Chronic Pain

According to the National Institutes of Health, less than half of the fifty million Americans suffering with chronic pain seek help out of fears of dependency on or side effects from medication. For those who do seek help, adding counseling to the pain management program may be beneficial.

Emerging research highlights the complexity of pain transmission as well as other factors affecting pain. Sometimes there is a discrepancy between patient report of pain severity and objective findings. This does not mean the patient’s claims are exaggerated. Some studies show gender differences in pain tolerance. According to NIH, while “both males and females have strong, natural pain killing systems,” these systems “may operate differently” and may be influenced by estrogen and testosterone. In another study, patients who linked the onset of their pain with a traumatic event reported greater pain than counterparts who had not.

The context of the patient’s life may also influence the patient’s pain. Stress makes everything worse and pain is no exception. Of course, chronic pain creates stress, and in the process, may compound the patient’s problems by adding depression and anxiety to the mix.

For that reason alone, for those who do seek treatment, traditional pharmacological and rehabilitation interventions may not be the total answer for patients with pain. Including a cognitive-behavioral approach to the patient’s pain management program may also help.

When a provider suggests patients “talk to someone” about pain management, patients may become defensive and need to be reassured provider isn’t dismissing their pain as being “all in their heads.” Patients need to know that some cognitive-behavioral interventions have been research-proven to help with pain management.

In her book Cognitive Therapy for Chronic Pain, Beverly Thorn, Ph.D., states “patients’ cognitions, especially negative thought processes, predict poor patient adaptation to pain better than any other variable – including disease state, pain severity, sex, age or depression.” Thorn believes that patients with pain often feel helpless and totally dependent on a “cure” from the medical community. Thorn advocates patients take assertive role in their own pain management.

That may include refocusing the patients from waiting for a miracle cure to the quality of their lives as they are presently. She starts with patients’ perception of their pain – is it seen as a threat, loss or challenge to the patient? If seen as a threat, for example, the patient’s fear level increases and the patient may withdrawal from potentially helpful activities out of that fear.

Thorn also addresses how the patient’s perception is played out in the patient’s self talk. Does the patient’s self-talk decrease or increase stress? Does the patient say, “With this pain, I’m worthless,” or say something more adaptive such as “The pain is difficult, but I am still able to do....”

Sometimes pain patients need to vent their fears and frustrations. They need to know they are still loveable despite their limitations. Traditional talk therapy, journaling and/or family counseling may also be helpful to the patient. The latter may be especially helpful if significant others are nonsupportive or “too” supportive (taking on too much of the patient’s responsibilities.)

(First published in Stephanie Hittle’s Heallth Care Today column and used by permission of the Dayton Daily News.)

Disclaimer: Information provided on these pages is general in nature and should not be used in place of individual counseling.