Psychotherapeutic Approaches in the Treatment of Pain

“I’m not a top, I will not go to a psychologist.” So many of us have not heard such an opinion. Why do not people want to help themselves? Unfortunately, in Poland regular visits to the psychotherapist are stigmatizing, because “normal do not go to a psychologist.” Not many people know that psychotherapy can help to many diseases, not only those associated with mental disorders, which are also a disease. And that’s how psychotherapy is a very effective method of pain treatment.

Today we know that pain is not equal, and different types of pain require different treatment. Acute pain, whose task is to alert about damage (eg pain sensation, when we break a hand or cut a finger with a knife) will not necessarily require psychotherapy. However, in the case of chronic pain, which lasts longer than it should (for example, the expected duration of pain after fracture is 6 weeks, and you have a painful hand for 3 months), psychotherapy may be the most effective. However, the problem arises at the very beginning of our path to cure, because chronic pain can have a different background, which makes diagnosis difficult and therefore sometimes prevents effective treatment. Nociceptive pain, i.e. a clearly visible physical cause, is often successfully treated pharmacologically. It is different in the case of neuropathic or psychogenic pain. Neuropathic pain caused by peripheral nerve injury is called “Silent disease”, often imperceptible even to an experienced doctor. It happens that it is sometimes confused with psychogenic pain, which has no physical basis.

Note! Psychogenic pain is extremely rare. Psychics play an important role in pain, but pain usually has its physical cause.

Our brain is responsible for the sensation of pain, which consists of a network of connections between areas performing various functions. When he receives information about the fact that something hurts us, other areas responsible for emotions or the storage of memories are activated. In this way, an emotional reaction to pain arises. For example, a woman once again has a strong headache and does not allow her to play with children, which causes her frustration and feelings of helplessness. These thoughts and emotions can modulate the sensation of pain. Another example is a person who has undergone kidney stones and now every little prick in the side receives as an attack, a relapse of the disease. The pain may seem stronger than she would have been if she had never been ill before. A positive example of the impact of emotions on the sensation of pain may be a person who broke his arm, but has just learned that he will get a high compensation from the insurer. This time the pain may seem less to the person than he would if he did not receive any good news. Emotions can be so strong that they are able to suppress the sensation of pain. A marathon runner who spins his ankle while running may not be aware until the route is completed. This is due to endorphins – substances that secretes our brain when we are excited or happy. Endorphins are natural opioid derivatives and have an analgesic effect.

People differ not only in how they affect pain, but also in how pain affects them. There are those who experience pain, but they do not suffer because, for example, they have a high tolerance for pain or simply can fight pain and its consequences. There are also those who suffer the pain experience very badly. Negative thoughts often appear in them (“I’m good for nothing”) and catastrophes (“I will never be free from pain”). Feeling pain can also increase the sense of danger in these people. This is because the pain originally arose for this purpose – to inform about the danger. Psychotherapy is usually dedicated to a group of people whose pain has negative consequences, especially emotional ones.

Remember! Emotional problems may arise not as a reaction to pain, but also as a result of long-term treatment.

It is estimated that psychological problems affect 30-100% of the population suffering from chronic pain. This chronic pain causes them to be much more than an acute pain. People with chronic pain mainly suffer from depression more often. But why?

“First, the pain that persists despite pharmacotherapy causes frustration and a sense of control. This prolonged condition can cause muscle tension, which only exacerbates pain. A self-winding spiral is created, which is difficult to stop.

Pain causes some physical limitations that are the cause of various undesirable behaviors such as withdrawal from social contacts, isolation or overeating. These behaviors can exacerbate the pain, because if you break your contacts with your loved ones, then you will lack such an important support in the process of recovery. Incorrect eating can affect your health or make you gain weight, which certainly will not affect your well-being. Therefore, not only emotions, attitudes and thoughts, but also behaviors will be the subject of psychotherapy.

Cognitive therapy

Cognitive therapy is a specific type of therapy that aims to teach a person suffering from chronic pain in dealing with this experience by controlling thoughts and imaginations. Psychotherapy is also focused on emotions. All these elements need changes so that the person can effectively fight the pain. An important element of therapy is the identification of negative thoughts at the beginning, followed by their evaluation and modification. When you get rid of these thoughts and change into their positive counterparts, you will be able to change your beliefs and attitudes. At the end, the person is trying to solve the problems related to pain and learns. There are negative thoughts about pain that can be generalized for a lifetime, eg “I suffer because I deserved it.” I have made many mistakes in the past. ” or “Pain is still with me, I’m not able to function normally, I’m hopeless and I will never get better again.” People experiencing chronic pain are sometimes additionally burdened with more specific problems such as job loss or financial difficulties. What is worse, family relationships are often strained and the closest, instead of helping, are harmful. The pain just causes tension and various relaxation techniques. In all this restructuring under the influence of therapy, it is very important for a person to learn to perceive pain as a dynamic and multifactorial phenomenon. This will help her to see a close relationship between thoughts, feelings and behaviors. When the adverse reactions are already recognized, the person learns with the help of a therapist how to replace them with appropriate treatment strategies.

One of the most important healing factors in psychotherapy is the ability to talk with someone empathic, who believes in us and tries to understand us. Earlier contacts of people with doctors could not have such a positive effect

Cognitive therapy can be carried out in the form of group therapy. A very important element of such therapy is contact with people who experience the same, understand us and the fact that we can help others. On the other hand, individual therapy is specially prepared for a specific person. Sometimes individual and group sessions are combined because they are the most effective in a duet.

Who is cognitive therapy for?

Cognitive therapy is for you if:

  • you suffer from chronic pain,
  • you can not deal with him,
  • you can not cope with the emotions that it causes (outbursts of anger, crying),
  • you have negative thoughts related to pain (“I am sore and hopeless, I’m fine.”),
  • you do not feel support in the family,
  • previous pain management was ineffective.

The indication for psychotherapy may be another problem that we have not mentioned above. If you just feel that it could help you, it’s worth a try.

Cognitive therapy is not for people:

  • with cognitive disorders (thinking, attention, planning, for example in dementia),
  • with memory disorders that make it impossible to remember what happened during therapy sessions,
  • with current psychotic disorders.
  • or those who do not have cognitive therapy, behavioral therapy or a support group can be proposed.

Behavioral therapy

During behavioral therapy, patients recognize and change anti-health behaviors (eg lack of movement) and self-destructive (eg isolation), that is, those that we simply damage. In addition, they implement techniques such as modeling, or learning by observation, relaxation training and training of social skills.