Medicine of the Mind: Treating Chronic Pain Psychologically
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We have all at one point in our times felt pain. Although it is an intrinsic part of life, it is not a constant factor in the majority of the world’s population. However, there are people who have lived with uninterrupted pain for years, maybe even their whole lives. Around 307 million people are afflicted with chronic pain worldwide. Some of these cases can be controlled using medicine but the vast majority of these people will find very little relief, if any, in their lifetime. As time passes, most of these people experience decreased life satisfaction. In this article, we will delve deeper to understand what chronic pain is, what its affects are and how people suffering from chronic pain can find relief. There is hope for these people as chronic pain, which affects people’s day to day happiness, can be treated psychologically.
Let us start by examining pain itself. What exactly is pain? In the world of medicine, pain is defined as “a variably unpleasant sensation associated with actual or potential tissue damage” (Stedman’s Medical Dictionary v.7). From its definition, we can see that pain is actually a good thing. It alerts us to the fact that something is going wrong in our body. It is like an internal security alarm that keeps on ringing until we have addressed the potential harmful stimulus. As soon as the stimulus has been removed, the pain subsides. This normal pattern of stimulus, pain, removal of stimulus, and relief is known as the pain cycle. Chronic pain is the result of a non-functional pain cycle where removal of the stimulus is not followed by relief. It occurs in about 4.5% of the world’s population who live with varying degrees of constant pain. This pain has both physical and psychological components so it is important to examine both.
The most surprising thing about chronic pain, as far as the body is concerned, is that it has no perceivable physical basis. Even after extensive medical tests, the cause of the pain cannot be pinpointed in almost 47% of the cases. Normally, we feel pain when a surge of electrical impulses travel from a certain point in our body to our brain after we experience a noxious stimulus. However, in the majority of chronic pain patients, the nerves in some parts of their body fire for no apparent reason. There is also a minority of people who feel pain somewhere in their body even though the nerves in that respective area display no signs of abnormal activity. Amputation is an extreme example of this. Around 70 to 80% of amputees experience “phantom limb” sensations. This means that the amputee will experience sensations in the limb that is not even there. These sensations are not limited to pain although the majority of phantom limb occurrences do include some form of pain (Beard & Aldington, 2011). The lack of any physical basis for this pain highly suggests the presence of an active psychological aspect.
Most medical professionals believe that the active factor in the cause of chronic pain is the psyche. Linton and Shaw (2011, p 701) sum up the way modern medicine views psychology when they say, “In our view, awareness of these factors [psychological factors] is crucial for understanding patients in pain and is a prerequisite for integrating them into clinical practice.” (2011, p 701). Linton and Shaw then go on to describe these “psychological factors”.
In their article, they talk about two main factors: attention and interpretation. Attention is self-explanatory. In order to feel pain, you have to be aware of it and designate a certain amount of your attention to it. However, the problem arises when we pay too much attention to pain which we can do very little to alleviate. Paying too much attention to pain can lead to fear, anxiety, and feelings of hopelessness. In some extreme cases, abnormal focus on an injury (referred to as vigilance) amplifies pain. This is one reason why small injuries can cause so much pain (Linton & Shaw, 2011, p.702).
Interpretation also plays a big role in how we experience pain. Our interpretations of a painful situation are influenced by our expectations. The way we perceive pain is reflected in our expectations and play a very important role in our experience of that pain (Linton & Shaw, 2011, p703). For example, if an individual has a headache and decides to take a pain-killer, he/she expects the pain to stop. If it does not stop soon after taking the medicine, the pain will become more bothersome than before even though the intensity of the pain has remained constant. People who experience chronic pain try multiple treatments, most of which fail to meet their expectations. This makes living with chronic pain more troublesome and to some degree magnifies their pain.
Although chronic pain has elusive causes, its effects are very real. The amount of damage it can do to a person’s life is astounding. Life with chronic pain is extremely difficult and in some cases it becomes impossible for the affected individual to live alone. It is so destructive as it causes damage on two different levels: the physical level and the emotional level.
From the physiological viewpoint, chronic pain takes a devastating toll on the human body. When we experience pain, our bodies react in a phenomenal way. We enter a state of heightened awareness as our hearts start to beat faster, our blood pressure increases, and our breathing quickens. If the pain does not subside, these symptoms may remain causing our body to become exhausted. This exhaustion leads to a decrease in the efficiency of our immune system. It is a well-known fact that stress decreases the strength of the immune system with long lasting and chronic stressors being the most dangerous as they slow down both our innate and acquired immunity (Passer & Smith, 2011, p 524).
The mind is also affected by chronic pain. People who experience chronic pain are likely to experience a certain degree of helplessness. No matter what they try, their pain never subsides. This can lead to frustration, jealousy, anger and above all, depression. On average, 52% of people who suffer from chronic pain also fit the criteria for depression (Linton & Shaw, 2011, p704). This correlation between pain and depression cannot be overlooked. Because of depression, people lose interest in the things that might bring them pleasure which further perpetuates their negative affect. In some extreme cases, their movements slow down and even simple tasks like walking and talking require immense effort (Passer & Smith, 2011, p 562). Once a chronic pain patient becomes depressed, a viscous cycle is created. As the depression sets in, the individual will decrease the amount activities that used to provide positive reinforcement such as hobbies or socializing. They may become a burden on the people around them due to their decreased functionality. This pushes people away from the depressed individual effectively decreasing the amount of social support that person has. This is a big problem as social support is usually tantamount to the individual’s recovery (Passer & Smith, 2011). A patient in this position may blame the pain for ruing his or her life, thus drawing more attention to the pain and magnifying it.
Depression is probably the most crippling part of living with chronic pain. It has the power to render the people it plagues unable to function socially. About 25% of the general population is affected by both chronic pain and depression (Shawn, Wang, 2003). That is why it is so important that the field of medicine provide a cure for these people. With all the advances in medical technology there have been many breakthroughs in the race to cure chronic pain. Up until recently, medical researchers have focussed on treating the body. This has had limited success. However, since chronic pain is so deeply routes in the psyche, it would make more sense to treat it using the power of the mind instead of trying to treat the body.
There are many physical methods of treating chronic pain now. The most effective treatment is in the case where the cause of the pain can be directly pinpointed. The stimulus can then be treated through surgery or medicine depending on its nature. So how do you treat somebody who is in pain when you can’t find any physical explanation for their pain?
Conventional medicine decided that if it couldn’t find out what was causing the pain, at least it would treat the symptoms. Pain-killers are a type of medication that work by blocking the transmission of pain signals to the brain. This blockage can occur in the neurons directly around the hurting area or in the nerves in the central nervous system. By disrupting the chemical signal and not allowing it to pass from one neuron to another, pain relievers effectively stop pain in its tracks. As most people know, their effect is not permanent. Over the course of a few hours, the chemicals that block the neuron transmissions are cleared away by our body. As the chemicals disappear, the pain comes back. That is why people who are in pain for a longer period of time have to take analgesics every couple of hours. This is a great method of treatment because it does not require an understanding of exactly how or where the pain is coming from.
Unfortunately, pain-killers are not a perfect solution. Although they work well in the short run, frequent use of pain-killers builds up a certain resistance to their effect. After using a certain pain medication for a while, the body needs more and more of it for it to have the same affect. It gets to a point where for the medicine to have its relieving affect, a person would have to consume more of it than is considered safe. When this happens, the person will have to move on to a more potent medicine. After a while, the person may grow full tolerance to all the major kind of pain-killers, leaving him or her with no source of relief. This leaves the person worse off than before and ultimately renders pain-killers useless in the battle against chronic pain.
Although conventional medicine has undoubtedly helped countless people from all four corners of the world, when it comes to chronic pain, there is only so much that it can do. Luckily, that does not mean that people who suffer from chronic pain should give up on getting better. All of the previously mentioned treatments do not seem to provide a permanent cure. The good news for people with chronic pain is that that is not the only thing they have in common. All of those treatments try to cure chronic pain by stopping the pain on a physical level. For many years, medical professionals have focused on treating the physical side of chronic pain and neglected the other essential half: the psyche. Now, with awareness of the of the important role of psychology in experiencing pain spreading, more and more doctors are turning their attention away from trying to treat the body and are focusing on how to use the power of the mind to cure chronic pain. So far, they have had a lot of interesting results.
The first method of psychological treatment is called Distraction Therapy. The theory behind it is pretty simple. Since we need to give pain a certain amount of attention for us to actually feel it, and since the more attention we give it the more intense the sensation is, then it follows that distracting ourselves from the pain should lessen its intensity and possibly cure it altogether. Although the phrase “distraction techniques” sounds like something from advanced psychology, it is actually very simple. For some people, going for a nice walk out in nature or spending time with some friends will distract them. For others, just watching TV, might suffice. Each individual must come up with their own means of distracting themselves.
For some people, especially those with more extreme cases of chronic pain, effectively ignoring their pain can be very difficult. It takes time but with practice, and maybe the help of a psychologist, anyone can learn to ignore their pain. According to a study done by Masome, Yaghoubi and Keikha, there is a significant correlation between happiness and ignoring pain (Masone & Yaghoubi & Keikha, 2011, p 64). According to their study, the correlation between happiness and ignoring the pain was higher than any of the other variables tested.
The second major form of treatment is referred to as Interceptive Exposure. This is the complete opposite of distraction therapy. Instead of directing the patients focus away from his or her pain, interceptive exposure helps the patient focus on it. This may seem counter-intuitive. As we have seen before, focusing on the pain can make it worse. The difference is in the attitude with which the person focuses on the pain.
If you recall, vigilance is the abnormal focus of a person on his or her pain. In this context, “abnormal” means that the patient is focusing on his or her pain with a sense of fear, depression, or anger. This is where vigilance and interceptive exposure differ. Interceptive exposure is a series of exercises that help the patient focus on his or her pain with an attitude of acceptance. The outcomes are as different as the attitudes associated with them. Interceptive exposure is usually very effective in treating chronic pain. As the person focuses on his or her pain and accepts that pain, the body habituates. Habituation is a decrease in the strength of response to a repeated stimulus (Passer & Smith, 2011). As the body habituates to the pain, the pain begins to disappear. Even though, neurologically speaking, the neurons are still firing, the brain no longer interprets those electric impulses as pain but as normal neural activity.
Because it is very easy to switch from focusing on pain in a positive light to focusing on pain in a negative light, interceptive exposure is usually done in the presence of a psychologist who guides their attitudes and helps keep them calm by using basic relaxation techniques. This is very important for the success of the treatment. If the patient is experiencing negative emotions while doing the mental exercises, the treatment will do more harm than good.
The third method of treatment is known as Cognitive Restructuring. This is slightly different from the other two methods in that it doesn’t actually target the pain itself. Cognitive restructuring is reshaping the way a patient thinks about the situation he or she is in. It aims to change people’s thought processes from negative to positive. This can be done in many ways. Decreasing the amount of negative thoughts that a person has drastically increases that person’s reported levels of satisfaction. By focusing on the bright side, chronic pain patients will feel better about their lives even if the pain they are living with is not reduced. Cognitive restructuring can also be used to manage people’s expectations. This is very helpful because, as we mentioned before, expectations play a large role in how we experience pain.
Since cognitive restructuring is aimed at helping people deal with their emotions, it is often a starting point for a person’s treatment. Many doctors will use it as a platform from which they will launch off to other forms of treatment. Since the other treatments usually take some time to show results, it is important to manage the patient’s emotional responses and expectations using cognitive restructuring.
There are many other forms of psychological pain treatment but the above mentioned are the most commonly used today. With more and more people deciding to try non-conventional treatments, the popularity of psychologically treating pain has increased. It is amazing to be able to harness the power of the mind and use that to heal the body. This is why the psychological treatment of pain patients is witnessing unprecedented successes in the field. The cure to chronic pain does not lie in conventional medicine because the cause of the pain does not lie in our bodies. The answer has been with us all along: our minds.
In conclusion, where treating the body has failed, there is nothing left to do but treat the mind. Conventional medicine has reached its limits for now. The evidence is compelling; people with chronic pain should seek help and try to heal their pain psychologically. They should turn to psychology as a first resort and not a last ditch effort. Nobody should have to live through the pain that they do. Now, thanks to advances in the field of psychology, less and less people will ever have to.
Azizi, m., Yaghoubi, N., & Keikha, A. (2011). The Study of Relationship between Coping with Pain Experiences (Migraines) and Happiness. Modern Applied Science, 5(4), 63-67. doi:10.5539/mas.v5n4p63. Retrieved from: http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=65144913&site=ehost-live
Beard, D., & Aldington, D. (2012) Psychosocial Correlates of Chronic Pain and Depression in Young Adults: Further Evidence of the Utility of the Profile of Chronic Pain: Screen (PCP: S) and the Profile of Chronic Pain: Extended Assessment (PCP: EA) Battery., 14(1), 57-66. doi:10.1177/1460408611412434 Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=69612355&site=ehost-live
Linton, S. J., & Shaw, W. S. (2011). Impact of Psychological Factors in the Experience of Pain. Physical Therapy, 91(5), 700-711. doi:10.2522/ptj.20100330 Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=60677655&site=ehost-live
Passer & Smith, (1965). Psychology: The Science of Mind and Behaviour, McGraw-Hill
Shawn, R. C. & JianLi W. (2003). Chronic Back Pain and Major Depression in the General Canadian Population, Pain, Vol, 107 Retrieved from http://www.sciencedirect.com.ezproxy.aub.edu.lb/science/article/pii/S030439590300397X