Pain and What Your Body May Really Be Telling You

50 million Americans, 20% of the population, lives with chronic pain. The numbers continue to rise, which creates opportunities to develop treatments beyond the utilization of traditional health care. The distress, disability, and cost related to managing a chronic pain condition can be overwhelming. Those with chronic pain often have co-existing psychological symptoms including anxiety and depression. The need for non-pharmacological treatments that conceptualize chronic pain as a psychophysiological disorder is well recognized. Physicians may refer patients to psychologists that specialize in pain management as part of a multimodal treatment plan, following a standardized comprehensive evaluation. In cognitivebehavioral therapies, the focus of control for symptom management shifts from the healthcare provider to the patient. Considering the emotional, psychological, and social elements of chronic pain, cognitive-behavioral therapies enable those with chronic pain to develop coping mechanisms to help boost function, improve mood, manage pain, and advocate for themselves Figure 1.

Figure 1:

Relaxation therapy is a useful approach for chronic pain and includes progressive muscle relaxation, diaphragmatic breathing, meditation, and guided imagery. The ability to relax helps by decreasing overall sympathetic arousal. A reduction in overall anxiety-based symptoms may also increase a patient’s ability to tolerate pain. Relaxation training protocols help clients to learn and utilize these techniques so that they can be recalled rapidly and automatically.

Biofeedback is another helpful, non-pharmacological approach to managing chronic pain. Through biofeedback, a client’s physiological processes are monitored including muscle tension, skin temperature, galvanic skin response, pulse rate, and blood pressure. This information is sent back to the patient with visual or auditory signals and the patient learns to gain control over these processes. Electromyography activity (muscle tension), electro-dermal activity (sweat gland response) and temperature control are all responses to the sympathetic nervous system and can be easily monitored by the patient through biofeedback.

Cognitive-behavioral therapy is a non-pharmacological approach which enables patients to handle chronic pain-related stress and concurrent psychological conditions more effectively. Cognitive-behavioral therapy modifies behavioral patterns related to reactions to certain events, thoughts, and interpretations by recognizing the interconnections between stress, coping, and chronic pain. Cognitive-behavioral therapy also addresses negative automatic thoughts, avoidance, behavioral reinforcement, and the patient’s perception of control over pain symptoms. Combined approaches using cognitive behavioral therapy, relaxation, and biofeedback is quite effective and clients often see improvements within a week. Full treatment protocols may require more sessions and those who complete these protocols are better equipped to manage chronic pain for years. The therapeutic benefits of cognitive-behavioral therapies endure over time and give the chronic pain patient a significant clinical advantage to address and manage their symptoms.

Recognizing pain and/or “feeling sick” are ideal indicators that there may be something more going on. Therapy can help discover underlying behavioral health concerns that may be manifesting through physical symptoms or pain by providing insight into how psychological factors like anxiety, depression, trauma, and/or other clinical concerns may impact the physical body.

Individuals and caregivers/dependents of those who are considering Bariatric Surgery or coping with Ehlers-Danlos Syndrome (EDS), Fibromyalgia, Functional Neurological Disorder, Headache Conditions, (Migraine, Cluster, Tension- Type), Irritable Bowel Syndrome (IBS), Multiple Sclerosis, Pain Management, Postural Orthostatic Tachycardia Syndrome (POTS), Psychogenic Non-Epileptic Seizures, Psychological Factors Affecting General Medical Conditions, Somatoform Disorders, and Temporomandibular Joint Dysfunction (TMJ), have benefited and experienced relief from engaging in therapy as part of their treatment plan. However, I encourage individuals to be proactive with their behavioral health before physical manifestations develop.