The Smart Patient's Guide to
Chronic Pain Management

Using Your Head to Control Your Pain

You may not think you’re a candidate for traditional counseling or other forms of therapy, but once you understand how different treatment approaches, along with emotional support and guidance, can help diminish the effects of chronic pain, you might change your mind.

As difficult as it seems to live with chronic pain, research has shown that many people can improve their ability to cope with pain so that it becomes less debilitating and intrusive in their day-to-day lives. With counseling, you can personalize your own treatment so that it takes into account your individual experiences with pain and its limitations.

“There is no cure for pain, anymore than there is a cure for hypertension, diabetes, asthma, or other chronic conditions,” says Robert J. Gatchel, PhD, ABPP, professor in the department of psychology, College of Science, at the University of Texas at Arlington. “But as with these other conditions, pain and discomfort can be managed with appropriate techniques.”

Dr. Gatchel is a proponent of taking a biopsychosocial approach to healthcare. Managing pain requires tackling the biological, psychological, and social issues that are unique to each person. The influence and degree to which each of these factors interact helps explain why there are such differences in the way patients manage chronic pain conditions. Social support, or dependable relationships with family or friends, social involvement, attitudes toward pain, and a knowledge and understanding of specific coping techniques, can be as important as conventional medicine, and can go a long way toward helping to manage chronic pain.1,2

These techniques help train you to stop wrestling with, and take better control of, chronic pain. Using these approaches, you can learn how to become more forward thinking, so that you can start to set goals for yourself and achieve them without letting your health issues get in the way. You learn how to stop defining yourself by your condition and to prevent pain from setting limi

tations on what you can achieve. However, there are some differences among these techniques that could make one more suitable for some people than others.

 “These biopsychosocial-based approaches incorporate mindfulness and mind-body exercises such as biofeedback and muscle relaxation,” Dr. Gatchel explains. “The approaches teach you how to better tolerate your pain and recognize the power you have to manage the negative effects of pain.”

Chronic pain conditions with psycho-social components include migraine and tension headaches, irritable bowel syndrome, bladder pain, lower back and neck pain, peripheral neuropathy, and fibromyalgia, as well as co-existing disorders such as 

insomnia and anxiety, that can worsen pain.

Controlling Pain with Talk Therapy

Cognitive-behavioral therapy (CBT)— which helps you problem-solve, and teaches you how to think and behave in ways that will improve your mood and functioning—was the first psychological technique used for successful management of pain. Since then, there have been numerous “offspring” of CBT, such as mindfulness/stress management and acceptance and commitment therapy (ACT). ACT helps you accept your condition and commit to managing it in a goal-oriented way in order to live your best life in spite of your pain.3,4

The goal of ACT is to help you develop psychological flexibility, or the ability to accept what you need to do in the present moment in order to meet your goals and, at the same time, understand that things might change and you in turn might have to change your thinking and behavior to stay in line with your goals. Practitioners who use this approach can teach you ways to better manage your pain, reduce the disability associated with your pain, and better cope with your painful condition.

Something known as pain catastrophizing,5 a pattern of thought characterized by a lack of confidence and control, and an expectation that the pain will get worse, can also be effectively treated with CBT techniques as they can work to reverse distorted cognition.

According to Dr. Gatchel, pain catastrophizing results from a strong connection between how you think and how you feel. In other words, it may not be what happened to you (the injury) that causes you to become anxious or tense but what you tell yourself about what happened. This results in a more intense pain experience which is linked to depression, higher levels of self-reported pain and more disability.

Effective CBT approaches have been developed to change non-constructive thinking and replace it with more constructive, positive self-talk that reduces negative emotional components to treat depression, anxiety and stress in general.

Stress-Reduction Techniques

Biofeedback6 and relaxation can alleviate pain by combating the body's physical response to stress. Consistent pain or a pain surge can cause muscle tension, elevated heart rate, sweating, and quicker breathing. Unfortunately, these physical reactions increase pain. These approaches can help you take control of the body and minize the stress response.

  •  Biofeedback: Ordinary items such as a thermometer (for temperature), bathroom scale (for weight) and a mirror (appearance) provide biofeedback—visual displays of information— just as a heart rate monitor and blood pressure cuff give information about the cardiovascular system. Biofeedback involves working with a trained psychologist who uses non-invasive machines7 to measure your bodies’ physical reaction to stress. The machines are typically a combination of sophisticated recording equipment that measure muscle stress, breathing, brain waves or other physical responses and an audio visual teaching display component that helps you see how stress impacts you. As you learn to purposefully relax during a stress response, you’ll see your vital signs return to normal. With practice, you’ll be able to relax your body without biofeedback equipment.
  • Relaxation Therapy: Meditating, listening to calm music, and using guided imagery can help you relax. When engaging in these activities muscle tension lessens, blood flow increases, and toxic stress chemicals subside. These actions also decrease anxiety, elevate mood, and ease pain. An experienced counselor, psychologist, or relaxation specialist can help you discover what practices work best for you.

“Most pain is the result of a physical disorder that has considerable psycho-social components,” Dr. Gatchel points out. “If you have this type of pain, which often surfaces or worsens during times of stress [even if you think you’re not feeling the stress], you can benefit greatly from CBT-related techniques.”


Updated on: 03/25/21
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