Interventions for Chronic Pain and Illness: Why Psychotherapy? Part 1
Updated: Oct 9, 2018
Colleagues and other mental health professionals often ask me how I treat chronic pain and illness. They ask what are the methods I use in session and what are the best interventions? People with chronic pain often present to pain clinics with multiple and overlapping problems with depression, anxiety, initial and middle insomnia, sexual desire and arousal issues, hypersomnia due to deconditioning of mobility issues and a concerning overuse of medication. Pain specialists in the community are often at a loss when they have a patient inform them they need more medication because the pain will not stop. Well, what it comes down to is that medications are not always the answer. This is clearly the one of the issues he have with the opioid crisis. I have been consulting with more pain specialists in the Washington, DC area and some of these medical professionals refuse to prescribe opioids or they have limitations with the prescriptions.
What is fascinating is that research is now showing that when individuals with chronic pain are able to control their thoughts and emotions, they can decrease the signals to their somatosensory nerves (SS nerves) and actually experience less pain. This is why psychotherapy is so critical in treating chronic pain! In consulting with pain specialists, I have been informed that when SS nerves receive input from spinothalamic nerves but also from many additional nerves, including those that come from the limbic system (emotions), the frontal cortex (thinking and decision-making), the hippocampus (memory), and the amygdala (memory and fear), with central sensitization, the SS nerves may be activated without any input from spinothalamic nerves but instead from other areas of the brain. When this happens, stress, anxiety, depression, and excessive worrying, bad memories, or other events can actually cause pain that feels exactly the same if there were damage or trauma to the tissues.
Some of the psychological factors that are associated with chronic pain and illness include anger, fear, anxiety, and distress, which can trigger low mood, depression, and an increased perception of the pain. These psychological factors are also activating the SS nerves causing pain. Often my clients will experience pain catastrophizing where their thoughts jump to the worst possibilities of what could happen. Therefore, the interventions I find most helpful are cognitive-behavioral therapy, mindfulness meditation, couples sex therapy and acceptance & commitment therapy. I will discuss acceptance & commitment therapy and couples sex therapy in part II of this blog. I highly recommend that clinicians understand how chronic pain impacts individuals psychologically (thought and emotions), behaviorally, socially, and physically. I find it is critical to treat the whole person rather than just the symptoms.
I assist my clients with chronic pain and illness by examining their thoughts and cognitive distortions. My objective is to modify their thoughts into more productive, accurate, and helpful thoughts. The hope is the helpful thoughts will help in driving healthy behaviors. In using mindfulness, I conduct a series of meditations that focus on relaxation breathing, guided imagery, and progressive muscle relaxation. Being aware of the present experience with acceptance brings contentment rather than inner turmoil. When clients are able to do this, they are able to observe their pain with less reactivity. The approaches foster cognitive change and openness. My clients report they can tolerate pain differently, by findingit less distressing and unpleasant.