Chronic pain and mental health: Psychological interventions

by | Mar 15, 2023

chronic pain and mental health

Your chronic pain is relentless, you don’t want to rely on meds, and you’re anxious and depressed. Wisely, you’ve decided to learn about psychological interventions. Say no more…

Dr. Darnall submits that psychological treatments should be first-line, applied early, and not just recommended after meds and/or physical treatments don’t deliver.

We started our two part series last week with Chronic pain and mental health: What you need to know.

The article detailed my induction into the chronic pain club. And we took a look at a new study that reviewed how folks with chronic pain can protect their mental wellbeing.

For yet more helpful info, let’s do part two…

”Psychological Interventions for the Treatment of Chronic Pain in Adults”

I found a fabulous article in the journal, Psychological Science in the Public Interest.

“Psychological Interventions for the Treatment of Chronic Pain in Adults,” published in September of 2021, was written by a high-powered team of psych researchers led by Dr. Mary Driscoll.

Highlights are in order…

What is chronic pain?

The team kick things off with the International Association for the Study of Pain’s definition of chronic pain: “…ongoing or recurrent pain that lasts beyond the usual course of acute illness or injury or for more than 3 to 6 months and adversely affects an individual’s well-being.”

They went on to make these observations…

  • Chronic pain is commonly viewed as a symptom, but can also be seen as a disease.
  • In many cases, the underlying biology of chronic pain are unknown, therefore medical interventions might not be beneficial.
  • People with chronic pain often report frustrations with health care systems and health insurance.

And perhaps the most important observation: the significant negative consequences of chronic pain go beyond physical suffering, affecting wellbeing, emotional functioning, and overall quality of life.

Those of us tussling with chronic pain know that all too well.

The biopsychosocial model of chronic pain

treatment of chronic pain in adults

“The pain is excruciating. And my anxiety, depression, and social life aren’t much better.”

To explain its complexities, the team use the biopsychosocial model of chronic pain.

That’s significant because It emphasizes the interrelatedness of biological, psychological, and social factors.

And wouldn’t you know it, the biopsychosocial model is recognized as the foundation for the study of pain and the clinical practice of pain management.

Chronic pain and mental health: Psychological interventions

The team point out that a variety of psychological factors play a role in the onset, maintenance, and exacerbation of chronic pain. And a variety of psychological interventions are used to treat them.

Here are the interventions most widely accepted within the pain-care community…

  • Supportive psychotherapy: emphasizes unconditional acceptance and empathic understanding.
  • Relaxation training: uses breathing, muscle relaxation, and visual imagery to counteract the body’s stress response.
  • Biofeedback: uses biofeedback equipment to monitor physiological responses to stress and pain and teaches how to down-regulate the body’s physiological responses.
  • Hypnosis: involves a clinician’s hypnotic suggestion to reduce pain and incorporates relaxation training.
  • Operant-behavioral therapy: seeks to replace maladaptive behaviors consistent with the “sick” role with healthier “well” behaviors.
  • Cognitive behavioral therapy: identifies and seeks to change maladaptive thoughts about pain that cause distress and unhelpful behaviors, such as isolation and withdrawal; promotes the development of helpful behavioral coping strategies (e.g., relaxation).
  • Acceptance and commitment therapy: encourages acceptance of chronic pain and focuses on strategies for identifying and reinforcing behaviors consistent with the desired goals.
  • Mindfulness-based interventions: aim to disentangle physical pain from emotional pain via increased awareness of the body, the breath, and activity.
  • Emotional-awareness and expression therapy: highlights the interconnectivity of brain regions responsible for processing physical pain and emotions; encourages confronting avoided emotions to reduce the connection between emotions and pain.
  • Psychologically informed physical therapy: integrates physical therapy and cognitive behavioral therapy.

Keep in mind, sex, gender, and sociocultural factors may present differences in risk for pain, suboptimal treatment, and poorer pain outcomes.

If it hasn’t already crossed your mind, I suggest that you use the list as a screening tool for current and future care providers.

It’s simple. If they have a profile available, look for your therapy of choice. No profile? Give them a call: “Are you qualified in _____?”

Integrated pain care

integrated pain care

“Yeah, it still hurts. But having a care team on my side makes a huge difference.”

The team noted that in 2016 the U.S. Department of Health and Human Services published its National Pain Strategy (NPS).

The NPS calls for “integrated pain care” and defined it as “the systematic coordination of medical, psychological, and social aspects of health care.”

That’s right, the biopsychosocial model. Seems to be a lot of it going around. And that’s a good thing.

Critical role for psychology

According to the team, all models of pain-care delivery that comply with NPS recommendations suggest a critical role for psychology in treating chronic pain.

Now, there are bound to be issues with psychology being a major player. Well, barriers will have to be torn down.

Speaking of which: patients not recognizing the benefit of psychological treatments, stigma toward mental health treatments, providers misunderstanding the rationale and mechanisms of psychological treatments, inadequate insurance coverage to ensure timely and equitable access to treatments.

Time to rephrase

The team included an insightful commentary from Dr. Beth Darnall.

Dr. Darnall submits that psychological treatments should be first-line, applied early, and not just recommended after meds and/or physical treatments don’t deliver.

It gets even better. She believes describing psychological treatment as “pain coping skills” is often misinterpreted by patients as “learning to cope with pain.”

According to Darnall, that’s a problem and it’s time to rephrase. She says the most accurate description of psychological treatment is “…directly reducing the intensity of pain and favorably shaping the nervous system toward relief.”

A mouthful, but she’s spot on.

We all need support

None of us have to endure chronic pain alone – even if we live alone. I mean, we all need – deserve – support.

In addition to groups you may find on, say, Facebook, see what’s up in these neighborhoods…

Pain Connection

U.S. Pain Foundation

Chronic Pain Association of Canada

Chronic Pain Anonymous

American Chronic Pain Association

International Pain Foundation

But it always was

Let’s see, relentless chronic pain, trying to go easy on meds, anxious and depressed, dicey social life. Absolutely, it’s time for psychological interventions.

But it always was.

Be sure to dig in to part one: Chronic pain and mental health: What you need to know

And head on over to Psychological Science in the Public Interest and read the full article: Psychological Interventions for the Treatment of Chronic Pain in Adults

Finally, take a moment to peruse those Chipur mood and anxiety info and inspiration titles.

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