By DR. MARY CATHERINE SEGOTA
Pain is one of the leading reasons patients seek medical care. Estimates of chronic pain among adults range from 11 percent to 40 percent (Interagency Pain Research Coordinating Committee, NIH 2016). A NHIS 2016 survey revealed that 50.0 million adults experience chronic pain and 19.6 million experience high-impact chronic pain that limits work, social, recreational, and self-care activities. More adults suffer from common chronic pain conditions than the number affected by heart disease, diabetes, and cancer combined (Tsang et al., 2008). Chronic pain contributes to an estimated $560 billion in yearly direct medical costs, lost productivity, and disability programs (Institute of Pain Medicine, 2011). Because of this impact, it is imperative that we have a greater depth of knowledge of the complexities of living with and treating chronic pain.
The impact of chronic pain
The chronic pain experience is the interaction of the following factors:
- Biological (injury, trauma, infection, illness, cancer, nerve damage)
- Psychological (sleep, fear, anxiety, depression, coping skills)
- Social (work, family, social network)
These factors affect the patient’s health-related quality of life such as their physical functioning, daily life activities, mental health, and social and family functioning.
What does this look like in practical application?
Chronic pain results in reduced physical activity, which is influenced by intensity, duration, or location of the pain. The patient’s ability to walk, get up and down, do physical exercise, perform household chores, participate in hobbies, and maintain an independent lifestyle are all affected.
Chronic pain results in impaired sleep quality. This results in increased levels of stress, impaired cognitive ability, and impaired emotional coping. There is an association between sleep and pain experience, whereby poor sleep result in higher pain reports, and higher pain results in poor sleep reports.
Chronic pain impacts personal work and career trajectories. Chronic pain results in higher absenteeism, decreased work efficiency, decreased work, productivity, and contributes to early retirement. This not only effects an individual’s financial position, but also business structure and functioning, and the larger scale economy.
Chronic pain affects the family. Family members undertake additional activities, such as care duties, supervision, participation in medical appointments, and become involved in evaluating treatments and decision making. As a results of family member’s changing and often challenging roles, they may experience depression, anxiety, and decreased socialization as a result.
Chronic pain causes chronic stress. Chronic stress can contribute to many health problems including high blood pressure, heart disease, obesity, diabetes, depression and anxiety. In addition, stress can trigger muscle tension or muscle spasms that may increase pain. Managing emotions can directly affect the intensity of the pain.
Chronic pain can result in opioid addiction. A patient’s difficulty coping with pain can lead to a greater dependence on pharmaceuticals to which makes the pain condition ultimately more difficult to manage. Opioid addiction has great financial, social, and emotional costs for both the patient and their loved ones.
The psychological and emotional effects of chronic pain
Chronic pain is complex and difficult to manage. Chronic pain can cause mood alterations such as anger, hopelessness, sadness, and anxiety, sleep disturbances, fatigue or lack of energy, neurocognitive changes (impaired attention, concentration, problems solving, task persistence etc.), and other vague symptoms including generalized diffuse pain. Mental health diagnoses are associated with a higher reported pain experience. Effective pain management treatment addresses each aspect of the physical, emotional and psychological aspects of chronic pain.
Medical treatments, including medication, surgery, rehabilitation and physical therapy, may be the first line of defense in treating chronic pain. However, psychotherapy can also be effective at relieving chronic pain because it can alter how the brain processes pain sensations. Understanding and managing the thoughts, emotions and behaviors that accompany the discomfort can help the patient cope more effectively with their pain—and can actually reduce the intensity of their pain.
Mental Health professionals trained in pain management help the patient gain insight into their physical and emotional health. They asses the patient’s pain experience, location, intensity, and location, and what factors exacerbate it or alleviate it. They assess anxiety, worry, stress, and depressive factors related to the pain experience. Mental Health professionals trained in pain management assess the patient’s lifestyle, and help the patient make changes that contribute toward improved physical functioning, work, or activities. They utilize standardized assessments, as well as subjective measures to gain a deeper understanding of the patient’s pain experience.
Mental Health professionals are trained in a wide variety of techniques that have been used in the successful treatment of the chronic pain patients, including:
- Behavioral Approaches (relaxation training, diaphragmatic breathing, progressive muscle relaxation, autogenic training, visualization/guided imagery, sleep hygiene, activity monitoring, and activity pacing)
- Operant Behavioral Techniques (graded activation, time contingent medication schedules, and fear avoidance)
- Cognitive Behavioral Techniques (psychoeducation about pain and the patient’s particular pain syndrome, coping skills training, problem-solving training, thought monitoring, and cognitive restructuring, combined with behavioral interventions)
- Acceptance Based Approaches (acceptance, cognitive diffusion, being present, self as context, values, and committed action)
- Biofeedback (teaching the patient how to control certain body functions including heart rate, breathing rate, skin temperature, and muscle tension, resulting in decreased pain experience)
Tips to help your patients cope with pain:
- Understand your condition.Ask questions so you have a true understanding of your diagnosis and treatment options.
- Manage your stress. Pain is stressful, and stress can make everything feel worse. Learn and utilize new stress management techniques to help your coping.
- Stay active. Pain and the fear of pain can lead you to stop doing the things you enjoy. It’s important not to let pain take over your life.
- Know your limits.Learn to assess your activity level. Be active in a way that acknowledges your physical limitations, but don’t push yourself to do more than you can.
- Stay healthy with low-impact exercise such as stretching, yoga, walking and swimming.
- Be social.Research shows that people with greater social support are more resilient and experience less depression and anxiety. Ask for help when you need it.
- Have a pain plan.Learn what affects the intensity and duration of your pain, and what helps to make it better.
- Manage Expectations.Be aware of “all or nothing thinking.” Seek help to learn different coping skills and ways to manage pain.
- Use prescriptions carefully. Be sure to use medications as prescribed by your doctor to avoid possible dangerous side effects and reduce the chance of overuse.
Pain patients with psychiatric comorbidities are often labeled “difficult patients” by healthcare providers. Patient statements of I’m dying!, This will never get better!, This medication isn’t working! are often triggering for practitioners. Emotional reactions and labeling can lead to diminished quality of care, thus, it is critical for the healthcare provider to monitor their own thoughts and beliefs toward the patient to optimize patient-practitioner interactions. Pain patients are also often unaware of their own thoughts and beliefs, as well how these affect their pain experience, behaviors, and ultimate outcomes. The motivation to change is one of the key predictors of behavioral modification. Thus, assisting the patient in developing their awareness of emotional, social, and physical factors, identifying their own thoughts and beliefs, and facilitating appropriate pain management expectations will result in a more successful treatment outcome.
With a doctorate in clinical psychology and over 20 years of experience in the field, Dr. Segota has conducted university-based behavioral medicine research, acted as a consultant to professionals and organizations, and worked with a diverse number of psychological and medical conditions. By identifying unique needs, the source of distress, and what’s perpetuating the problem, she will help develop the tools to overcome seemingly insurmountable circumstances. She offers an environment where patients will become empowered and achieve maximum personal and professional growth, through therapy, testing, biofeedback, mediation, and coaching. Visit www.CounselingResourceServices.com