Psychological Approaches to
 Chronic Pain
DeLee Lantz, Ph.D.

If you're in pain, you know that you are not only physically distressed, but psychologically distressed as well. You might feel depressed, frightened, worried and out of control. Constant pain makes it hard to concentrate and think. It saps energy and you’re fatigued a lot, even if you haven’t done much. You often feel irritable and might be short with others. Often there is no outward sign of anything wrong; it’s something only you are aware of. Others in your life might have a hard time understanding why you aren't able to do what you used to do and why it's taking so long to get better. Or, they might feel frightened themselves about what's happening to you and unable to support you as you'd most like. Despite your own distress, you sometimes wind up having to take care of the others. You might feel you must hide your own pain and fear to keep from overwhelming them.

Or, your loved ones might lean in the other direction and become overly involved in your condition. Their concern leads them to see you mainly as a "patient". You become a "person in pain" and lose your role as a whole person who is more than your pain or illness. With the medical team, your family and your friends all focusing on this one aspect, you, yourself can become identified with this role of "sick person" and little more. Chronic pain can reduce the world of the sufferer.
(“Chronic” pain is generally defined as pain that has persisted for more than six months.)

Your illness or your pain is a physical condition. Of course your body does need attention and treatment. But you are more than a physical body. Is the rest of you getting the attention and treatment you need? Never has it been more important to support the rest of you, even as you do all you can for your body. This article will discuss some of the types of psychological support available to you. A National Institutes of Health panel recently concluded that approaches such as these, that increase awareness and self-control, equal the effectiveness of medications for relief of pain!


Psychotherapy
Psychotherapy is adapted to your unique set of circumstances and needs. The focus is not on the "pain patient," but on the whole person who has pain. It usually includes attention to emotions, communication, pain management, stress management, ways of coping, and encourages you to preserve and express that part of you that is not the pain or illness.

Many people are dealing with depression, anxiety, fear, anger and isolation that so often accompany pain. In fact, an international study recently published in the medical journal Pain found that people with pain were 160% times more likely to have accompanying depression than people in the general population. They were 120% more likely to have anxiety and 60% more likely to over-use alcohol or other substances. This is far greater than earlier estimates. It is easy to understand why these symptoms might accompany chronic pain. A one-to-one relationship with an understanding therapist can provide a place to deal frankly with all aspects of your experience.  A therapist who is experienced in working with people with pain is able to hear your real feelings and experiences, unlike others you might have to protect. You don’t have to hide what you’re really feeling. You need a place where you can let down the pretense and “be real”.

A therapist who specializes in working with people with pain can also help you with difficulties you may be experiencing in communicating. Open and honest communication is probably the single most important factor in your relationship with your health care team and your family. Yet the person with pain and illness often feels he or she is unable to do that. Being able to say “no” or “I don’t understand what you mean” or “Let me tell you my opinion and wishes about this” or "This is what I need" is not always easy. A therapist can help you claim your own voice in this difficult process. This is absolutely essential if you are to feel you have any control over what’s happening to you and what you need from others.

Some therapists specialize in “cognitive-behavioral therapy” (or “CBT”). The “cognitive” part looks at your beliefs and assumptions and the “self-talk” that arise from them. Sometimes these are of a kind that exaggerate your sense of despair and hopelessness. These “faulty” cognitions can be challenged and more realistic ones can be strengthened. (Note that “more realistic” does not mean denying the truth of your situation.) The “behavioral” part focuses on behaviors that can be more helpful to you. An example is learning to pace yourself in your activities and building in rest periods instead of going full steam ahead as you may have done formerly.

CBT therapists as well as most other therapists also teach pain management techniques. There are many such techniques and you will find which ones are most helpful for you. Most of them include a relaxation technique of some kind. Muscle release, breathing techniques, guided imagery or other visualizations, music,  hypnosis, gentle movement and meditation are examples. Tools for managing stress are important in pain management. Biofeedback and neurofeedback, which are discussed below, are also used for pain management.

Individual therapy can also be of help to partners, siblings and other family members and caregivers as they go through their own experience of a loved one’s pain or illness. It is sometimes forgotten that they are often in great need of a supportive and therapeutic place of their own. They generally have their own fears, anger and conflicts and often can't talk about them with other family members, let alone with the loved one with pain.

Biofeedback
Biofeedback is a powerful tool for increasing mind-body communication and providing a sense of control over what your body is doing. It uses electronic sensors to measure what's happening in your body and to feed back this information to you on a computer screen as it’s happening. It can measure such things as muscle tension, breathing, heart rate, skin temperature and brain wave activity. Biofeedback is commonly used to help in the treatment of pain. It can be used to identify and retrain body habits that produce or maintain pain. Examples of this are excess muscle tension and breathing patterns that heighten anxiety and trigger muscle spasms. It is also used for learning to relax, quiet and calm yourself. Many people say that they don’t feel as helpless when they have something they can do, instead of just enduring the pain. (If you’re interested in learning more about biofeedback, you can read my article, “What is Biofeedback?”, on this website.

 

Psychological Testing
Psychological testing can provide helpful information about your response to pain and illness and your particular combination of resources and difficulties in dealing with it. Testing can range from brief questionnaires assessing physical and psychological symptoms; presence and extent of depression, anxiety, anger or denial; coping styles, beliefs, levels of distress, etc., to longer inventories assessing how individual personality style might affect response to illness and pain. This information can be especially useful in identifying and broadening your ways of coping with living with pain. Having a variety of coping styles not only gives more ways to cope, but increases a sense of resources and control, often absent when in pain. (A survey of studies by the Center for the Advancement of Health concluded that an individualized “menu” of six to twelve coping strategies seemed to be the most helpful to people.)

If you or a loved one is living with chronic pain and/or serious illness, perhaps one or more of these psychological approaches could be helpful to you. It’s important to know that there are psychotherapists who understand what you’re going through because they have listened and learned from others in pain. In addition to a willingness and ability to hear your experience and feelings about your pain, they will not lose sight of the fact that you are so much more than your pain.

All of the Integrated Psychology Associates have a specialty in working with people with pain and illness. All Associates work with individuals. In addition, Dr. Kay sees families and Dr. Young Voigt sees couples dealing with the relationship issues that often arise when one member has chronic pain. Dr. Lantz provides biofeedback and psychological testing. (You may read each Associate's profile page by clicking on a name in the left column or by going to the Associates page and clicking on a photo.)

Readers of this article might also be interested in reading Dr. Shelley Diamond's article on The Stress of Living with Chronic Illness.

Integrated Psychology Associates (I.P.A.) Offices

Main Office: 2859 Sacramento Street, San Francisco, CA 94115
(Please use this address for general correspondence.)
Main Telephone and Facsimile: (415) 331-5433
(See phone numbers for individual Associates on their pages. Use number above for general questions and for faxes.)
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