Treating Chronic Pain…With Therapy?

Chronic pain is at an all-time high in the United States, with about one-third of our population living with persistent physical distress. It’s a national issue—one we have been challenged with for years.

But, one of the biggest breakthroughs has also happened during this time: we now know that the treatment of choice is not found in a doctor’s office, but through behavioral health.

However, we also know that the medical community is limited in their ability to relieve recurrent pain. Treatment as usual—such as opioids—is risky and ineffective. And the tools at their disposal, such as surgery, injections, imaging studies, and medications just don’t work well in eliminating pain.

Rather, behavioral approaches are the evidence-based tools that provide relief.

Cognitive-behavioral techniques and building mindfulness have a proven track record of success. And rehab professionals such as physical and occupational therapists are in a good position to implement these skills as they treat people who are hurting.

But chronic pain is not only just a physical concern. Living with pain that has gone on longer than three months has an impact in many areas.

The International Association for the Study of Pain says that pain is both a sensory and emotional experience. We know that chronic pain enhances depressive symptoms and emotional distress. We also realize that emotional distress and depression make pain worse.

So, what do we do?

The evidence is in, and we know that in order to treat pain effectively we need to develop a pool of clinicians who understand pain and how to treat it.

Here are six essential things we need to know:

1. Central sensitization. This is a condition that contributes to increased pain in many people. The central nervous system abnormally amplifies the pain signal to the somatosensory cortex. In some cases, there is no tissue damage and abnormal negative thoughts and emotions actually trigger the origin of the pain process. The pain is very real and is felt in a certain part of the body, but the problem isn’t really in that body part. The problem is actually in the brain.


2. Catastrophizing is a very common response to living with pain. People believe that the worst thing that could happen, will happen, and that they won’t be able to deal with it. Pain catastrophizers have worse outcomes overall, so it’s imperative that we help people interrupt this pattern of thinking.
   
   One way you can help interrupt these thoughts is by using a decatastrophizing exercise. This process has four steps:
   
   
   1. Elicit a catastrophic thought, one that is causing distress for the person.
   
   
   2. Ask how much the person believes this thought, using a 0-100 scale.
   
   
   3. Have the person identify what they would do if this feared thought actually happened. Who would they turn to? Where is their support? What resources do they have?
   
   
   4. Now ask how strongly they believe their original catastrophic thought. The number typically goes down, sometimes dramatically. This is a result of identifying their support and resources, which lowers anxiety and fear.


3. Cognitive-behavioral approaches are proven to have a huge impact in enhancing quality of life. Working with the ABC model (activating event, beliefs, and consequences), thought distortions, decatastrophizing, and automatic negative thoughts can help improve quality of life in those who suffer.The ABC worksheet is a good place to start with this approach. The goal of this activity is to help clients see that its often their interpretation of the event that leads to distressing emotions, not necessarily the event itself.

Download a free worksheet featuring this exercise here.

4. Mindful approaches can have tremendous power to bring relief. We know that a practice of deep, slow breathing can restore calm, enhance the flow of oxygen to the brain, and ease distress, both in the body and the mind. Practicing meditation, yoga, guided imagery, personal visualization, body scan, breath work, and many others, can bring greater acceptance and reduced reactivity for those in pain.


5. The goal of treatment is not to bring pain to a zero. Appropriate goals include developing an enhanced quality of life, becoming more active, having joy and pleasure, building meaningful social connections, and moving more. These are all worthy goals to work toward


6. Opioid medications are not our most effective pain relief. Science shows that for acute pain, taking one extra-strength acetaminophen (500 mg) at the same time as one 200 mg ibuprofen every 6 hours provides more effective pain relief than 10 mg of Percocet or 15 mg of oxycodone. For chronic pain, opioids commonly cause hyperalgesia (worsening the pain) and may lead to misuse in up to 50% of people. The risks of the opioids and their lack of effectiveness compel us to find new and better ways to help people.


There is an overwhelming need for trained professionals to support people in pain and their families. This work can be so rewarding as you witness people finding emotional and physical relief along with an improved quality of life.

I encourage you to educate yourself, learn all you can, and dive into this rich and meaningful work! For more on behavioral treatment of chronic pain, register for my upcoming trainings.