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According to Gustin, GABA has a calming effect on our brains and helps us regulate emotions, so a decrease means all feelings are amplified. “It really results in an increase in overwhelming negative emotions.”
Along with physical changes in the brain, constant pain can cause negative emotions too.
“Your pain worsens your mood and then when you’re in a worse mood, you perceive your pain to be more intense,” says Alexandra Green, a Sydney-based statistician who has suffered chronic pain for eight years. “It’s a vicious cycle.”
An increasing number of studies have attempted to address the oversight and examine how
emotional-focused skills to manage stress, anxiety and low mood can affect pain perception and life quality.
In the new paper, the first systematic review and meta-analysis of its kind, Gustin and Norman-Nott found that by learning to regulate emotions, patients experienced sustained reduction in pain levels, reporting a clinically significant improvement of 10 points on a 100-point pain intensity scale.
Pain researchers Sylvia Gustin and Nell Norman-Nott.
“Through certain skills in emotion regulation, things like mindfulness, you can utilise neuroplasticity to instigate the reversal of some of the changes that we see in the brains of people with chronic pain,” says Norman-Nott.
“We are not saying that we can decrease the pain to zero,” Gustin adds. “It’s more that you have something to work on daily to increase your quality of life. It’s the missing link that is needed because people are suffering.”
Last year, Green participated in the online-based Emotional Recovery Program for Chronic Painfacilitated by Gustin and Norman-Nott. She had a spinal fusion at age 12 to treat severe scoliosis. It led to osteoarthritis and, seemingly out of the blue, pain flared in her early 20s and never went away.
Until then, Green had an independent life, travelling the world by herself and completing a PhD. It was a shock to have to rely on others to do basic tasks like carry groceries and do household chores. The pain limited her capacity to socialise and over-exertion could leave her bedridden for days.
Appointments with numerous specialists and doctors, some of whom suggested the pain was all in her head, left her thousands of dollars out of pocket, while some treatments she was prescribed ultimately made her pain worse. Last year, she finally found help.
Green says “when you’re in chronic pain, you feel so helpless and there’s just nothing that can be done”.Credit: Louise Kennerley
A combination of medication, a surgical treatment called radiofrequency ablation, daily gentle exercise, heat packs and massage therapy have provided some relief, Green says. The skills she learned via the program with Gustin and Norman-Nott have also improved her perception of the pain and allowed her to manage it.
“Before, if I was in a pain flare up, I would freak out, and I’d get really stressed, which would then make the pain worse,” she explains. “Now I’m able to calm myself down.”
It’s more effective than CBT (which is more focused on thought-patterns), she says, because it acknowledges the emotions that exist alongside pain and provides strategies for managing them, including mindfulness, acceptance, learning the triggers, managing the expression of negative emotions and using distraction.
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“The power of the brain is just incredible,” says Green. “So while it might not remove your pain entirely, it’ll help you cope with it a lot better.”
The University of Adelaide’s Professor Mark Hutchinson, chair of the steering committee for the Australian Pain Solutions Research Alliance, says the findings are interesting, but believes “much more” is still needed as people continue to experience unacceptable levels of pain.
“What this study does do very nicely is highlight the power of acknowledging and treating the biopsychosocial complexity that is the lived experience of pain,” Hutchinson says.
“As such, a convergence of interventions that enhances the resilience of the mind and body in an evidence-based manner is a good thing.”
For Green, it may not be a cure but it’s a step towards reclaiming her life from pain.
“When you’re in chronic pain, you feel so helpless and there’s just nothing that can be done,” she says. “But there are options for people.”
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