The involvement of a Clinical Psychologist in treatment of pain can be an important part of a holistic approach in the treatment of a person affected by chronic pain. It offers the opportunity to explore the different ways in which people experience and handle their pain. At Action on Pain we are often asked if being referred to a Clinical Psychologist means that I am “round the twist”! Far from it- you are being offered a form of support that is invaluable in helping you and your family deal with the issues that can come with chronic pain. It can be challenging so we always encourage people to go with an open mind.
Chronic pain affects people in an individual way who in turn respond in manner linked to their personality and feelings at the time..They have particular ways of thinking and reacting to situations as a result of past experiences. Chronic pain adds a complication to people’s lives, reducing their emotional and physical capabilities. It challenges their coping strategies, often draining them and their family and friends. Chronic pain often leaves a person feeling isolated and alone, thinking and believing that no one understands them or their pain.
Often chronic pain is inadequately managed as a result of the patient’s unfounded fears, inadequate communication between patient and doctor or a lack of knowledge and understanding of the factors underlying their condition. Understandably all these elements are likely to have a psychological effect on the patient’s sense of well-being. A skilled clinical psychologist is will be able to identify any misplaced beliefs and fears which may be hindering the effective management and treatment of the pain
The official definition of pain by The International Association for the Study of Pain (IASP) is given as “an unpleasant sensory and emotional experience, associated with actual or potential damage or described in terms of such damage.”.
This not only recognizes that pain involves thoughts and feelings, but also that pain is real whether or not the biological “causes” are known. The idea that pain is a subjective and highly personal experience, affecting each person differently and changing from day to day, acknowledges that pain involves all the sensory modalities.
Consider this: How reasonable is it to think that anyone with a significant degree of chronic pain will only be affected physically?
Pain makes you feel tired:- it is mentally draining, making you far more irritable, emotional and unable to remain positive. It is hardly surprising that as a result, things can rapidly spiral out of control. After all, if a person goes from being very energetic, fun-loving and happy, to being edgy, withdrawn and lethargic because of the pain, it is inevitable that very quickly family & social relationships begin to change. An employer or colleague who sees a promising employee beginning to look tired, stressed and tearful may quickly change their opinion about that persons abilities to cope.
It is due to these sorts of effects on individuals that Clinical Psychologists are seen as a valuable part of the treatment team. Their role is not to assess whether the pain is real or imaginary, as it is fully accepted that the pain is real to the patient and is having a major impact on their daily lives. Pain hampers your activities, affects how you feel emotionally, impacts on the quality of both your life and those family and friends around you. It is therefore inevitable that there will be many losses and lifestyle changes bought about as a result of pain, e.g. job loss, financial pressures, poor self-esteem and loss of confidence. Unsurprisingly, thinking patterns may become more negative and greater feelings of frustration begin to build up inside, tempers become more frayed, with memory and concentration levels starting to be affected as fatigue sets in.
How can a Clinical Psychologist help?
Treatment by a Clinical Psychologist may reverse some of the impact of the pain giving people a greater sense of control, reducing anxiety, whilst improving memory, concentration and self-esteem. The aim is to help people work out how to live their life as normally and in the most satisfying way possible, despite the pain. The Psychologist will not tell you how to live your life- after all you are the best expert on how to be yourself. Their role is to help you explore and discover what things in life are important and meaningful to you and what factors past and present stand in the way of you regaining control of your life.
Complex interactions between cognitive, behavioural, emotional and physiological factors will determine an individuals experience of pain. Pain experience is therefore different from person to person as a result of varying combinations of these factors. Clinical Psychologists are able to gain insight into the dynamics which are likely to determine whether you are a suitable candidate for specific drug therapies, intrathecal infusion pumps and surgeries. Assessing the bio-psycho-social aspects of a patients pain can be vital to identifying the most successful treatment options before any intervention begins.
The assessment of the psychosocial aspects of an individuals chronic pain involves and requires the accurate evaluation of:
- Behavioural changes affecting work and domestic responsibilities, leisure and social activities, marital and family relationships, sleep patterns and medication use.
- Cognitive factors, including beliefs and attitudes, expectations, coping skills.
- Emotional state (such as the presence and severity of anxiety and depression).
- Whether any post traumatic stress disorder linked to an incident which has caused the pain could be affecting the patients experience of the pain.
After an evaluation your Clinical Psychologist might recommend several types of treatment including:
Individual psychotherapy aimed at providing a better understanding of the behavioural and emotional responses to the pain and to help modify such responses to increase ones comfort, ability to cope, and sense of well being.
Pain management group to help you learn sufficient self-management strategies for your pain.
Biofeedback to help you learn to reduce activity of the part of your nervous system that responds to stress. Activity from this part of the nervous system increases pain.
If your doctor or consultant refers you to a Clinical Psychologist, you are being given the most positive and effective treatment solution available. This may help you with all aspects of your pain placing you back in control of your life, your future as well as opening up the chance of accessing the most appropriate treatment for your condition.