Barbara Fish Counselling Services ... helping your life work

Chronic Pain

Helping Your Life Work

Volume 9, Issue 2

February 2013

Dear Reader,
As I mentioned in last month's newsletter, a number of my colleagues have volunteered to be guest writers for my newsletter. Today's column is the first written by my colleague, office mate and friend, Joanne Pilon.

Joanne Pilon is a psychotherapist in private practice who sees individuals, couples and families. Her experience includes providing assessments and psychotherapy to people with a wide range of challenges, such as depression, anxiety, and trauma as well as interpersonal and adjustment issues. Ms. Pilon also provides cognitive-behavioural therapy services to individuals experiencing chronic pain as a result of involvement in a motor vehicle accident or work-related injury at LifeMark Rehab. She is a certified provider for Homewood Human Health Solutions, an international organization providing short‐term, problem‐focused therapy to employees and dependents of the organizations they serve.

One in five Canadians suffer from chronic pain, including 2% of male and 6% of female children. Chronic pain affects not only physical but also emotional health and intrudes on many aspects of life including relationships, work, household tasks and leisure activities. It differs from acute pain in that its cause is not always easily identifiable and it lasts longer than six months.

Learning to live with chronic pain is complicated by the fact that our brains are programmed to respond to pain as if it were acute rather than chronic. This means that when we are in pain, our brains tell us to rest so that we can heal. This makes sense for acute pain because if you were to walk on a broken leg, it would cause further damage to the leg. However, with chronic pain, if we were to only rest, then the pain would not only not disappear; it would, in fact, increase over time because of atrophy, or wasting of the muscles. Rest is still recommended, but only after movement.

Chronic pain is best treated by using the Biopsychosocial Model of Pain Management. This model acknowledges the biological, psychological/emotional and social factors that contribute to the pain experience. Biological influences include tissue damage, scarring, degenerative changes, posture, muscle tension, inflammation, sleep disturbance and fatigue. Psychological influences include thoughts, beliefs and ideas about living with pain, anger, frustration, irritability, boredom, attention to and focus on pain and feelings of helplessness and lack of control. And social factors influences include the reactions of your family and friends to your pain, cultural and religious upbringing, and how health professions, work insurance, and disability systems have treated you.

The goal of treatment of chronic pain is not the total elimination of pain but rather the acceptance that there are real changes and limitations that you must live with as a result of your pain. This does not mean resigning yourself to the status quo, but focusing on the positive and the possible, rather than the negative and impossible. And it is about setting some achievable and realistic goals. For example, knowing how stress can impact your pain and function, you can work on reducing stressors or coping more effectively with these stressors. You can focus on raising pain tolerance and expanding your activities, rather than attempting the complete elimination of pain. You can understand that recovery is a process of daily renewal and not a quick fix. This means that after you have had medical opinions and treatments and your pain remains the same despite these interventions, that you focus on what you can do to help your pain experience.

The role of a psychotherapist in the treatment of chronic pain includes education about pain and helping you to identify what is contributing to your pain experience. You would then work together to set small, personal, flexible and achievable goals that will assist you in making your life meaningful despite pain. If you need help with your chronic pain, please call (416) 388-3964 or email me at to set up an appointment.

Barbara Fish, M.Ed.
Personal and Career Counsellor
“Helping Your Life Work”

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For more information, or to book an appointment at her Toronto office,
please contact Barbara by telephone at 416-498-1352 or by email at