By Alex Fradera

In chronic pain, the pain system is locked in to a high-alert mode. One of my colleagues describes it as replacing your alarm system after a burglary, but with one so sensitive it goes off when a fly goes through the room. Mere touch may now be experienced as pain. The pain is real, it isn’t “just in the head”, but nor is there a hidden injury to fix or illness that can be cured. It’s a system that needs retuning, and that calls for participation from the body itself.

According to a new paper in the Journal of Clinical Psychology one particularly promising way that psychologists can help with this is by encouraging self-compassion: a practice of recognising one’s own suffering, accepting this is part of a shared human experience, and not over-identifying with the suffering.

Sérgio Carvalho from the University of Coimbra and his colleagues surveyed women living with chronic pain, to better understand which psychological states seem to coincide with, and potentially support, pain acceptance – an important outcome given that past research has demonstrated a causal link between greater pain acceptance and lower depression (pain acceptance is about recognising that the pain experience is part of your life and may continue to be so for the foreseeable future. It also means being willing to put up with that pain, and, crucially, to pursue valued goals and act in their pursuit, despite pain).

Two hundred and thirty-one Portuguese women with chronic pain (symptoms lasting more than three months) – most of them diagnosed with fibromyalgia – reported their acceptance of pain using a well established instrument that looks at both willingness to experience pain and how much valued actions are attempted in the face of pain. As expected, those women who said they completed more valued activities in the face of pain also reported fewer depressive symptoms (and also a lower pain intensity).

The participants also completed measures of their mindful awareness – how aware they are of present-moment daily activities – and self-compassion, measured by items such as “I try to see my failings as part of the human condition”. Both of these measures correlated negatively with depression, but only greater self-compassion was linked with engaging in more activities in the face of pain.

It’s plausible then that self-compassion lifts mood because it encourages people to accept their pain and act. Engaging in activity starts to strengthen the body, send hormones flowing that increase mood and themselves can reduce pain, and puts back sources of pleasure and satisfaction into one’s life.

This study suggests mindfulness (which was not linked with greater activity) may also be useful in decreasing depression, but by other means, possibly through creating distance from unhelpful thoughts that may arise around pain or the experience of disability.

As cross-sectional research, we can’t draw clear causal conclusions from the new findings, but they do help us refine our understanding of which mechanisms are more likely to increase pain acceptance. The findings may also help pain management professionals focus their methods, providing people with the ground from which they can build and sustain a life defined not by pain, but by values and meaning.

Mindfulness, selfcompassion, and depressive symptoms in chronic pain: The role of pain acceptance

Alex Fradera (@alexfradera) is Staff Writer at BPS Research Digest