By: Dr. Greg Harms
Right before Christmas I wrote an article about how to cope with chronic pain during the holidays. Since then I’ve received questions about why therapists should be concerned with chronic pain. After all, therapists treat things like depression, anxiety, substance use, marital problems; they’re not medical doctors. If someone has chronic pain, why should they turn to a psychotherapist? This is one of the exciting areas of mental health treatment.
It turns out that there is a huge connection between our brain and our body. What affects our bodies affects our emotional function, and what affects our emotions affects our bodies.
So, the easy answer to the question about how therapist can help with chronic pain is that by treating emotional conditions, pain can be lessened. Despite its biological origin, pain is a highly subjective and emotional experience. It is a well established fact that when our mental state is down (sad, dejected, anxious, fatigued, etc.), we are much more sensitive to physical pain. Two people can have the exact same injury and if one is depressed and one is not depressed, the person with depression will feel the pain more intensely. On the flip side, pain is also an inherently demoralizing experience. As it goes on, as is the case with chronic pain, it is natural for depression to start setting in, which creates a downward spiral. Therapy can help to reverse the depression and thus make the pain seem less painful.
However, there is much more to the connection between pain and depression that makes therapy a useful form of treatment. Other mental conditions can actually cause pain, particularly anxiety. When we are anxious, we often tense our muscles, especially in our shoulders and neck, and may experience other unpleasant bodily sensations such as upset stomach, feelings of choking, etc.
Prolonged muscle tension can cause serious headaches, so by treating the anxiety, the potential for long term pain is decreased. Some people in pain can also turn to addictive medications. Even under the supervision of a doctor, over time this use can become problematic and also makes the pain a lot worse, in a phenomenon known as rebound. Therapists can help with the recovery process and as patients become less dependent on medication, they may actually see an improvement in their pain as they are no longer in the overmedicate-rebound cycle.
There are also psychological treatments that can also directly impact pain, particularly biofeedback and hypnosis. Biofeedback involves training the body to relax and make other alterations in functioning, such as improving blood flow, reducing blood pressure, slowing heart rate, etc., all of which can help to decrease pain. A therapist will hook a client up to a measurement device, such as a thermometer, heart rate monitor, or simple electrodes like those used for EKG’s, which display the results on a screen.
The therapist will then walk the client through a relaxation or visualization exercise while the client watches on the screen and sees how his or her functioning changes as he or she engages. The client can then do these exercises at home to get the benefit with confidence that he or she is doing it correctly.
There is really good research that shows that daily engagement in a relaxation activity for 6 months can result in decreased frequency and severity of headaches! Hypnosis works in a similar way by hyperfocusing the client on a suggestion to the point where the client’s brain accepts it as true.
There are many hypnosis protocols for chronic pain that involve suggestions that change the sensation of the pain, reduce its intensity, and give the client the confidence that he or she can handle pain more effectively. There is also really good research supporting the effectiveness of hypnosis with chronic pain. However, not all therapists are trained in biofeedback and hypnosis.
It is not a standard part of the curriculum, so therapists need to seek out additional training to be able to provide these treatments. If this is something you are interested in, don’t just assume any therapist you find in the yellow pages will do it, you need to ask about it when setting the appointment. A Google search can help to identify therapists in your area, including those of us at Second Story Counseling, who can provide these services.
Chronic pain is a severely life-altering condition. Despite its medical origins, it requires a multi-disciplinary approach and mental health therapists can make a strong contribution to the client’s health. If you have been suffering from pain, you might want to consider meeting with a therapist trained in treating chronic pain to see how it might enhance your treatment and improve your quality of life.