Psychological Approaches To Pain Management
Psychology and psychological approaches to pain are an important and accepted part of the holistic pain management model. Research has shown that psychological approaches such as cognitive behaviour therapy (CBT), mindfulness and hypnotherapy can be important components in improving pain management and indeed for warding off or being of benefit if anxiety or depression develop.
There are a variety of psychological approaches needed to deal with chronic pain because not all treatments work the same way for everyone, hence the therapist will work with the patient to try alternative approaches to lessening the stress that pain causes on brain function and emotional responses.
Cognitive behaviour therapy
CBT has been researched intensely and shown to be effective in reducing the psychological distress that is associated with long-term pain. Through the use of learning adaptive coping skills such as: relaxation, distraction, planning and routine, and problem solving, people are able to reduce the pain experience, improve positive social function and generally cope better with chronic pain. All of these techniques are used in order to replace the negative and catastrophic thoughts common to unmanaged chronic pain with more positive and calming thought processes.
MoodGYM, an Australian innovation, is a web based CBT program designed to prevent and manage anxiety and depression. MoodGYM has been shown to reduce depression and anxiety in research studies.
Jon Kabat-Zinn has been the leading figure in bringing mindfulness to the fore in recent decades. His approach to mindfulness involves: deliberately paying attention to everything, using all the senses, to be in the present moment, and to let each experience happen moment by moment without judgement.
The mindfulness technique is about recognising that the person with pain's mood, thoughts and emotions can play a huge role in an individual's quality of life. Therefore, this approach is about separating the person's emotions, thoughts and mood from the pain sensation itself.
The thoughts, emotions and mood associated with the chronic pain experience may seem attached to the pain experience. However, a mindful approach involves noticing when an individual is preoccupied with thoughts about the future or the past, recognising whether these are helpful or not, and developing the ability to free yourself from them.
A growing awareness of mindfulness allows an individual to differentiate between the unpleasant experience that is pain, from thoughts about it, for example "I'm going to become disabled by it" or the emotions sparked by it, such as fear.
The 'acceptance' element of mindfulness is about modifying the unnecessary distress caused in fighting (or ignoring) the fact that something unwanted has happened. It is not about "giving into the pain" but rather it is about finding that an individual doesn't have to pin an unpleasant value to it – it can just exist or to 'be there'. It is not surprising that people with pain are often relieved to find that they can gradually let go of their unpleasant reactions to pain and in turn, can learn that the pain itself becomes more tolerable as the mindfulness begins to retrain the brain's response to pain.
Antidepressants are often effective in treating anxiety and depression, and neuropathic pain in some people. However, if people with chronic pain can lessen the amount of medication used or boost the drug's effectiveness by employing psychological techniques as well, then this is likely to benefit long term health as well as pain management.
Biofeedback is the process of gaining a greater understanding of how to notice and control body processes eg tension. This can be gained using an instrument to measure the tension or be taught without mechanical support.
Biofeedback has been found to be effective in the treatment of adult migraines and headaches. Paediatric studies have also found that chronic migraines and episodic headaches can be improved by using biofeedback therapy.
Biofeedback therapy comprises learning and performing relaxation and visualising exercises with the aim of lessening muscle tension and gaining some influence over autonomic nervous system functions such as heart rate and skin temperature. These techniques are then used to stimulate relaxation, lessen muscle tension, prevent worsening of headaches, and reduce the frequency of headaches and pain.
Trials have found that biofeedback has produced similar effectiveness to that of meditation and relaxation in treating anxiety.
Biofeedback is also gaining legitimacy in the rehabilitation for stroke victims after being subjected to scientific scrutiny.
Another quick note is on relaxation. This technique may be recommended for anyone dealing with chronic pain which could lead to ways to control and cope with chronic pain on a daily basis. Some activities linked to relaxation include meditation or yoga or simply just activities that you find relaxing and that reduce your stress levels overall.