Chronic pain could be eased by learning to regulate negative emotions

Learning how to regulate negative emotions like anxiety could ease chronic pain. Scientists have found that a form of therapy that partly focuses on tolerating distress relieved ongoing discomfort more effectively than existing treatments.

“Chronic pain is more than a sensory experience, it’s incredibly emotional,” says Nell Norman-Nott at the University of New South Wales, Australia. “We see increased levels of anxiety and depression in up to about 80 per cent of people with chronic pain.” This leads to a “vicious cycle”, where pre-existing pain amplifies negative emotions, which then worsen pain, she says.

To see if they could break the cycle, Norman-Nott and her colleagues used a programme based on dialectical behavioural therapy, a form of cognitive behavioural therapy that has been adapted for people who feel emotions very intensely. The programme focused on mindfulness, emotion regulation and distress tolerance.

Eighty-nine people with chronic pain, lasting 16 years on average, were randomised to receive either the programme, delivered by a therapist via an eight-week online programme, while continuing with any treatments they were already receiving, such as medication or physiotherapy, or to just continue with their usual treatment.

Nine weeks later, those in the therapy group experienced an improvement in emotional regulation of about 5 points more, on a scale of 18 to 90, than those in the control group. The intensity of their pain also started to lessen at week 9, and by 21 weeks they experienced significantly less pain those those in the control group.

“I think that’s interesting and promising,” says Benedict Alter at the University of Pittsburgh, Pennsylvania. It could also help people with limited access to in-person care, he says. “It’s great that they did this as internet based. It’s a huge problem that there are small numbers of providers who do therapy, and they tend to be in urban areas.”

Exactly how the therapy reduces pain is unclear, says Alter, but “at any given pain intensity, if you had better emotional regulation, people’s overall lives would be better: less suffering, less functional impairment. I think pain intensity decreases as everything gets better.” The mechanism could be teased out in larger studies, he says.