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Psychological approaches to chronic pain management
However, for some, pain can continue well beyond the healing phase. This is typically referred to as chronic pain. By definition, chronic pain is any pain that lasts longer than six months and is not suggestive of ongoing injury or tissue damage. Sufferers with chronic pain are legion. It is estimated that one third of all Americans have chronically painful conditions. The most common forms of chronic pain include headaches, arthritis, low back pain and muscle related pain such as fibromyalgia and myofascial pain. As the pain becomes chronic, psychological factors can become more evident. An individual with chronic pain may be unable to participate in those activities that are rewarding and purposeful. Further, the perception of pain may be effected by past history of pain, the reaction of others within the patient's surroundings and stress. As a result, psychosocial factors are often considered important in the overall treatment of the person with chronic pain. To begin psychological treatment an evaluation is typically conducted. At that time, such the cause of the pain, pain patterns, sleep habits, and the effect of pain on the family are assessed. Assessment includes determining the level of stress, depression and anxiety. A careful evaluation is necessary for the development of an effective treatment protocol. Treatment of chronic pain can be varied depending on the diagnosis and the needs of the patient. Psychological approaches can be grouped into four areas: relaxation training/biofeedback, cognitive restructuring, behavioral therapy and traditional psychotherapy. Relaxation training is a well-established therapeutic strategy. Often times, pain contributes to an elevated level of muscle tension, which exacerbates pain and increases pain sensitivity. Relaxation has been shown to reduce subjective pain levels and enhance coping while reducing stress levels. The effects of relaxation training can be heightened by biofeedback. In biofeedback, specific bodily activities are electronically monitored in real-time and the results are presented to the patient in the form of visual or auditory feedback. With biofeedback, the patient can further maximize relaxation of specific targeted muscle groups. As a result, the ubiquitous pain/tension cycle can be more effectively disrupted. Special consideration is given to relaxation generalization training in which relaxation strategies are used in real life situations. Imagery emphasizes the connection between mind and body. Creating specific mental images can be effective in reducing the severity of pain. Cognitive therapy recognizes that the expectations, beliefs and interpretations can make a significant contribution to the overall pain experience. Individuals are taught to recognize maladaptive thought patterns and replace them with thoughts that emphasize self-control and self-efficacy. For example, the patient that repeats thoughts such as, “I can't stand it anymore,” “The pain will never go away,” or “Something is terribly wrong,” will tend to experience heightened feelings of suffering. The goal of cognitive therapy is to assist the patient identify negative self-talk and develop positive self-talk alternatives. For example, a patient could supplant the previous self-talk examples with internal dialog as “I recognize I hurt, but no harm is being done,” or “I know I can handle this. I've done it before.” Self-support appears be an effective strategy to increase pain tolerance. Behavioral approaches emphasize the role of the patient's surrounding environment in the overall pain experience. Those behaviors that are positively or negatively reinforced tend to be performed at a higher frequency. Several research studies have shown that pain behavior increases in the presence of a solicitous spouse or family member. As pain behavior increases, positive and functional behavior decreases. Examples of pain behaviors include limping, bracing, seeking medication and pain verbalizations. Sources of reinforcement are encouraged to extinguish reinforcement of the non-desired behaviors and selectively reward adaptive functional behaviors. Behavioral therapy can be very effective, but does call for considerable effort of those in the patient's environment. Oftentimes, specialized inpatient pain clinics emphasize an intensive behavioral approach. Psychotherapeutic approaches tend to focus on personality issues that may have existed prior to the onset of pain. Through the resolution of these issues, a patient may cope more effectively with pain. For example, some individuals may benefit from assertiveness training thereby reducing the likelihood that pain behavior would be used to relate to others in the natural environment. Another patients may have perfectionist traits that lead to difficulty pacing and subsequent frequent flare-ups of pain. Investigating acceptance of current limitations may prove to be a fruitful effort in improving function in spite of pain. Chronic pain is both a physical and psychological challenge to the sufferer and treatment team. Psychological approaches have demonstrated effectiveness in identifying patient characteristics that may enhance or delay treatment response. Further, psychological techniques have shown to be helpful in improving pain tolerance and coping while reducing associated stress. Psychological approaches are varied and based on the needs of the patient. Such a flexible approach is an effective adjunct to the total treatment regimen of the chronic pain patient.
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Pain
is universal experience. It is usually associated with an illness or injury.
The pain signals us to seek medical assistance and rest so that healing can
take place. Typically as we heal, the pain subsides and ultimately
disappears. This pattern has occurred hundreds if not thousands of times in
a lifetime. 