Facts About Pain
It is estimated that chronic pain afflicts as many as 100 million Americans per year with costs exceeding $560-635 billion dollars (Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research). There are an estimated 8.5 million Americans permanently disabled by back pain, 20-50 million arthritics and 10-20 million migraine headache sufferers. There are approximately 600,000 new arthritis cases diagnosed per year. Despite our medical knowledge and technology, it remains unclear as to why individual with the same medical diagnoses respond differently to identical treatment. Pain is a complex phenomenon, which is combination of physical, psychological and socio-environmental factors. Therefore, the successful treatment of chronic pain includes attention to each of these areas within an individualized treatment plan.
Pain is a warning signal that something is wrong with our bodies. In this regard, pain is valuable because it prevents further injury. However, long-term chronic pain no longer serves this useful purpose. When in danger or facing injury, the body naturally protects itself by tightening up and bracing against some type of assault. Sometimes, the muscles remain tight and naturally braced as if the brain forgot to “let go”. There are many sources of chronic long-term pain including this type of continuous muscle tension, scar tissue, disturbances in the mechanical alignment of the back, de-conditioning, muscle spasms, etc. Surgical procedures and medication are not helpful with many of these chronic pain disorders. Surgery may not be recommended by a physician due to the potential risks involved including the possibility of an increase in scar tissue, which may cause additional pain. The most effective pain medications often cause medical complications and side effects. Long-term use of pain medications may include stomach ulcers, gastrointestinal difficulties, liver and kidney damage, depression, cognitive impairment and chronic fatigue. Physical and psychological treatment may be the best or only options available to the chronic pain patient.
The Experience of Pain
The first thing that many patients tell us when they realize they have been referred to program involving a psychologist is that “the pain is not in my head.” While it is clear that chronic pain is not fake or imagined pain, the reality is that all pain is in our heads. The experience of pain is created in the brain. For example, individuals suffering from a phenomenon called “phantom limb pain” have the sensation of discomfort in a limb that no longer exists. The brain can create the sensation of pain even when there is no signal from an injured part of the body. Therefore, it makes sense to attempt to control pain by retraining the mind.
Effects of Chronic Pain
Unlike most injuries and disease processes, chronic pain does not follow the normal course of treatment or recovery. When we are sick or injured, the normal course of treatment is to go to bed and heal. Chronic pain does not respond to inactivity. Patients who suffer from chronic pain enter a pain cycle in which they decrease activity in an effort to decrease their pain condition. Long-term inactivity results in muscle weakness and a depletion of oxygen to the muscles, resulting in painful muscle spasms, and atrophy. This decrease in activity also has a negative psychological impact including a decline in social contacts, isolation from friends and work associates, and a tendency to focus on the pain condition. Chronic pain also results in a loss of self-worth, an increase in feelings of depression, stress, anxiety and physical tension. Patients are often frustrated by the lack of a cure by medical science. When the condition persists despite the best efforts of physicians and the patient, chronic pain sufferers often become depressed and disillusioned with the medical profession. Many patients feel that their physician does not believe that they are suffering. The patient begins to become more and more focused on the sensation of pain and suffering instead of coping with their disability and learning how to return to productive lives.
The patient’s family is also affected by chronic pain. The chronic pain sufferer is often more irritable due to their inability to participate in previous family activities. Financial status often changes dramatically with the patient’s inability to work and resulting reduction in income. Family relations are often strained and the patient becomes increasingly isolated and alone. Sexual interest wanes due to pain and depression and marriages frequently collapse. All of these factors increase the patient’s subjective pain experience and pain disability.
Pain medications are effective for short-term management of a medical condition. These drugs are often prescribed following a surgical procedure or immediately after an injury. Over an extended period of time these medications may have negative side effects, which cause harm to the human body. After a short period of time, these drugs also may lose their effectiveness due to our body’s development of something called “tolerance”. Our nervous system produces natural pain reducing chemicals called neurotransmitters (examples are “Endorphins” and “Serotonin”). Many pain-reducing drugs (Opioids) interfere with our natural pain suppressing chemicals or they produce “tolerance” which makes our own neurotransmitters ineffective. Exercise, activity, psychological treatment and biofeedback increase the effectiveness of our natural pain suppressing chemicals.
Individual and family psychotherapy are recommended for those individuals who are having difficulty coping with their pain condition and would like to learn biofeedback and self-hypnosis techniques to assist them in managing their pain. Treatment of medical patients often includes problems with depression, substance abuse, marital issues, sexual dysfunctions and behavioral management of health concerns such as weight control and nicotine dependency. Treatment of anxiety disorders and chronic pain often require hypnotherapy and biofeedback as well as providing patients with emotional support for the psychological trauma associated with a catastrophic illness or injury (such as an automobile or work-related accident). Marital and family therapy are also important to help the family in coping with their loved one’s chronic pain or medical condition.
For those individuals who are unable to work or function in their daily routine, a more intensive chronic pain program is recommended. This program will provide specialized, comprehensive, physical and psychological treatment to individuals suffering from chronic pain. Their treatment plan will assist them in breaking the chronic pain cycle and in returning to gainful employment. Because chronic pain does not follow any one pattern of symptoms or treatment, an interdisciplinary treatment approach and individualized treatment plan is developed. In a chronic pain program both the physical therapy component and the psychological component are emphasized. A chronic pain program is developed to improve strength and conditioning and to reduce physical as well as psychological stress. As physical endurance improves, the patient will return to normal daily activities which will further enhance their recovery and experience of well-being.
Candidates for Chronic Pain Treatment
Any patient with chronic pain who is a non-surgical candidate
Chronic back pain
Chronic neck pain
Post laminectomy pain
Chronic muscle strain
Migraine and tension headache
Temporomandibular joint dysfunction
Atypical facial pain
Reflex sympathetic dystrophy
Phantom limb pain
Peripheral nerve trauma / Neuropathy
Stomach ulcers, gastrointestinal difficulties
- Reduction of pain
- Increase in strength and flexibility
- Decrease or eliminate the need for pain medications
- Increase in psychological control of pain
- Decrease in psychological stress and physical tension
- Reduction of pain-reinforcing behaviors
- Increase in physical exercise and activity
- Initial Evaluation and Treatment Plan
An initial evaluation will be performed to assess psychological and physical functioning. The psychological evaluation assesses the patient’s experience of pain, the related emotional stress, and any factors, which may be contributing to their condition. Psychological testing is administered to fully evaluate the patient’s level of psychological distress, the impact of this distress on their physical condition, and to assist in the development of a treatment plan. The treatment plan will be determined by the patient’s diagnosis and symptoms and is likely to include individual psychotherapy, group treatment, family therapy and biofeedback and self-hypnosis training for pain management.
Physical assessment will include a licensed physical therapist and occupational therapist to evaluate the patient’s functional status. These therapists will consult with the prescribing physician to formulate an individualized treatment plan according to the patient’s needs based on their diagnosis, symptoms and outcome goals.
Results of Treatment
During the first two weeks of a physical therapy program, many patients experience a temporary, heightened sense of physical discomfort as their muscles become readjusted to increased activity levels. However, with a return to an active lifestyle, comes an improvement in strength and physical ability, a heightened sense of control and a decrease in pain perception. Most chronic pain sufferers never become completely pain free. However, through consistent, daily exercise, relaxation training, and a positive outlook, they can learn to cope with their chronic pain, return to many of their activities of daily living, resume gainful employment, and experience an improved quality of life.