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  • Writer's pictureMonica Pandey

Psychotherapies for Pain Management: How Do They Work?

Does chronic pain only impact you on a physical level? If you are a long time sufferer, you know better than anyone else that this is not true. Chronic pain impacts every aspect of life. How many times have you restricted your activities due to pain? Opted out of social events? Wished it would go away so you could get more out of life? Chronic pain impacts the quality of life. In the previous articles, if you have read them, then you will know that I have already established a clear linkage between pain and psychology. The aim of this article is to help you understand better, how exactly does psychotherapy work for you, more specifically which are the various therapies that are engaged to help you reach a better level of functioning.

Since decades, various studies have been conducted all over the world to establish the efficacy of different psychotherapies on pain management. There are numerous citations possible but I will highlight only one or two of them here. In a study conducted by Vitoula et al (2018), conducted on patients of chronic lower back pain, various cognitive and behavioral treatments were studied. Their findings were that treatment outcomes can be significantly improved if a personalized multi-disciplinary approach is adopted. In particular, they found that behavior therapy is very effective in altering patients’ pain perception and to help regain functionality.

In 2017 Ayah Ismail et al published findings of a systematic review of five databases scanning for relevant published studies on osteoarthritis of the knee patients who received Cognitive Behavior Therapy or Pain Coping Skills Training, both forms of psychotherapy. They established that patients receiving such training had lower scores on WOMAC pain scales as compared to the other groups.

That brings us to the question that may be in your mind, what exactly happens in psychotherapy sessions and what are the different approaches psychologists use? Is there just one technique or are there several? Is this a general treatment or is it tailored to suit different people? Let us start with the latter question first. As everyone experiences pain differently and as everyone has different life experiences, psychologists tailor the program to suit individual needs in order to maximize the effectiveness. There are various methods and different therapies which are employed, such as behavioral techniques such as biofeedback, mindfulness based stress reduction, cognitive behavior therapy, relaxation training and so on and so forth. Let us look at some therapies in brief.

Biofeedback training is a method that focuses on enabling patients to understand physiological responses to stress. Patients are taught to monitor their biological patterns such as heart beats, pulse rate. In today’s times, this is easily done with the help of various smart devices, even a basic smart watch can help with this easily. Once the mechanism is understood, patients are taught to identify personal triggers. Then, often times in conjunction with relaxation training, these stress responses can be altered. Relaxation training employs different methods such as abdominal breathing, progressive muscular relaxation, guided imagery etc. The focus of this training is to help the patients attain a relaxed physical state, thereby reprogram the stress response. This combined approach works wonders for chronic pain patients, as they are able to shift the focus away from the physical experience of pain.

Cognitive behavior therapy is another approach often employed by psychologists for pain management. CBT is one of the most widely studied psychotherapies, especially when it comes to chronic pain. Several studies have successfully established the efficacy of this talk based approach which is oriented towards changing the thoughts and beliefs associated with the experience of pain. Every human being is a sum total of life experiences, childhood events and cultural impact. Together, these lead to deeply embedded belief systems, which become involuntary, subconscious response patterns that individuals frequently employ in all life situations, and mostly for a lifetime. These patterns, due to the rigidity factor, can often have a negative impact on an individual’s life. Especially with chronic pain, it is important to uncover these patterns with professional help and restructure belief systems to have better coping strategies. CBT is wonderfully suited to this task and is very effective in helping pain patients.

Mindfulness based stress reduction training, offered by Dr. Kabat-Zinn, holds its roots in the Eastern philosophies of mindfulness and focusing on the present. It is a healing approach that combines yoga and meditation. Like relaxation training, the focus is on improving the patient’s sense of calm and wellbeing. Similarly mindfulness based cognitive therapy is an approach that combines mindful meditation and cognitive therapy. Both these programs enable individuals with high stress and chronic ailments to live better lives.

Operant conditioning is another approach that works wonders with pain patients. It uses the technique of reinforcement to change response patterns to pain behaviors. In this form of therapy, patients are taught to learn appropriate pain responses and unlearn unhelpful responses. Psychologists use one or a combination of approaches and customize it from individual to individual. In this manner, patients are able to experience a greater sense of wellness and improved ability to deal with chronic pain.

While you consider and reflect upon this article and decide when to seek an appointment, here are some behavioral quick tips for you to start practicing.

  1. Breathe Deeply – One of the best ways to control pain is deep abdominal breathing. All you have to do is breathe deeply, hold and count till 4, release. Repeat ten times.

  2. Mindfulness Meditation – Our mind is constantly thinking, which means several thoughts run through our mind at once. Mindfulness meditation is a simple technique of allowing thoughts to flow freely through the mind like clouds.

  3. Guided Imagery – Imagine a serene place. Focus on each and every aspect of the place including all the sights, sounds and smell. Experience the beauty through your senses. Repeat daily, preferably twice.

  4. Thought Decentering – Thoughts are an impermanent state of mind, thus be aware of thoughts but do not react to them. Focus on achieving the “being” state of mind, where there is awareness of state of mind but no pressure to change it.

  5. Stop Self-criticism – Negative thoughts about self damage self esteem and hamper the sense of well-being. So avoid blaming and criticizing self for any reason. Instead focus on finding solutions to problems.

Try these easy tips. If these help, that is wonderful. However, managing chronic pain can be a daunting task so feel free to reach for professional help and seek a customized program. The stigma attached with psychotherapy is culturally induced, thus it is only in your mind. To experience a complete release from pain, REACH OUT!

I leave you with that thought and welcome your comments on the same.

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