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  • Writer's pictureMonica Pandey

Pain Management: Why is Psychological Assessment Overlooked?

Do you suffer from Chronic pain? Does the pain only affect you physically? Or does it have an impact on your emotions and life too? How exactly has it impacted your life? How can you manage pain better in order to get better outcomes and improve the quality of your life? While pain may be real, suffering is optional. If you suffer silently in pain, then this article is for you. The aim here is to help you understand how parallel therapies can help you better manage your pain experience, and debunk some myths pertaining to the role of psychotherapy in pain management. To do this, relevant research based facts are included here, to help you decide for yourself whether or not psychological assessment is crucial. Another aim of this article is to enable understanding of how psychotherapy works with respect to pain management.

There are various studies in the Western countries on the numbers and impact of various types of pain. A study was conducted by Ashok Kumar Saxena et al in 2018 on The Prevalence of Chronic Pain among Adults in India. Approximately 30% of the world's population suffers from pain. This pain survey by Saxena et al is the first-ever extensively conducted CP prevalence study in Indian population. This study shows a huge chronic burden in India by the prevalence rate of 19.3%, which translates into 180–200 million adults having Chronic Pain.

The study includes a very large sample which is a mix of both urban and rural population. It even goes to state that most Indian adults suffer silently in pain rather than reaching out for help. This is perhaps a cultural thing. As far as memory goes, we are taught by our parents to not be a burden on others and to develop tolerance for life and life events. Perhaps it is this factor that precipitates the reluctance of adults to seek treatment.

The study also found that the most prevalent location of pain was knee (23.6%), followed by lower back and head. Joint and muscle pains were the most common causes of pain. What makes this study even more interesting is the finding that 36% of the respondents reported inability to engage in routine work, 25.5 % accepted it as a part of their life – reiterating the above observation about cultural acceptance and tolerance; and this above all – 14.1% of the respondents had depression and anxiety as a result of Chronic Pain. The study went on to find that various alternate therapy options, such as massage, physical therapy, yoga, meditation, even acupuncture, besides others, were considered by most of the sample, however psychotherapy was not one of them. Now, if this does not serve as a wakeup call, what will?

Pain is real – FACT! Chronic pain is real – FACT! People suffer in silence – FACT! Depression and anxiety are real – FACT! Chronic Pain can result in depression and anxiety – also a FACT! How and why does chronic pain lead to depression and anxiety?

Research suggests that the experience of pain is more perceptual than sensory. Even if people are experiencing pain due to similar causes, every person’s experience of it is subjective in nature. This is because pain and emotions share similar neural pathways. This is the prime reason why some people feel pain more or less than others. It is also the reason why even placebos are known to make pain patients feel better.

Besides this, as pain reduces the ability of a person to engage in normal, daily activities, it has an impact on the thinking pattern as well. Over a period of time, pain increases dependence on others. It causes worry about the future. It affects relationships with family, friends and even colleagues. It affects performance, thus leading to issues at work. Simply put, pain steals happiness from life, diminishing the sense of personal worth. This leads to engagement in negative and unhealthy thinking patterns such as, “This is going to last forever; my pain will never go away.” This kind of negative and catastrophic thinking can lead to worsened response to treatment. Sometimes, people tend to become fearful and engage in avoidant behaviors which again deter treatment.

Seeking psychotherapy can help deal with the management of depression and anxiety. It can help deal with tolerance of pain. It can help with response to pain itself. It can help individuals address the ways in which their pain condition is interfering with their ability to fulfill their human needs. It helps to minimize negative thoughts, in order to develop a healthy attitude and response to pain. When individuals receive both medical treatment and psychotherapy in conjunction, it works wonders for the individual as the quality of life improves dramatically.

Psychotherapy is talk based therapy which uses scientifically researched techniques to restructure thinking and behavior patterns. There are various forms of psychotherapy. Psychoanalysis helps to look into the past and identify patterns of the unconscious mind. It is often used to treat depression and anxiety. Cognitive Behavior Therapy is a short term future oriented therapy also used commonly. Another future-oriented therapy is Reality Therapy. All these therapies help understand the workings of the sub-conscious mind. A psychologist assists with developing acceptance of and overcoming fear related to pain. Psychological treatments for pain can even alter how your brain processes pain sensations. Psychologists can help you manage the stress in your life related to or a result of your chronic pain. It is important to deal with these issues because, if ignored, they can escalate into larger issues subsequently. They can also negatively impact treatment outcomes of medical interventions, and at times, even lead to resistance of treatments. While you consider and reflect upon this article and decide when to seek an appointment, here are some mental wellness quick tips for you to start practicing.

  1. Remain active, but know your limits – Staying active is very important for the perception of control over life, so it is important to remain active. However, it is also important to be aware of one’s limitations and not over-exert, as this may lead to further accentuation of pain.

  2. Maintain social bonds – often, dealing with chronic pain leads to withdrawal from social life. Human beings are social animals and need to feel connected to society. Do not let chronic pain take over to the extent that you isolate yourself. Technology has made it easier to remain socially active, even if physical attendance is not possible every time. In fact, the

current pandemic is a case in point towards this. So maintain the social ties.

  1. Preserve hope – Bear in mind that things improve, situations change. Do not let the thought that this is the future impact to an extent that you feel dull and hopeless. Remember, you are in charge of “you”. So infuse yourself with a dose of positivity and hope.

  2. Find other challenges – Perhaps the pain has had an effect on the things you did well earlier leading you to feel at loss due to inability to continue at the same pace. Slow down. Tell yourself it is fine. Accept that you can change your previous pace. Find other exciting or challenging things to do.

  3. Be grateful – An attitude of gratitude always helps go a long way. No matter how much the pain, there is always something in life to be grateful for. So let your grateful list overflow!

Try these easy tips. If these help, that is wonderful. If yet, the feeling of missing out persists or if despite the medicines you cannot find relief, feel free to reach for professional help. No matter what, remember that the stigma attached with psychotherapy is culturally induced, and so something you can overcome. All you have to do is, REACH OUT!

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