The History of Chronic Pain and the Link to Psychotherapy
Did you know that chronic pain has been the cause of human suffering from the beginning of time? Stories about pain and its devastating consequences on the quality of human life have been recorded throughout history. Reference is made to King Ra in ancient Egypt who had bouts of severe head pain. In 1863, English physician Thomas Sydenham described the pain he had suffered from gout to thirty-four years. During the Civil War, many surgeons wrote of the pain and suffering experienced by wounded soldiers, who, after amputation, were left with phantom limb pain. Sigmund Freud wrote about the effects of cancer pain after he was diagnosed with cancer of the jaw.
Today, in the medical literature we see examples of individuals who are left with chronic pain following an injury and the effects the pain has on the quality of lives. Chronic pain can affect our ability to function in our jobs and can prevent us from participating in many activities that we once enjoyed. This is where we start to experience depression and anxiety that comes with chronic pain. Our lives drastically change and people have described to me they feel like a shell of a person. Chronic pain can be debilitating physically, emotionally, socially, and financially. Chronic pain is a multidimensional phenomenon that involves physiological, psychological, and social factors.
Multiple interventions are typically used to treat chronic pain. Treatment regimens vary depending on the chronic pain disorder and symptoms and may target the cause of the pain or the pain itself. Interventions may include medications, nerve blocks and injections, physical or occupational psychotherapy, rehabilitative exercise, electrical stimulation of muscles, implantable exercises, surgery, and psychotherapy. I often get asked how I treat chronic pain as a psychotherapist. Current research suggests that psychological and psychosocial variables are as influential, if not so more, regarding the individual’s experience of pain and suffering as physiological factors are. When the physical symptoms and psychological reactions interact, I call this the “PSPR effect”, meaning there is this pain cycle that leads to further dysfunction and suffering. For example, when you become depressed, it may trigger more pain and pain can trigger more depression. Often, we see individuals who will begin to self-medicate with drugs (and this includes opiates) and alcohol to help cope with the pain, depression, and anxiety. Therefore, we are treating a co-occurring problem. I treat the substance abuse issue and the mental health problem simultaneously.
How Chronic Pain is linked to Psychotherapy:
Cognitive-behavioral therapyfor chronic pain coincide with those of gait control theory, which proposes that the experience of pain can be triggered by emotional reactions, thinking and perception, behaviors, and environmental factors. For example, if you have intense emotional reactions to stress, this can certainly affect your pain levels. When you become upset, it influences your physiological state. Using this type of treatment will help you begin to alter your perceptions and realize you have some control over your pain. For example, clients learn that with some painful conditions morning stiffness and pain are common. I tend to see this with my clients who have de-conditioning issues where they are not moving regularly. These symptoms do not necessarily mean they have to remain in bed or necessarily limit their activities. By using stretching exercises, followed by a hot shower, they can possibly decrease their pain and stiffness. In session, we are able to process and learn there are interventions they can use, most often in combination, that allow them to have better control of their pain and function more effectively in their daily lives.
Cognitive reappraisal is a method whereby you can learn to monitor and evaluate your thoughts and replace them with more positive thoughts and images. Negative self-statements or self-talk tend to increase pain and suffering. When experiencing an exacerbation of pain symptoms from over doing, you may respond by saying to yourself…. “I can’t do anything without causing my pain to be worse!” Revaluation is critical here because you may discover that by pacing yourself and using other interventions, you can participate in other activities. We call this pacing for pain.
Problem Solving can help you manage your pain by learning a systematic, objective approach to resolving issues. For example, many of you with chronic pain may experience sleep disturbance. Problem solving is a useful tool in identifying possible solutions. For example, if you have chronic back pain, you can identify with your psychotherapist solutions such as changing your position, elevating your legs, eliminating day time sleeping, sleeping on a firmer mattress, or using relaxation techniques such as mindfulness meditation.
Attention control and distraction are techniques that can help you learn to focus your attention away from pain or negative emotions accompanying pain. Attention to pain maintains or increases pain levels. There are mental exercises such as reading, listening to meditations and music that can be helpful. I think sometimes we take our breathing for granted; therefore, breathing exercises, imagery exercises, and progressive muscle relaxation can be used to induce a state of relaxation.
Coming face to face with our own mortality is thought provoking and difficult to accept. The reality of having to live with pain day in and day out for the remainder of our lives can be even more disconcerting. However, having support and learning to live well with chronic pain can bring acceptance and healing.