When a person is first referred to me for pain management, I find there is often confusion about how a psychologist can help them. Usually these misunderstandings are rooted in one of several common myths about the meaning of the referral.
Myth # 1 The Pain Is All In Your Head
Far from it! Pain specialists know that chronic pain is influenced by physical, mental, emotional, and social factors. In treating pain, we prefer a multidisciplinary approach that can address all of these elements. Your physician can reduce pain using medications, and your physical therapist can help train you to improve movement and stamina. Your psychologist’s goal is not to reduce the pain itself, but rather to reduce the impact of pain of your life. CBT has been shown to be effective in increasing feelings of control and ability to manage pain (Turner, Holtzman & Mancl, 2007). The goal is to improve quality of life, so that even if pain is present, it does not become the central feature of your life.
Myth #2 Difficulty Managing Pain Is a Sign of Weakness or A Moral Failing
To the contrary, people seeking treatment for chronic pain have worked very hard to reduce their pain and are often able to give long lists of things they have tried. Sometimes misinformation plays a role because the common recommendation for managing acute pain—rest—does not hold for management of chronic pain. The vicious, life-limiting cycle of chronic pain can sneak up on you. For example, as pain continues, you may begin to withdraw from activities you enjoy. You may decline invitations to socialize because you can’t anticipate your pain levels. Limited activity can lower your self-esteem, create self-doubt, and contribute to a decline in mood. Depression and anxiety can magnify the perception of pain and lead to further withdrawal. Eventually, isolation keeps you from the enjoyable activities that distract you from your pain, and pain becomes the central focus of everyday life. CBT can teach you to be aware of these traps and build the skills necessary to stay out of the cycle.
Myth #3 My Doctor Doesn’t Believe My Pain Is Real
Pain is difficult to treat. There is no blood test or scan that can objectively measure pain, which leads to our reliance on self-report. More and more physicians are recognizing the benefit of a referral for CBT in chronic pain management. This does not mean the physician suspects a psychological origin of the pain only that he or she is seeking to equip you with the best tools to improve your quality of life.It has long been known that CBT is effective in influencing the way people interpret pain and can improve functioning (Morley, Eccleston & Williams, 1999).
Myth # 4 Psychotherapy Is All Talk
Unlike common TV portrayals of the therapist asking, “but how does that make you feel?”, CBT is more than just talk. There are several key skills taught during a course of CBT for pain management. Many of them involve taking real action or practicing a different response to pain. They include:
1.) Pacing activity- not underdoing and not overdoing. Many times people with chronic pain fall into a cycle of overdoing activity on a good day and then “paying for it” with increased pain for the next few days. Learning to pace activity may be counterintuitive to our goal-driven culture, but this pacing can help you reduce the chance of a pain flare-up while increasing productivity in the long run.
2.) Relaxation. Muscle tension and stress can increase the perception of pain.
3.) Changing the meaning of the pain. The way we interpret pain can add a layer of emotional suffering on top of coping with the pain itself. Emotional suffering occurs when you begin to wonder if you are somehow being punished, get down on yourself for your current ability level, or feel decreased self-worth. Examining the beliefs that grow up around pain can help disentangle these unhelpful thoughts from the pain sensations.
4.) Managing the impact of negative mood. Sadness, anger, and anxiety can all serve to direct attention to the pain sensations and can magnify both the sensations themselves as well as the suffering associated with pain.
Far from attempting to invalidate your pain or hinting that your pain isn’t real, a referral for CBT for chronic pain management is a sign of comprehensive pain management and a vote of confidence that there are things you can do to positively affect your life. Your life is bigger than pain.
Morley, S., Eccleston, C., & Williams, A. (1999). Systemic review and meta-analysis of randomized controlled trials of cognitive behavior therapy and behavior therapy for chronic pain in adults, excluding headache. Pain, 80, 1-13.
Turner, J. A., Holtzman, S., & Mancl, L. (2007). Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain. Pain, 127, 276-286.