How can we tackle pain-related distress? The De-Stress research team share their story
30 September 2024
Chronic pain affects all aspects of our lives, including our mental health. We funded the De-Stress project to learn more about how we might tackle pain-related distress.
This pain awareness month, we sat down with the De-stress team to learn more about their research and what it means for people living with chronic pain.
The team includes principal investigator, Professor Tamar Pincus, and co-leads Professor Carolyn Chew-Graham, Dr Hollie Birkinshaw, and Dr Stephanie Hughes.
What is pain-related distress?
“Pain-related distress is like the natural normal reaction to persistent pain.” - Dr Hollie Birkinshaw
Tamar: “It can often look similar to depression, sharing many of the same symptoms.
"However, when talking to people, it becomes clear that their experience is not clinical depression but rather a response to the everyday challenges that pain brings to everyday living. Additionally, the level of symptoms do not reach those of severe depression and may not respond to anti-depressants."
Carolyn: This difficulty in distinguishing it from depression means that GPs often find it difficult to offer the right treatment for pain-related distress.”
“Before starting this project, we recognized a 'perfect storm' in the realm of chronic pain management…” – Professor Tamar Pincus
Carolyn: “In our qualitative study, GPs described an awareness of the problem of pain-related distress but described a sort of helplessness in being able to offer effective solutions due to variable effectiveness of current treatments like pain management and CBT and long waiting lists for pain clinics.
"Even after completing these treatments, many patients reported feeling a sense of a ‘void’, leading them seek help again from GPs, which can create a revolving door back to primary care.”
Hollie: “Our previous research led us to develop an intervention focused on providing optimism and moving forward, rather than focusing on the pain like CBT.
"Inspired by earlier work, funded by Versus Arthritis, we wanted to give participants a supportive advocate who could offer pragmatic help, discuss community resources, and foster hope—something GPs may not have time for in primary care consultations.”
So, this is where the De-Stress project came in, what did you hope to find out?
Tamar: “The De-Stress Project aimed to address pain-related distress as a distinct issue from clinical depression. We started by gathering information on pain-related distress. We worked with GPs, patients, and social prescribers through surveys and interviews to explore their views on pain-related distress and what has or hasn’t worked in the past.”
Hollie: “Our findings indicated that a significant number of patients diagnosed with depression might actually be experiencing pain-related distress, emphasizing the need for tailored approaches in treatment and support, as currently, GPs are unsure how to address distress within brief consultations. Overall, the project aimed to empower individuals to acknowledge their pain while focusing on improving their quality of life, rather than solely seeking pain elimination.”
“The concept of our study is best illustrated by the plasticine video, serving as a metaphor for our project” -Tamar Pincus
You started with a proof-of-concept study, what did that look like?
Steph: “We used insights from earlier studies to create a proof-of-concept intervention with 17 participants recruited through GP practices.
“Social prescribers provided 4-6 sessions, helping participants re-engage with enjoyable activities through a flexible plan. We also developed a website with modules on things like self-kindness.
“Social prescribers focused on overall well-being rather than pain, which participants appreciated. We assessed the impact through interviews and questionnaires before and after the intervention.”
What did you find out?
“The De-Stress study showed positive trends despite the small sample size." Dr Stephanie Hughes
"Participants found the intervention acceptable, reporting improved mood, increased hope, and a more positive outlook, along with greater activity levels.
“Social prescribers were particularly effective and played a key role, providing motivation and building valued relationships.
“Some participants felt indulgent engaging in enjoyable activities, suggesting future research should emphasize the importance of prioritising well-being.
“Overall, while the study did not aim to impact pain levels directly, it successfully indicated movement towards better well-being and mood, affirming that the intended outcomes were being achieved.”
How has the De-stress project moved this area of research forward?
Tamar: “The De-Stress Project has significantly advanced the chronic pain research field by focusing on psychosocial approaches and co-creation with individuals who have lived experience of chronic pain.
“Overall, in collaboration with leading institutions like Keele and Bath, we are at the forefront of developing holistic, non-pharmacological strategies for managing chronic pain.”
Tamar: “This work contributes to the broader landscape of chronic pain treatments by exploring alternatives to common pharmacological treatments, such as antidepressants.
“By addressing the emotional, cognitive, and social dimensions of living with pain, the De-Stress project is helping to shift the focus of chronic pain research from curing pain to helping people live better with it—an essential step forward in the field.”
“This intervention has the potential to go far beyond helping with chronic pain and could benefit people with various conditions.” - Professor Tamar Pincus
Tamar: “The big takeaway for us is that community-based, personalised interventions like this one can improve not just individual well-being, but also the sense of connection within communities. It’s not simply about reducing GP workload—it’s about helping people live better lives, and that has the potential to create happier, more connected neighbourhoods.”
What's next, and what are your big hopes and dreams for the future of this project?
Tamar: “Looking ahead, our next steps include more qualitative research to improve recruitment, focusing on local groups and people with greater physical challenges, such as those who've completed pain programs who are in that ‘void’ previously mentioned.
“Our plan is now to do a feasibility study, which if funded, will be conducted over the next two years, before moving to a full trial.”
Carolyn: “Our hope is to help GPs better support patients with pain. Pain management is a key part of general practice, and this framework could offer GPs an alternative to over-prescribing of analgesics, including opioids, giving them a new way to support patients”
Do you have anything to say to our supporters?
Carolyn: "Thank you so much for funding this project. With a relatively small investment, we've accomplished a great deal and made significant progress. Often, research doesn’t always lead to substantial movement, but under Tamar’s leadership, we’ve really advanced things. So, thank you again”
Want to share your experience?
Alleviate Pain Data Hub, the UK Wide National hub for Chronic pain is running the 2nd UK National Pain Survey to gather the experiences of those living with chronic pain.
The survey’s target is open to anyone 18 or over, living in the UK and living with chronic pain over the last 12 months (chronic pain being defined as pain which has persisted for at least 3 months).
Take the National Pain survey
The survey is now open and will close on the 15 October 2024.
Take the National Pain Survey