Pain Management

Pain Management

Biological, psychological, behavioral, cognitive and spiritual factors impact the experience of pain. Comprehensive assessment of these areas supports optimally effective treatment. Psychological (i.e. behavioral, cognitive, etc.) treatment has proven effectiveness in reducing physician visits (The Clinical Journal of Pain, 1991), and improving individuals’ abilities to manage their pain.

Evidence-based outcomes can include:

• Reduced emotional distress
• Reduced frequency, intensity and duration of pain symptoms
• Decreased disability
• Decreased fears of re-injury

After an initial assessment, our clinicians work with patients to identify an individualized treatment plan that is time and cost effective. Treatments may include:

• Acute vs. Chronic Pain Management
• Cognitive Behavioral Treatment of Pain
• Exposure Therapy
• Stress Management Skills
• Relaxation Training
• Assertiveness/Anger Management Skills

Acute pain typically begins suddenly and is usually sharp in quality. It may last for months (usually no longer than 6 months) or only for a moment, and it is a message to us that our bodies are vulnerable or in danger. For example, the burn we feel when we touch a hot stove alerts us to move away from the stove before more damage to our body occurs. Similarly, pain following surgery may alert us that our body still needs time to heal.

Chronic pain is very different in many respects. The quality of the pain is less sharp and the duration of the pain is typically much longer than that of acute pain. Most significantly, chronic pain is not serving as a warning mechanism alerting our bodies of danger. The pain signal in our bodies has gone awry leading to intense and long-term pain when there is no danger.

Thus, treatment of chronic pain involves learning that the pain is not signifying danger, and that many of our functional activities may be resumed. However, it also involves learning an array of new skills, including cognitive (i.e. thinking) and behavioral coping skills such that the pain can be optimally managed.

Cognitive-Behavioral Treatment (CBT) of Pain

Because pain is supposed to function as the body’s warning signal, it is very difficult for individuals to override that signal and resume normal functional activities in the presence of pain. Individuals suffering from chronic pain often think they are doing more damage by continuing with everyday activities, and they are fearful of re-injury. However, decreasing or stopping functional activities may actually make the pain worse, and it increases the likelihood of re-injury.

CBT teaches individuals to challenge the beliefs that limit their functioning and increase the beliefs that allow them to increase their functioning and independence.

Behavioral change is targeted specifically in treatment such that the individual begins to learn how much to expect of him/herself and how to set goals that are achievable, versus the common tendency to overdo on “good days”. For more information, please click here.

Meta-analysis has revealed the efficacy of cognitive behavioral treatment in pain management (Morley, Eccleston, & Wiliams, 1999). Specifically, studies have shown that individuals typically experience a reduction in pain and an increased ability to cope (Keefe, 1996). A study by Turner & Clancy, (1988) demonstrated decreased disability sustained over a twelve-month period of time.

Exposure Therapy

Often people who have experienced pain following an injury are very fearful of re-injury. Exposure therapy enables individuals to confront their fears in a safe environment resulting in a decrease in fear and improved functioning. A study by de Jong, Onghena, Goossens, Geilen, and Mulder (2005) found that following this treatment, individuals experienced less fear about previously feared situations, increased performance of daily activities, and reduced pain intensity.

Stress Management Skills

Many individuals with chronic pain also suffer from depression and anxiety. Even if the depression or anxiety is not at a clinically significant level, it may be increasing the amount of felt pain. Therefore, it is extremely important for individuals to be able to understand what they are feeling and learn how to soothe themselves. These are also skills that can be taught and are very helpful in the individual’s sense of mastery over their emotions and their pain.

Relaxation Training

Part of learning how to soothe oneself is learning how to relax. In this approach, an individual learns to bring about a state of deep relaxation. Deep relaxation allows the brain to process pain signals with less urgency and intensity, thereby decreasing the experience of pain. Deep relaxation also allows the muscles in the body to release thus decreasing additional pain caused by muscle tension.

Studies have demonstrated the effectiveness of relaxation and visualization in relieving pain (Syrjala, Donaldson, Davis, et al, 1995). In addition, mindfulness meditation techniques have also allowed patients to experience significant benefits (Kabat-Zinn, Lipworth, Burney & Sellers, 1987; Grossman P., Tiefenthaler-Gilmer U., Raysz A. & Kesper U., 2007).

Anger Management/Assertiveness Skills

Studies have shown that suppressed anger leads to increased pain sensitivity, increased pain intensity and poor response to pain management treatment (Pain, 2003). Therefore, teaching anger management skills and assertiveness training enables individuals to better express themselves, resulting in decreased pain (American Pain Society and The Canadian Pain Society, Joint Meeting, 2004).

Selected References

Bruehl S, Chung OY, Burns JW. 2003). Differential effects of expressive anger regulation on chronic pain intensity in CRPS and non-CRPS limb pain patients. Pain, 647-654.

DeJong JR, Vlaeyen JW, Onghena P, Goossens ME, Geilen M., Mulder H. (2005). Fear of movement/(re) injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction? Clinical Journal of Pain, 21 9-17, 69-72.

Grossman P., Tiefenthaler-Gilmer U., Raysz A. & Kesper U. (2007). Mindfulness training as an intervention for fibromyalgia: Evidence of postintervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics, 76, 226-233.

Kabat-Zinn J., Lipworth L., Burney R., & Sellers W. (1987). Four-year follow-up of a meditation-based program for the self-regulation of chronic pain: Treatment outcomes and compliance. Clinical Journal of Pain, 2, 159-173.

Keefe FJ. (1996). Cognitive Behavioral Therapy for Managing Pain. The Clinical Psychologist, 49, 4-5.

Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE. (1995). Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain, 63, 189-98.