Pain Psychology

There are various Psychological techniques available to the pain specialist in the management of Chronic Pain. Patients often build up complex coping strategies themselves, sometimes consciously and sometimes in a natural, spontaneous, adaptive way to cope with their pain. With professional help, greater understanding can be achieved and so such coping skills can become more sophisticated and effective.

There are two broad areas of pain psychology which are categorised into Cognitive and Behavioural.

Cognitive - this addresses the thoughts a patient experiences, the ideas and emotions that are felt and how they are interpreted. Some pain patients may have developed some negative, unhelpful thoughts which in a very real sense may lead to an increase in the level of their pain. Therapy is directed at developing a more balanced mindset that enables a patient to cope better with their pain.

Behavioural - this type of pain psycology addresses the way in which the patient conducts their life. Some patients develop over cautious or abnormal fears about their pain such that it hinders their movement and function. This may lead to muscles becoming tight and stiff increasing pain further. Therapy is directed by the pain specialist at increasing the mobility and activity in a controlled, purposeful way such as to reduce the impact of the Pain Condition

Cognitive Behavioural Therapy (CBT) This is a mixture of cognitive and behavioural therapies. They are often combined as they complement each other in many pain problems. How a patient perceives his/ her pain often controls their movement and how they might put restrictions on their activities.

The emphasis on cognitive or behavioural therapies depends on the nature, severity and impact of the pain condition on an individual patient. For instance there may be more emphasis on Cognitive therapy in a pain patient that is experiencing depression or more Behavioural therapy in a patient with Complex Regional Pain Syndrome, a condition that frequently results in a stiff, painful limb.

Effective CBT is tailored by the pain specialist to the need of the patient.

CBT for pain management has three basic components.

The first component of CBT- is to try and help patients understand that cognitions and behaviour can affect the pain experience and emphasizes the role that patients can play in controlling their own pain.

The second component of CBT- is coping skills training. Progressive relaxation and cue-controlled brief relaxation exercises are used to decrease muscle tension, reduce emotional distress, and divert attention from pain.

Activity pacing and pleasant activity scheduling are used to help patients increase the level and range of their activities. Training in distraction techniques such as pleasant imagery, counting methods and use of a focal point helps patients learn to divert attention away from severe pain episodes.

Cognitive restructuring is used to help patients identify and challenge overly negative pain related thoughts and to replace these thoughts with more adaptive, coping thoughts.

The third component of CBT pain psychology involves the application and maintenance of learned coping skills. During this phase of treatment, patients are encouraged to apply their coping skills to a progressively wider range of daily situations. Patients are taught problem solving methods that enable them to analyze and develop plans for dealing with pain flares and other challenging situations.

Self-monitoring and behavioural contracting methods also are used to prompt and reinforce frequent coping skills practice.

CBT for pain management is typically carried out in small group sessions of 4 to 8 patients and usually held weekly for 8 to 10 weeks. The groups are typically led by a Psychologist.

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