Psychotherapy for Chronic Pain Management
We all need pain; you may not agree, especially if you are suffering from chronic pain. Nonetheless, we need pain to tell us all is not right with our body. Pain is a symptom of a physical injury or a disease; it is a sensation induced by our nervous system when we hurt ourselves. Without pain, we could bleed to death and not know it. We have all experienced pain at some time or the other; whether due to a scraped knee during childhood play or a tension headache, we have had it. In its most ordinary form, managing pain can be simple. An aspirin or a pain balm can relieve your nagging headache. If you have the flu, for instance, you ache all over; when you get better, the pain goes away.
However, if you are suffering from a chronic condition like backache, migraines, arthritis, or cancer, pain could become a constant part of your life. (Sometimes, the aetiology of the constant pain is not known). Chronic pain could interfere with your day to day life, leaving you incapable of functioning normally. Pain management can help to ease your suffering and improve the quality of your life.
There are many methods for treating chronic pain. Depending on the nature or cause of the chronic pain, a treatment modality for managing pain is chosen. Medication, surgery, alternative pain treatments such as acupuncture, yoga, and biofeedback (where devices are used to control blood pressure, heart rate, and brain waves), and psychotherapy are all some ways of managing pain. Here at the Centre, Process Experiential Emotion Focused Therapy (PEEFT) is the treatment of choice.
Chronic Pain Conditions that Can Benefit from Psychotherapy for Pain Management
At least one person in 10 complains of chronic pain. Some of the most common diseases or disorders that can cause chronic pain are:
- Headaches: If you are having a headache almost every day in a month, you could be suffering from chronic headaches. Stress or fatigue causes the shoulders and neck muscles to tighten up and build pressure on the head, resulting in a headache. Other causes include migraines, eye strain, and chronic headaches as a result of a disease such as cancer or hypertension or a side effect of the medication you take for this.
- Back Pain: This chronic pain could develop as a result of an injury or due to aging. Some common reasons for back pain are slipped discs, spinal stenosis, ligament damage due to heavy physical work, compression fractures as a result of osteoporosis, and fractures due to accidents. Back pain can also be chronic if a person has spinal deformities such as kyphosis or scoliosis, which put pressure on the back muscles.
- Joint Pain: Chronic pain in the joints can occur in the elderly as well as the young. While joint pain due to osteoarthritis is common in the elderly, rheumatoid arthritis develops at a younger age and is one of the main causes of chronic pain in younger adults. Athletes who suffer from frequent injuries can also have chronic joint pain.
- Cancer: Chronic pain in cancer patients could be because of the disease itself or due to side effects from the medications.
- Neuropathic Pain: This occurs when the nerves that carry pain signals to the brain are activated due to nerve damage, compression or swelling. Sciatica, for instance, is caused by compression of the sciatic nerve that lies between the back and the feet, causing shooting pain in the leg. Slipped discs compress the spinal cord, causing pain. Nerves damaged due to diabetes, multiple sclerosis, carpel tunnel syndrome, etc., are all reasons for chronic pain.
- Depression: People with depression often complain of debilitating and chronic pain. Medications to treat depression can also help in managing pain that occurs with this psychiatric disorder.
Why Do Doctors Recommend Psychotherapy for Pain Management?
Chronic pain can change a person mentally. The patient can experience emotional distress in the form of anger, gloominess, or despair. These feelings worsen the patient’s sense of pain. Psychotherapy can aid the patient in learning to cope by easing these psychological effects of pain. There are several psychological therapy techniques that can help to lessen the actual pain, including counselling, relaxation and conditioning techniques, and hypnosis (including self-suggestion).
In patients with cancer, for example, pain can occur from the disease itself, or from infections and inflammatory changes. Treatments given for cancer, like surgery, chemotherapy and radiotherapy, could also induce pain. However, it has been found that many cancer patients receive improper pain management, either because their primary care provider did not recommend pain medication or because of their own fear of addiction to pain meds. These patients can benefit from psychotherapy and alternative therapies to control pain.
Does Psychological Evaluation Mean that the Pain Is Imaginary?
Many patients feel concerned about undergoing psychological evaluation thinking that this could imply that their pain is imaginary rather than considered as an actual physical experience. While it is true that some people suffer from pain that is delusional, this is not the case for a majority of patients who seek psychotherapy for pain management. Physical pain has many psychological effects and an evaluation by a psychologist can determine these effects and help in managing pain.
Pain can be magnified due to psychological reasons. For instance, a patient with post-traumatic stress disorder (PTSD) – who has suffered a physical injury (like, from an accident) as well as has depression – has psychological as well as physical components to his pain. The psychological conditions may augment the perception of pain, since the patient is unable to cope with pain due to the psychological difficulties in addition to the physical injury. This patient, therefore, suffers from a pain disorder that is both psychological as well as medical.
How Psychotherapy for Pain Management Can Make a Significant Difference
Pain not only affects the patient physically, but also mentally and emotionally. Added to this, the patient’s ability to think, concentrate, and socially or physically interact is also inhibited. In other words, the patient’s quality of life suffers. A psychological evaluation and then intervention can help the patient to learn techniques for managing pain and improve his or her quality of life.
Here at the Centre for Emotion Focused Practice, the patient undergoes an initial evaluation by a psychologist specializing in pain management. At this point, the patient’s history and personal information is gathered and the patient is assessed for psychological effects of the pain. The initial consult will also require the patient to complete psychological tests and questionnaires so that the psychologist can better understand the patient’s situation. Personal interview with the psychologist together with testing will ensure that an appropriate multidisciplinary treatment plan for the pain is charted out.
Psychotherapy for Pain Management with PEEFT
At the Centre for Emotion Focused Practice, both physical and emotional effects of pain are addressed. Pain therapy is offered on an individual basis and we work with what is happening here in the present.
Cognitive behavioural therapy (CBT) has been found to be efficacious in managing pain. CBT is a form of counselling where the therapist and the patient talk about the patient’s cognitive processes – thoughts, attitude, and beliefs – and how these affect the way the patient behaves. Together, the psychologist and the patient work on how the negative aspects can be changed to improve the patient’s current situation. This develops a positive outlook that is essential in managing pain.
Emotions interface between body and mind, and often arise outside of our awareness. The distress that patients feel about their condition can magnify their pain. Pain and emotions are interlinked; working with emotions is the best way to tackle pain. To that end, here at the centre, CBT is taken one step further with Process Experiential Emotion Focused Therapy (PEEFT), one of the most rigorously researched and evidence based therapies. PEEFT is a process-orientated therapy and is based on the principle that emotions influence psychological, cognitive, behavioural, biological and neurochemical system functioning.
The person-centred approach of PEEFT helps patients to identify, explore, regulate, process, transform and integrate experiences from an emotional viewpoint alongside reflective processing in order to elicit deep, effective, long lasting change.
Together with Emotion Focused therapy, the following treatments are also used:
Anxiety and tension can worsen the actual physical pain. The patients are taught to control their reactions to pain by means of biofeedback and unwinding/relaxation techniques. The patients enter a state that promotes healing and pain reduction. Our patients who have learned to release their stressors by using these alternative pain treatments have succeeded in decreasing the pain to a significant degree.
Hypnosis can also help in managing pain. Under a hypnotic state, alpha waves are produced and the mind is relaxed, thereby reducing pain.
These include maintaining a pain diary and a gradually increasing the patient’s activity level.
The patients are encouraged to monitor how their pain levels change over the treatment period and record these in a diary. This can help the patients to appreciate the pain coping skills that they are developing.
Debilitating pain prevents patients from going about their daily lives. With training and encouragement, the patients will be able to slowly increase their social as well as work activity levels, improving their quality of life.
The patients are taught self suggestion or self hypnosis techniques as a means to control pain. They are also taught to reduce emotional distress, which can considerably scale down the pain perception.
Here at the centre, the patients are provided with self help materials, such as relaxation tapes, which encourage the patient to manage their pain themselves (when they are not at the clinic) and aid them to become more independent. The patients are also encouraged to seek social support, change their environment, and plan activities that can distract them from their pain. For more information on pain management, please call the Centre for Emotion Focused Practice. You can also make an appointment for an initial visit and learn how psychotherapy for pain management and the alternative pain treatments that are offered here can indeed make a huge difference when dealing with chronic pain.
Elaine Chen is an experienced clinical psychologist who is specialised in pain management. To get an appointment or to find out more about our pain management services, please call (03) 9820-5577. To get an appointment or to find out more about our pain management services, please call (03) 9820-5577.