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MY SPECIALTIES
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Chronic pain What is "chronic pain"? Chronic pain is persistent, long-lasting discomfort that doesn't resolve on its own or respond to routine pain-relief methods. Chronic pain comes in many forms, including headaches, arthritis, shingles, sciatica, back pain, neck pain, and cancer pain. In addition to being relentlessly uncomfortable, chronic pain clouds the way you think and feel about yourself and life in general. It impairs normal functioning and is usually accompanied by fatigue, difficulty sleeping, anxiety, and depression. How is chronic pain treated? Unfortunately, chronic pain is poorly recognized, poorly assessed, and inadequately treated in a large portion of patients. Many medical professionals often lack the attentiveness and skills necessary to deal with the complex needs of patients living with different kinds of chronic pain. Fortunately, this situation is beginning to change, and increasingly more professionals are becoming aware of the importance of treating pain. There are a variety of options for treating chronic pain. Pain-relieving drugs (analgesics) are a mainstay of chronic pain management. Mild discomfort can be relieved with drugs such as acetaminophen (Tylenol), aspirin, prescription and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Stronger drugs may be used to manage more difficult pain problems. Pain is a complex syndrome, and medication works better when combined with complementary approaches such as relaxation techniques, biofeedback, psychological counseling, or self-help programs designed to address the mental and emotional aspects of chronic pain. Even though many pain sufferers are hesitant to engage in day-to-day activities, getting back to a reasonable level of functioning is important. I'm afraid that my regular doctor will think I'm just a complainer if I bring up my pain as a problem. Many people feel uncomfortable seeking treatment for their pain, believing that doctors will dismiss them as hypochondriacs. Even so, you must be proactive in your care. You have the right to have your description of pain believed and treated. Be prepared to describe your pain to your primary care doctor. Helpful words might be "sharp," "stabbing," "achy," "throbbing," "burning," or "shooting." Rate your pain on a scale of "0 to 10," with "0" being "no pain" and "10" being "worst possible pain." Give specifics about what you have tried that has helped or worsened the pain. Have your tried over-the-counter drugs, heat or cold, massage, acupuncture, and so forth? How long does the pain last? How often does it recur? Does it move from one part of the body to another? What seems to provoke it-sitting, standing, noise? How long have you suffered this pain? How can I find a doctor who is able to treat my pain? Your primary care doctor may be willing and able to work with you to help manage your pain. He or she can also refer you to a pain specialist or a pain-management clinic. If you reach a point where your primary care doctor is not able to do anything further for your pain, you may want to consider seeing a doctor who specializes in the treatment of pain. Your primary care physician might be able to refer you to one, or you could go through one of several organizations such as those described below: The American Board of Medical Specialties is an umbrella organization for 24 medical boards and is considered the standard for medical specialty certification. To find out if a physician has American Board of Medical Specialties subspecialization in Pain Management, type in his or her name at www.abms.org/newsearch.asp or call the Board's certification verification line at 1-866-ASK ABMS (275-2267). The American Board of Pain Medicine (ABPM) is an independent organization not affiliated with the American Board of Medical Specialties. ABPM also certifies qualified physicians in pain medicine. To get a list of ABPM Diplomates, go online to www.abpm.org or write: 4700 W. Lake Avenue, Glenview, IL 60025 The American Academy of Pain Management is an organization that includes
many types of health professionals besides physicians. Included are acupuncturists,
chiropractors, dentists, nurses, psychologists, and physical therapists.
To see if your health professional is a member, go online to www.aapainmanage.org
or write: 13947 Mono Way #A, Sonora, CA 95370. How can psychotherapy help? Treating pain from the vantage point of the mind is an important component of a team approach to pain management. The team consists of the pain doctor, who is the quarterback of your medical team, a physical therapist, and a psychologist trained in the psychological management of pain. Other members of the team might include the acupuncturist, a chiropractor, or some other appropriate health professional. Pain consists of four parts. The first is the physical cause of the pain signal, which may be the result of injury, inflammation, or disease. The medical treatment of pain focuses on this aspect of pain. The second aspect of the pain experience is muscle tension. There is an important interplay between pain and muscle tension. Almost instinctively, people react to pain by bracing themselves. Muscles tighten and immobilize the areas surrounding pain. In the short run, muscle bracing contains the pain and prevents further pain-aggravating motion. Unfortunately, with long-term pain, the continued bracing seems to increase the pain and cause it to spread to adjoining areas. Although medication can help, non-pharmacological ways exist to relax muscles - massage, stretching, physical therapy, and the powers of the mind. The latter includes diaphragmatic breathing, progressive muscle relaxation, autogenic training, medication, and guided imagery. Attention and interpretation are the other two aspects of pain. The more a person focuses on pain, the more intense it gets. However, deep absorption in something else will push pain from consciousness, at least temporarily. Learning to control focus of attention can be a powerful means to alter pain. Meditation is a technique that develops control over attention and can be very useful in controlling pain, but it requires practice. Other means of attentional control include hypnosis and guided imagery. Interpretation of pain includes the thoughts, emotions and attitudes people have in reaction to pain. There is a difference between pain and suffering. Pain is only a sensation; suffering is all the interpretation we give to it - the judgments, expectations, attributions, and emotions that can habitually accompany the sensation. Thoughts like, "I can't stand it. Why me?" only increase the suffering component of pain. Treatment in this area involves becoming more aware of how thoughts and beliefs impact experiences of pain, and learning how to change your interpretation to reduce suffering. There is a saying that applies here: "Pain is inevitable; suffering is optional." Three of the four aspects of pain are clearly territories of the mind and the focus for psychotherapy. Muscle tension, attentional focus, and interpretation are all amenable to psychologically based strategies. These mind-based pain control skills take time, effort, and practice to learn. Not everyone can do this, but those who do can take control of their pain and even reduce their need for medication. Remember that chronic pain is managed, rather than cured. Management requires knowledge and the development of self-care skills. Psychotherapy can't take away pain, but it can help you cope better with it.
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Dr. Joyce Nash, PhD (650) 329-1000 |
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