When pain feels unmanageable, therapy can help
This is the first post in a three-part series on chronic pain management.
Many of us know that physical and mental health issues can occur at the same time. However, you might not realize how prevalent this is: up to 85 percent of visits to physicians are for physical conditions associated with increased risk for mental health disorders.
Pain is one of the most common chronic conditions and it can trigger or exacerbate severe issues like insomnia, depression, anxiety, and substance abuse.
Experiencing near-constant pain can also disrupt important aspects of someone’s life like relationships, ability to work, and finances. Taken together, the potential impact on mental health is staggering and can even be life-threatening: as much as 19 percent of people living with chronic pain experience suicidal ideation. As a psychologist with over 20 years of experience working with chronic pain patients, I’ve seen firsthand how collaborative care between primary care and mental health providers can make a big difference and even save lives.
Primary care providers are the first line of defense for chronic pain patients—they are in a position to connect patients to therapists who specialize in pain management. Taking this step is crucial in helping patients feel and live better, as psychologists can treat the emotional and mental effects of pain and provide nonpharmacological pain management options. This allows physicians to focus on treating the physical cause and symptoms of pain. Psychologists’ specific training in the mind-body connection can also help patients learn ways to apply the power of the mind to manage and reduce pain, and to mitigate the impact of pain on things like mood, sleep, and substance use issues.
Let’s start with applying the power of the mind to help reduce pain: Learning how to train the brain to focus on different sensory experiences can be a powerful tool to manage physical pain. Nonpharmacological methods like biofeedback, progressive muscle relaxation, relaxation training, autogenic training, and guided imagery can help reduce the guarded and hyper-vigilant pain response common in these patients and significantly reduce the perception of pain. These methods are ideally applied in coordination with a physician as part of a treatment plan that may or may not also involve medication.
Now, let’s think about how pain can impact people’s lives. Chronic pain can trigger different neurotransmitter responses that in turn negatively impact someone’s thoughts and feelings. As a result, people with chronic pain are more prone to feeling anxious, stressed, or depressed, and may have trouble sleeping. Psychologists also equip patients with ways to mitigate the impact of the pain on their mood. Through Mindfulness-Based Cognitive Behavioral Therapy, for example, patients learn how to better manage the impact of pain on their emotions and, therefore, improve their quality of life.
Significant evidence backs this approach: New clinical guidelines released earlier this year by the American College of Physicians recommend that providers first try noninvasive, nonpharmacological treatments for lower back pain. This includes a combination of therapy and alternative approaches like exercise or spinal manipulation. The recommendations are based on evidence of reduced pain and improved quality of life in patients whose care plan included such treatments.
Here’s the bottom line: integrating mental and physical aspects of pain management can result in significant improvements in patients’ mood, relationships, sleep, and in reducing pain and suffering. Physicians can initiate this by first helping the patient understand that the physical pain they experience doesn’t happen independently: it also impacts their mind, mood, sleep, and day-to-day life. By working with a trained therapist, the patient could experience a reduction in pain, improved mood, and better sleep in as little as two to eight weeks.
If you’re a provider, ask your chronic pain patients about their sleep and mood, and help them to understand the value of working with a therapist. You accomplish two crucial facets of chronic pain management in doing so: connecting them with care for the psychological impact of pain, and in turn, allowing you to focus on directly treating the physical cause of pain. With a simple conversation, you open the door to treatment that is efficient, effective, and helps your patient feel and live better.
Elizabeth Krause, Ph.D. is a licensed psychologist with special expertise in Mindfulness-Based Psychotherapy, Anxiety, and Health Psychology. Dr. Krause has a Cognitive Behavioral Therapy Orientation in her therapy approach and believes that understanding how stressors affect the mind, body, and spirit is integral to individual growth. Dr. Krause has over 25 years experience in the field of psychology with special expertise in Health Psychology and Behavioral Medicine. She works with Quartet as a clinical consultant.