Chronic Pain Management
Overcoming Anxiety, Depression
& Anger
Chronic pain can lead to hopelessness, depression,
anger and anxiety disorders such as: panic, generalised anxiety,
hypochondriasis and post traumatic stress disorder (see studies
cited in Winterowd, Beck& Gruener, 2003). This not surprising
as chronic pain sufferers may have many negative events and
stressors to deal with, apart from their pain, such as :losing
their jobs, experiencing financial hardship and having increased
stress upon their families. Chronic pain sufferers also may
have to contend with unpleasant side effects of pain killers
(and other medication) such as constipation, weight gain and
tiredness. Furthermore, chronic pain sufferers may find that
they can no longer engage in activities that they enjoyed
such as hobbies, crafts and sports, or that their participation
in such activities is greatly reduced. (Nicholas, Molloy,
Tonkin & Beeston, 2000) Chronic pain sufferers often end
up (1) inactive because they fear exacerbating their pain
through activity, (2) socially withdrawn and losing contact
with friends, and (3) overweight due to inactivity and/or
overeating
Research has shown that having realistic, helpful thoughts
is an important part of pain management. The cognitive model
of chronic pain is that negative, unhelpful, unrealistic thoughts
can lead to : increased perception of pain, anxiety, anger
and depression, social isolation and withdrawal, underactivity,
overreliance on pain medications and poor sleep (Winterowd
et al, 2003). Therefore, cognitive behavioural psychologists
aim to help chronic pain sufferers to change their negative,
unhelpful, unrealistic thoughts in relation to: their pain,
the effects the pain has had on their life, and other stressors
( e.g. legal issues, financial difficulties, unemployment).
Cognitive behavioural therapy, according to Winterowd et
al (2003), has been found by researchers to be a beneficial
treatment for chronic pain conditions including: arthritis,
whiplash, back pain, tendonitis, carpal tunnel, rotator cuff
syndrome, bursitis, noncardiac chest pain, knee pain and irritable
bowel syndrome.
Psychologists, using cognitive behavioural therapy, can assist
chronic pain sufferers to develop pain management skills.
Many people can learn pain management skills in as few as
12 sessions; however any treatment plan has to be tailored
to an individual's needs so the number of sessions required
may vary from person to person.
Cognitive behavioural therapy for chronic pain usually includes:
- relaxation techniques
- distraction techniques
- the pacing of activity
- challenging negative thoughts and beliefs about: pain, other stressors, the future and disability.
Relaxation Techniques
Relaxation techniques can reduce muscle tension and stress
and therefore chronic pain sufferers who practice relaxation
are better able to cope with their pain. Increased muscle
tension can further aggravate chronic pain. Helpful relaxation
techniques include, but are not limited to: deep breathing,
progressive muscle relaxation, biofeedback, guided imagery,
meditation and yoga. Relaxation is a skill which gets better
with practice so practice your favourite technique (e.g. yoga,
meditation or biofeedback) regularly. Relaxation can also
help chronic pain suffers to improve their ability to sleep
(Winterowd et al, 2003).
Challenging Negative Thoughts and Beliefs
Cognitive Behavioural therapy for chronic pain entails identifying,
evaluating and changing negative, unhelpful, unrealistic thoughts
, beliefs and images, Chronic pain sufferers may have unhelpful
beliefs about their pain, for example, " If may pain
increases I must be doing further permanent damage to myself"
or " I can't control my pain". Chronic pain sufferers
may also develop negative beliefs about themselves as being
weak, unlovable or incompetent. Pain patients may also have
negative thoughts and beliefs about other people as being
uncaring Pain patients may also predict bleak futures for
themselves. For example, " If I'm in this much pain now
just wait till arthritis sets in in my old age" or "
I can barely walk now, so in a few years time I'll probably
end up in a wheel chair" (Winterowd et al. 2003).
Distraction Techniques
Distraction techniques purpose is to get the chronic pain
sufferer to focus their attention on something other than
their pain. Distraction techniques may enable the sufferer
to experience somewhat less pain (Nicholas et al , 2000).
Pacing Techniques
Chronic pain sufferers often get into an overactivity -underactivity
cycle where they do more activity on their 'good days' when
their pain is lower, but then they spend a day or more resting
and recoverng from their burst of activity which has flared
up their pain. Pacing techniques aim to spread activities
evenly over the day and week so that flare ups in pain are
minimised and the pain sufferer can gradually increase the
amount of activity performed (Nicholas et al, 2000).
Where You Can Get Help.
Catherine Madigan, is a Melbourne clinical psychologist who
works with chronic pain sufferers and provides cognitive behavioural
therapy for chronic pain as well as anxiety disorders. Catherine
has worked in pain management programs in Victorian private
and public hospitals and currently sees chronic pain patients
in her private practice in Hawthorn, Richmond and Northcote.
Catherine is a registered provider of psychological services
for TAC and Workcover. For further details click
here.
REFERENCES:
Nicholas, M., Molloy, A., Tonkin, L. & Beeston. L. (2000)
Manage Your Pain. Practical and Positive Ways of Adapting
to Chronic Pain. ABC Books. Sydney, Australia.
Winterowd, C., Beck, A.T., & Gruener, D. (2003). Cognitive
Therapy for Chronic Pain Patients. Springer Publishing Company.
New York, New York.
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Anxiety
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