Have Chronic Pain, Why Do I Need a Consult with a Therapist?
Adapted from article by Vera A. Gonzales, Ph.D.
"Why am I seeing you? I’m not crazy, I’m in pain!" I hear these words several times a week from patients that have been referred to me for treatment, assessment, or consultation concerning chronic pain. During the first session with new patients I assure them that they are not crazy, but, in fact, very lucky to have a therapist that recognizes the many facets of chronic pain.
This type of treatment model, where a psychologist is involved, is relatively new to western medicine. Psychological treatment was actually considered an alternative treatment not too long ago. Today we realize that there is even more to this; there is actually a mind-body and body-mind connection representing that communication is two-way. Having this knowledge has enabled us to realize that something was missing in our treatment of chronic pain patients, namely a holistic conceptualization of our patients.
In 1979, The International Association for the Study of Pain (IASP) officially redefined pain as "an unpleasant sensory and emotional experience, associated with actual or potential damage or described in terms of such damage." This definition not only recognizes that pain involves thoughts and feelings, but also that pain is real whether or not the biological "causes" are known.
Recent research suggests that pain is mismanaged in up to 50% of cases. Many of the reasons for the mismanagement of pain are psychological. For example, irrational fears about addiction, underreporting of pain, inadequate communication between patient and doctor, lack of knowledge, etc. A skilled pain therapist is best able to identify blocking beliefs, fears, etc that may contribute to the mismanagement of pain. This information can be invaluable to other treatment professionals.
How can anyone with a significant degree of chronic pain only be affected physically? Pain makes you feel tired, mentally fuddled, irritable and often depressed. It affects you mentally and emotionally as well as physically. Many of the effects come into play quite quickly. If a family member changes from relaxed and easy-going, to irritable and worried by continued pain, how many weeks will pass before family relationships begin to change? Similarly, an employer who had confidence in a promising employee does not take too long to change his or her attitude to one who constantly looks tired and strained.
It is because of these effects of pain on individuals that a therapy has a part to play. Therapists working in chronic pain are not trying to see whether pain is real or imaginary. All pain is real to the sufferer. Pain doesn't just affect the body. It also affects how much you can do, how you feel emotionally, the quality of your life and those around you. There may be many losses as a result of pain, e.g. job, finances, self-esteem and confidence. Thinking patterns can change, become negative, low and full of frustration. Tempers can become short and memory and concentration poor as a result of long term pain, all of which can affect mood.
You may be referred to a pain psychologist for many reasons, some of which I have touched on above. Other reasons for the referral may be to see if you are a candidate for certain therapies including high dose opiods, intrathecal infusion pumps, spinal cord stimulators, and surgeries, such as fusions, laminectomies, etc. Your physician may also want to see if you would be a good candidate for a support group.
After a consult your pain therapist might recommend several types of treatment including:
• Individual psychotherapy to help you better understand your own behavioral and emotional responses to the pain and help you modify those responses in ways that increase your comfort, ability to cope, and sense of well being.
• Pain management group to help you learn sufficient self management strategies for your pain.
• Pain Management Program that is multidisciplinary (i.e. psychologist, chiropractor or physical therapist, pain physician) and aims at decreasing psychological distress and increasing functional capabilities. The program should include, among others, the following interventions: group psychotherapy, relaxation training, physical fitness and conditioning exercises, and medication management.
It is important when choosing a pain therapist or any provider for that matter, that you be aware of their training. It is my recommendation that your pain psychologist has had supervised training and experience in the assessment and treatment of patients with persistent pain. In my case, my education on pain therapy includes extensive postgraduate training, but more importantly, my own struggles with chronic pain.
Pain does not happen in a vacuum; it happens in a human being with a personality, likes and dislikes, strengths and weaknesses, and ways of thinking. Chronic pain complicates people's lives, diminishes their emotional and physical capabilities, questions their coping strategies, and fatigues them and their family and friends. Chronic pain often adds stress that breaks down relationships with family and friends, leaving a person isolated and alone and feeling no one understands them or their pain. Depression, anger, and anxiety often result from chronic pain.
I have studied pain and its effect on human functioning. I can help you with effective strategies and skills to increase your ability to cope with your pain. I can treat your depression and anxiety and help you to separate it from the pain so you no longer have the emotional "roller coaster" rides as your pain intensity varies. So when your physician refers you to me, a pain therapist, realize how much he or she is invested in you getting holistic treatment.