared this form of discrimination to telling a soldier in World War II who suffered from shell shock to “toughen up and pull yourself up by the bootstraps.” Yet “nobody who has not been through that experience can really offer anything.”
To drive home the point that chronic pain is a certifiable medical condition and not a choice, Dr. Nelson pointed to current-day national standards for assessing pain on a scale of 1-10. These standards for the Joint Commission (formerly the Joint Commission on the Accreditation of Healthcare Organizations or JCAHO) were originally developed to improve care of patients with pain issues and address the problem that pain often went under-treated.
Admittedly, such standards were not perfect at assessing and treating patients’ pain levels. Dr. Nelson explained that, inevitably, there are “people who say they have a 10 out of a 10 and are wanting more meds” (whether because they are addicted or because they genuinely need more pain medication); then there are “others who are saying their pain is a 2 out of a 10 but need more meds.”
People Use Opiates as a Crutch When They Should Be Able to “Just Quit”
This view is unfair in that it denies that pain is a legitimate medical condition that, like other conditions, can be helped by certain medications and treatments. Here Dr. Nelson was quick to note that opiate medications are a legitimate treatment for pain, one that “like other medical treatments is designed for quality of life.”
“If someone is suffering,” Dr. Nelson said, “they have a pain patient’s Bill of Rights,” so having pain adequately managed is your right.”
He went on to draw the following analogy: To say that someone with chronic pain should not be allowed to take pain meds is a bit like saying to someone with depression, “You need to be going to church and running,” instead of affirming their right as a patient to take antidepressant meds for their condition.
While affirming the right to pain medication, Dr. Nelson was also careful to mention that there are “lots of other things that people can do for pain management” as part of a “holistic approach.” For example, “in addition to meds, physical exercise is very important, so the person taking hydrocodone and lying on the couch is probably going to see their pain get worse.”
Similarly, cognitive-behavioral therapy (CBT), Dr. Nelson’s field of specialization, has been helpful at relieving chronic pain. Dr. Nelson has seen firsthand how patients with even severe chronic pain have benefited greatly from using CBT tools and strategies to manage their pain and reduce their reliance on pain meds.
“CBT has been very helpful for people with chronic pain management and other mood and life issues that could contribute to stress of the body,” he said.
Chronic Pain Is “All in Your Head” (vs. What Really Defines Chronic Pain)
The idea that chronic pain is “all in your head” is a fallacy, because “it’s in your leg, your head, your back … and the fact is that there’s an injury involved,” Dr. Nelson said. He also noted that chronic pain, according to the technical medical definition, is pain that has lasted for 12 weeks or more and cited the “gate control theory of pain.” According to the theory, pain involves the complex interplay between the central nervous system (CNS), or the spinal cord and the brain, and the peripheral nervous system (PNS), the nerves outside of the brain and the spinal cord.
As further illustration that pain is not “all in the head,” Dr. Nelson pointed to the emotional component of pain and the fact that “people with depression and anxiety tend to have higher rates of pain.” He also noted that “sometimes there are antidepressants that work well for pain also.”
Their Pain Can’t Be as Painful as They Say It Is
In response to this untruth, Dr. Nelson emphasized the importance of perception and offered the following reasoning:
Perception is reality for people … We don’t have an objective measure of pain like a blood test, but we have all experienced it and the body responds in different ways … but if you perceive that this is your situation, that’s your reality … If your daughter says, “I feel suicidal,” would you ignore the problem or get her help? The same with chronic pain. Are some people more pain-tolerant? Of course. Are others needing more for their chronic pain? Sure. Perception is reality.
Where Chronic Pain Comes From
Some cases of chronic pain have a clear cause, such as a long-lasting condition. Arthritis and cancer are often the culprits behind chronic pain, but many less severe issues can also cause ongoing problems. Sometimes past issues can continue to cause pain long after they have healed. The damage from a broken bone, a sprain, or even an infection can make you more sensitive to future pain or even lead to chronic pain.
Millions of people do not know where their pain originates. They simply experience the sensations, seemingly without reason. Some health experts refer to this type of pain as “psychosomatic” or “psychogenic.” Many researchers believe that psychosomatic pain originates from psychological issues like anxiety, depression, and stress.
Specifically, these mental health conditions may negatively impact endorphin levels in the body and block endorphin receptors from working properly. Because endorphins help relieve pain, being unable to utilize them can cause pain levels to skyrocket.
Some people have conditions that cause them extreme pain. Migraines are a perfect example of this. Because the pain is so strong, they begin to fear it. This can not only lead to making existing pain worse but could even cause them to feel psychogenic pain.
Depending on your medical history and your mental health status, you may even have several overlapping causes of chronic pain.
The Dangers of Self-Management
For various reasons, many people try to manage their chronic pain by themselves, without the help of a medical professional. While this is understandable, it carries some clear risks.
Pain—especially chronic pain—is complex. It is extremely difficult to resolve long-term pain problems. Many people want to simply “turn off” the pain and reach for over-the-counter medications in an attempt to do so. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the drugs of choice in these cases.
While NSAIDs are safe and often quite effective for short-term and minor pain management, using them for too long can create a host of problems. NSAIDs relieve pain by blocking certain enzymes that are active during the pain response, as well as limiting inflammation and swelling. Between these effects and the already present side effects, frequent use can cause:
- Gastrointestinal bleeding
- Stomach irritation
- Bruise more easily
- Worsening asthma symptoms
- Risk of stroke, blood clots, and heart attacks increases
- Kidney damage
- Liver damage
Some people also attempt to self-medicate using other substances, such as alcohol, marijuana, or hard drugs. Not only could this lead to dependency problems but some substances actually make the body more aware of pain—not less.
Changing the Conversation About Chronic Pain
Naturally, these stigmas are not just discriminating against people with chronic pain. They also take a toll on mental and emotional health and can pose obstacles to treatment.
What people living with chronic pain need to know, therefore, is that “it doesn’t matter what anyone else thinks of you.” Contrary to the “black-and-white model” of someone living with chronic pain who “is sitting on their couch taking pain pills,” Dr. Nelson drew another very common picture: that of the person living with chronic pain who must go to work every day and takes pain pills for their back.
Dr. Nelson was also able to offer words of hope and encouragement from the experience of having once taught pain management classes to geriatric patients in a public hospital system:
“We had a lot of patients who could reduce their pain with CBT, exercise, managing stress, eating healthy, and good social supports,” he said.
Meditation, some types of yoga, breathing exercises, and distraction have also been helpful for chronic pain patients, according to Dr. Nelson. In other words, chronic pain does not have to ruin your life. Dr. Nelson’s parting advice to anyone living with it:
Advocate for yourself. Seek out the various needs, and, again, other people’s opinions and societal norms really don’t play into this unless you let them influence you. We can’t eradicate pain, but we can manage it. How we choose to manage it is how we take care of ourselves … Sometimes there are trade-offs but dealing with attitudes and stigmas is probably not helpful. Stay focused on managing the pain. At some point, we’ll all have to face pain. We figure out how to adapt and deal with life on its own terms. At the end of the day, it’s your decision what choices you make.