Our team is dedicated to providing evidence based, high quality psychological services to clients suffering from mood, anxiety, pain and adjustment disorders. While the role of psychotherapy is often understood in the treatment of stress stemming from a family issue, life transition or work conflict the function of psychotherapy in the treatment of pain is less well known in the mainstream.
Depression and anxiety is extremely common in patients suffering from chronic pain conditions. Cognitive behavioral techniques shown to be helpful in depression and anxiety can also be utilized in patients suffering from pain. Aggressively addressing both the psychological component and pain is necessary for recovery to occur. Otherwise, a vicious cycle can ensue, where pain may exacerbate the underlying depression and depression may lead to decreased activity level worsen the pain complaints.
Psychotherapeutic approaches to patients in pain may vary depending on whether the patient is suffering from acute, continuous, or chronic pain. Patients with acute pain have suffered a recent noxious insult that generally can explain the patient’s pain complaint. Often, adequate pharmacologic analgesic relief is sufficient to treat the pain, and the course of treatment is uncomplicated. When typical analgesic doses fail to alleviate the pain, psychiatric consultation may be requested. Psychosocial components to the pain should be explored. Addressing these issues may sometimes prove helpful in alleviating the pain.
Types of Pain
A variety of psychotherapeutic techniques may be offered in the treatment of the patient with acute pain. Supportive therapy is used most often in such cases. Allowing the patient to know that someone “is in his corner” and that he or she is not suffering alone may offer great comfort. Therapist attempts to shore up the patient’s existing healthy defenses by offering reassurance and allowing the patient to express his or her fears and concerns to a nonjudgmental party. Concrete strategies to help control pain may be taught by the supportive therapist as well.
Patients who have pain from an obvious nociceptive source that has been present for over six months are said to suffer from continuous pain. These patients may suffer some degree of pain no matter how aggressively they are treated with narcotic medications, and they pose a different set of challenges to the psychotherapist. Supportive therapy is often utilized again, but a variety of other psychotherapies have been found to be helpful in such cases as well.
Cognitive-behavioral therapy have been found to be useful in such patients. The goal of such therapies is to help the patient to learn to live with his or her pain. These therapies may also permit the patient to decrease the amount of pain medications he or she needs to take on a daily basis and thereby lower the overall side effect burden of his or her treatment.
In patients with chronic pain, the original nociceptive source of the pain is no longer sufficient to explain the pain that the patient is currently experiencing. Physicians sometimes doubt the veracity of the pain complaints. Such pain behavior results from an expected adaptation to living with chronic pain and should not suggest that the patient is exaggerating symptoms. If patients feel they are not believed, treatment efforts may be further complicated. In psychotherapy the goal of treatment is not to cure the pain, but to help the patient function with the pain better.
Cognitive-behavioral therapy has been shown to be effective in patients who suffer from either continuous or chronic pain. Therapists are quite active in teaching a variety of skills to the chronic pain patient and assign homework to ensure that the lessons learned are solidified. Negative, inappropriate, catastrophic thoughts are often present in patients with pain disorders. Such thoughts are highly correlated to the intensity of pain complaints. Cognitive-behavioral therapy focuses on restructuring this negative cognitive schema into a more realistic appraisal of the patient’s current condition. When a realistic perspective regarding the past, present, and future can be gained, patients may be able to more easily deal with their pain.
Homework assignments: The cognitive-behavioral therapist will generally assign homework for the patient to complete between therapy sessions.
Relaxation: Relaxation training is often a component of cognitive-behavioral therapy for pain patients. Progressive muscle relaxation, stretch-based relaxation, deep breathing, and autogenic training are all relaxation techniques that may be learned. Techniques learned during the therapy sessions are practiced at home until they are mastered. Developing mastery over techniques that offer some relief from pain symptoms enables patients to feel that they have some control over their illness, and this may help combat the learned helplessness that is so often a part of the life of a patient living with pain.
Physical activity: Another aspect of cognitive-behavioral therapy involves the practical application of skills that permit better coping with day-to-day pain. Finding an appropriate level of activity is important. When patients try to do too much on days that their pain is relatively good, they often find themselves nearly immobilized the following day. Other patients may restrict movement too much for fear of worsening their pain. Prolonged inactivity can lead to further problems with mobility and pain. Activity should be encouraged, but in a restrained manner that is not likely to exacerbate the pain. Patients should be taught to monitor their pain during activity and to stop activity before pain becomes severe. Frequent rest periods may be helpful in allowing activity to continue without significant exacerbation of pain and may lead to increased functioning. Concrete, attainable goals should be set to enable patients to slowly become more active.
Our team is ready to assist in developing a better quality of life and improving functioning for our clients.