Wednesday, February 6, 2013
Controlling Pain with Psychological Methods
Cognitive strategies can change the perception of pain through cognitive restructuring (Marks, Murray, Evans, & Estacio, 2011; Carmody et al., 2000). One benefit is that after a few relatively brief coping skills trainings, patients can implement relaxation and distraction techniques to cope with pain successfully (Gil et al., 2000). A goal of cognitive restructuring is to intervene with negative thought patterns, although these prove difficult to affect permanently (Gil et al., 2000). Brief training was beneficial (in patients with sickle cell disease), but without continuing practice, the results became less beneficial over time (Gil et al., 2000). Gil et al. (2000) did find that when patients practiced daily, they were less apt to have to seek more immediate medical help for pain. The benefits for this type of pain management were significant, since these patients were able to self-manage their pain and decrease catastrophizing as well as other negative thought processes (Burns, Kubilus, Bruehl, Harden & Lofland, 2003; Carmody et al., 2000).
Using visualization techniques works as a distraction to pain, refocusing the patient's attention on mental images (Turk et al., 2008). These techniques may work well for some patients (Marks et al., 2011), although others may have difficulty conjuring the images. Research suggests imagery techniques are better used in concert with cognitive behavioral therapy and may not be effective as a sole therapy (Turk et al., 2008).
Because pain can be a physical manifestation of psychological distress, psychodynamic and insight-oriented therapies may help resolve obscure internalized early childhood issues that influence chronic pain (Turk et al., 2008). Although the effects of childhood abuse in chronic pain have been documented (Raphael, Chandler, & Ciccone, 2004; Toomey, Seville, Mann, Abashian, & Grant, 1995; Turk et al., 2008), determining causality in these cases proves challenging (Raphael et al., 2004). There is a paucity of research on the use of the psychodynamic and insight-oriented approaches for these circumstances, and although evidence is lacking on the affects of these approaches, they may work well for some individuals.
A substantial amount of research supports cognitive-behavioral therapy (CBT) as effective therapy for chronic pain. This approach uses a combination of cognitive and behavioral techniques to relieve chronic pain (Marks et al., 2011). Turk et al. (2008) suggest, however, rather than patients' implementation of a range of techniques from both cognitive and behavioral approaches, CBT considers patients' overarching beliefs, attitudes, and expectations that drive their overall ability to manage chronic pain. Further, CBT fosters a sense of resourcefulness that comes from self-control and self-management and replaces patients' sense of hopelessness, which can exacerbate pain (Turk et al., 2008). Although Marks et al. (2011) claimed approximately 85% of patients benefitted from CBT, it may not work as well for children, older adults, and those with cognitive deficiencies. Carla et al., (2012) found the effects of CBT were long term for chronic pain patients with insomnia. The positive outcomes of chronic pain self-management may be improved with individualized treatment plans that make implementation and adherence realistic for the patient (Heapy, Stroud, Higgins, & Sellinger, 2006). As with other psychological modalities, the use of techniques must be ongoing for continued benefit.
Even under the best medical care, most individuals with chronic pain continue to have persistent pain (Turk et al., 2008). Accordingly, self management is a crucial adjunct therapy to a realistic comprehensive program that uses a variety of treatment modalities that have been proven to produce better long-term, efficient, cost-effective outcomes for treating chronic pain (Gatchel & Okifuji, 2006).
Burns, J. W., Kubilus, A., Bruehl, S., Harden, R. H., & Lofland, K. (2003). Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis. Journal of Consulting and ClinicalPsychology, 71, 81–91. doi:10.1037/0022-006X.71.1.81
Carla R., J., Yolande, T., Michael T., S., Wilfred R., P., Sara, M., Yinglin, X., & Michael L., P. (2012). The Durability of Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain. Sleep Disorders, doi:10.1155/2012/679648
Carmody, T. P., Duncan, C. L., Huggins, J., Solkowitz, S. N., Lee, S. K., Reyes, N., & ... Simon, J. A. (2012). Telephone-Delivered Cognitive–Behavioral Therapy for Pain Management Among Older Military Veterans: A Randomized Trial. Psychological Services, doi:10.1037/a0030944
Gatchel, R. J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and costeffectiveness of comprehensive pain programs for chronic nonmalignant pain. The Journal of Pain, 7,779–793. doi:10.1016/j.jpain.2006.08.005
Gil, K. M., Carson, J. W., Sedway, J. A., Porter, L. S., Schaeffer, J., & Orringer, E. (2000). Follow-up of coping skills training in adults with sickle cell disease: Analysis of daily pain and coping practice diaries. Health Psychology, 19(1), 85-90. doi:10.1037/0278-6220.127.116.11
Heapy, A. A., Stroud, M. W., Higgins, D. M., & Sellinger, J. J. (2006). Tailoring Cognitive-Behavioral Therapy for Chronic Pain: A Case Example. Journal Of Clinical Psychology, 62(11), 1345-1354. doi:10.1002/jclp.20314
Marks, D. F., Murray, M., Evans, B., & Estacio, E. V. (2011). Health Psychology: Theory, Research, and Practice (3rd ed.). London: Sage.
Raphael, K. G., Chandler, H. K., & Ciccone, D. S. (2004). Is childhood abuse a risk factor for chronic pain in adulthood? Current Pain and Headache Reports, 8(2), 99-110. doi: 10.1007/s11916-004-0023-y
Toomey, T., C., Seville, J., L., Mann, J., D., Abashian, S., W., & Grant, J., R. (1995). Relationship of sexual and physical abuse to pain description, coping, psychological distress, and health-care utilization in a chronic pain sample. Clinical Journal of Pain. 1995;11:307–315.
Turk, D., Swanson, K., & Tunks, E. (2008). Psychological approaches in the treatment of chronic pain patients--when pills, scalpels, and needles are not enough. Canadian Journal Of Psychiatry. 53(4), 213-223.