While many of its effects are physical, chronic pain can also impact one’s mental health. It is often closely linked to stress, depression, and anger issues. Many people with chronic pain can benefit from adding a therapist to their treatment team.
HOW PSYCHOTHERAPY CAN HELP WITH CHRONIC PAIN
Chronic pain and mental health issues often feed into each other. For example, back pain may lead to insomnia. A lack of quality sleep can increase one’s fatigue, stress, and physical tension. As the cycle progresses, an individual’s condition may worsen. A therapist can help break this cycle by teaching a person about sleep hygiene practices.
Reducing stress is often a key goal in therapy. A therapist may teach the individual how to recognize and avoid stress triggers. A person may also practice relaxation techniques such as meditation. Lowering stress levels can reduce the perceived intensity of one’s physical pain. Therapy can also influence how the brain processes pain. According to the American Psychological Association, there are some cases in which psychotherapy can be as effective in relieving pain as surgery.
Biofeedback is a technique that can teach people to identify how their body experiences pain. In biofeedback, a person can get real-time data on their heart rate, brain waves, etc. As a person makes subtle changes to their thinking, they can see what tactics help them relax and ultimately gain more bodily awareness.
Many people with chronic pain also have depression. These people may be at increased risk of attempting suicide. Therapy can be vital for improving these individuals’ wellbeing. A therapist can help people with chronic pain feel hope again.
Therapy can be especially effective when one’s chronic pain has emotional roots. Some people convert mental pain into physical pain through an unconscious process called somatization. A compassionate therapist can help a person confront these underlying emotions. With support, a person can learn to reduce their psychological distress without converting it to pain.
SELF-HELP FOR CHRONIC PAIN
In addition to treatment, a person may use lifestyle changes to reduce pain. These could include:
- Workplace ergonomics: Sometimes people experience pain due to prolonged standing or repetitive movements. Workers can make small adjustments to their environment to reduce these triggers. A cashier may request a stool for their work station. An office worker may request an ergonomic computer mouse.
- Exercise: Many people can find relief from pain through exercise, which releases endorphins that act as natural pain killers. Individuals with limited mobility can still see benefits from doing stretches or a short walk.
- Social visits: Having a fun outing with family and friends can temporarily distract a person from their pain. Research shows social support can improve resilience. It can also decrease symptoms of anxiety and depression.
- Complementary and alternative medicine (CAM): Some people may find relief with CAMs such as massage or mild electrical stimulation. A 2018 meta-analysis by the American Pain Society found acupuncture reduced chronic pain for up to 12 months after treatment. (Said results were too consistent to be explained via the placebo effect.)
Depending on the situation, some lifestyle changes may be more feasible than others. An individual’s care team can help them find strategies that suit their unique needs.
CHRONIC PAIN AND OPIOIDS
Treating chronic pain with opioids often involves a difficult balance of priorities. On one hand, untreated pain can cause a severe drop in one’s quality of life. On the other hand, opioids pose a serious risk of addiction and overdose.
The National Institute on Drug Abuse (NIDA) says that among people prescribed opioids for chronic pain:
- Nearly 20% have experienced an overdose.
- 21-29% have misused the prescribed opioids.
- Up to 6% of people who misuse prescription opioids eventually transition to heroin.
In emergencies, an opioid overdose can be reversed with a drug called naloxone. Naloxone binds to opioid receptors in the brain, reversing the impact of opioids. Once used, naloxone may cause opioid withdrawal symptoms such as nausea or tremors. Otherwise it has no side effects.
Some states allow laypeople to purchase naloxone over-the-counter. After administering naloxone, it is important to call 911 so the affected individual can be monitored. Since naloxone lasts 30-90 minutes in the body, it may wear off before the opioids do. Medical personnel typically observe the individual for 2 hours to ensure they continue breathing.
If the overdose was caused by opioid abuse, the affected person may wish to get therapy for addiction. A mental health professional can coordinate with the rest of an individual's care team to safely manage chronic pain. If a person’s relationships have been impacted by the overdose or addiction, family therapy or couples counseling may also be appropriate.
CASE EXAMPLE OF THERAPY FOR CHRONIC PAIN
- Exploring roots of chronic, somaticized pain: Giulia, 47, complains of several chronic pain issues, including muscle aches, headaches, and a stiff back. She refuses the therapist's suggestion that her pain may have emotional roots. Instead she prefers to talk about the conflict in her friendships. The therapist follows Giulia's lead and does not bring up the interpretation of her pain again, but simply explores Giulia's feelings towards her relationships. After several weeks, Giulia begins crying regularly in session. Guilia says she feels ashamed of herself for doing so. After normalizing the need to cry, the therapist is able to uncover deep fears of abandonment, about which Giulia continues to cry. Before long, Guilia reports that her physical pains are diminishing. However, the pains have led her to adopt a sedentary lifestyle, which has led to muscle atrophy, so her pain does not disappear entirely. The therapist recommends physical therapy to address these issues.
- Chronic Pain: Symptoms, Diagnosis, & Treatment. (2011). NIH Medline Plus, 5-6.
- Deardorff, W. W. (2016, July 1). 4 tips to help cope with chronic pain and depression. Retrieved from https://www.spine-health.com/conditions/depression/4-tips-help-cope-chronic-pain-and-depression
- Devitt, M. (2018, May 21). Research finds acupuncture effective for chronic pain. AAFP. https://www.aafp.org/news/health-of-the-public/20180521acupuncture.html
- Managing chronic pain: How psychologists can help with pain management. (2013, December 1). Retrieved from http://www.apa.org/helpcenter/pain-management.aspx
- Naloxone for opioid overdose: Life-saving science. (2018). Retrieved from https://www.drugabuse.gov/publications/naloxone-opioid-overdose-life-saving-science/naloxone-opioid-overdose-life-saving-science
- Opioid overdose crisis. (2018). Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
- Opioid overdose reversal with Naloxone (Narcan, Evzio). (2018). Retrieved from https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio
- What is chronic pain? (n.d.). WebMD. Retrieved from http://www.webmd.com/pain-management/guide/understanding-pain-management-chronic-pain