Chronic Pain. How Can Psychotherapy Help? - Self-development

What is pain? We used to think of it as a physical problem, but modern science says it's not that simple. Our feeling of pain is directly dependent on how we perceive it and what we think about it. Therefore, psychotherapy approaches that help to work with pain are becoming more and more popular, especially in cases where it is simply impossible to turn it off at the body level

Everyone hurts differently

At all times, doctors have been looking for magic remedies to relieve pain. Only for a long time it was believed that pain is perceived equally by all people, because it depends only on the strength of the physical impact. If, say, two people are pricked with a needle with the same force, they must experience the same sensations. But over time, it became obvious that subjective experience plays an important role in how acute the pain seems.

Nowadays, medicine and psychology use the definition of pain proposed by the International Association for the Study of Pain in the 1970s: "Pain is an unpleasant sensory and emotional experience associated with real or potential tissue damage or described in terms of such damage." In other words, objectively everything may be all right with us, but emotionally it already hurts. Doesn't this mean that each of us can understand by the word “pain” something of our own?

Dr. Salima Megani of the University of Pennsylvania argues that the degree of pain depends on the "lenses" of perception, which are individual for each patient. The experience of pain is refracted through such seemingly far from pain things as income, level of education, place of residence, cultural stereotypes, and profession.

For example, the availability and quality of medical care, the choice of profession and the need to engage in hard physical labor, the severity of the stress reaction of the body often depend on the socioeconomic status of a person. Consequently, people with low SES and from vulnerable groups of the population will experience pain more often and more severely, and they will visit doctors less often due to fear of facing neglect and discriminatory attitudes.

Moreover, life experience and beliefs about pain can lead to the fact that a person will hide his pain from others, and sometimes from himself, as much as possible. “I can't look weak”, “If I show that I am in pain, I will be humiliated and will be used”, “Until I collapse, I must endure the pain and continue to work” - such thoughts very often aggravate the situation and prevent pain to perform its important function.

Why is pain needed

In our body and psyche there is nothing that appeared there just like that, by pure chance. All our organs, cells, emotions, reactions are needed for some reason. The same can be said about pain: it has a fairly obvious purpose - to protect us from danger. When we feel acute pain, we receive a signal: now something is acting on us too strongly (too hot or cold, too much pressure, too loud, too light), and this threatens the integrity and safety of the body.

The logical response to pain is to avoid contact with what caused it. Evolution even gave us defensive behaviors for this - the fight-or-flight response triggered by the sympathetic branch of the autonomic nervous system. And everything would be great if in the modern world we remained sensitive enough to our sensations and were able to respond in time to these internal signals. Or if they knew how to heal any disease. Unfortunately, in reality, both are not always possible. As a result, pain becomes chronic - if it persists for more than three months or as long as it takes to heal.

If it always hurts, then the body exists in a threat mode all the time, only this is no longer useful, but turns into chronic stress. The resources of the body and nervous system are depleted, metabolism is disturbed, immunity is reduced, digestion is disturbed, memory and concentration deteriorate, painkillers are addictive and lose their effectiveness. Relationships with people get complicated, productivity at work falls, medical costs rise, and negative attitudes about your condition accumulate in your mind, from which your health only worsens. A vicious circle begins.

From a psychological point of view, however, even chronic pain can perform certain functions: for example, attracting attention, distracting from urgent problems, avoiding unwanted contact with people, and justifying difficulties. If it really works, then pain can become a lifestyle, and positive reinforcement in the form of achieving the desired results will only reinforce the pain at the level of habit.

How to handle

What to do if the pain is supported by psychological disorders or irreversible processes in the body, about which medicine is powerless? Or if anxiety or mistrust makes it difficult to see a doctor? Or if countless examinations have not revealed any physiological basis for pain, and it still interferes with living a full life?

In general, pain has four components:

• sensory (those physical sensations that we used to call pain);
• emotional (how do we feel in relation to this pain: anger, sadness, resentment - and maybe gratitude?);
• cognitive (what thoughts and beliefs flash through our heads about pain);
• behavioral (how we deal with it).

Medicinal effects can affect the first two points, since only they are directly related to physiology. But psychotherapy has the potential to move all four components of pain off the ground.

A holistic or holistic approach to pain management involves working with a team of specialists - somatic physicians who assess and act on the physiological components of pain, psychotherapists who eliminate mental aggravating factors of pain - and support groups where one could learn to talk about pain and feel community with those who are going through similar difficulties.

According to Zlata Borisovna Polozhey, psychiatrist, psychotherapist and head of the Department of Psychotherapy at the Institute of Interdisciplinary Medicine, all psychotherapeutic approaches in which work with chronic pain occurs can be divided into three main categories:

• 1. Using suggestion in an altered state of consciousness to reduce pain or develop an intention to take the necessary actions to alleviate one's condition (hypnosuggestion, autogenic training, auto-suggestion).
• 2. Research without suggestion in an altered state of consciousness for the expression of an internal mental conflict or the emotional component of pain (Ericksonian hypnosis, partially symbolic drama, psychoanalysis and its modern offshoots).
• 3. Logical-rational and psychological techniques without an altered state of consciousness (cognitive-behavioral psychotherapy).

This abundance allows patients to try different methods and find what resonates most with them. Also, don't forget about classic breathing and relaxation techniques such as diaphragmatic breathing or Jacobson's progressive muscle relaxation. Often, it is with them that training in the processes of self-regulation begins in psychotherapy - that is, control of one's state.

Pain meditation

Of particular interest are approaches to working with pain based on meditation and ancient oriental practices, which have been revised taking into account the modern psychotherapeutic context. Mindfulness approaches, such as Mindfulness Based Stress Reduction (MBSR), teach patients to manage their attention to take an observer attitude towards pain and focus on the present moment with openness, curiosity, and acceptance.

MBSR techniques help you look at current experiences and your environment without judgment, separating the sensations themselves from the emotional and cognitive assessments that exacerbate the situation. Perhaps it is this nonjudgment, interest in their experiences and the opportunity to see a broader context that help patients change their attitude towards such a painful aspect of their life as pain.

To date, there have been many studies of this method in dealing with depression, anxiety disorders, stress and chronic pain. Unfortunately, the quality of the data obtained in these studies does not always lead to unambiguous conclusions, but, apparently, mindfulness-based interventions lead to improvements in the quality of life associated with mental and physical health, reduce the symptoms of depression, and improve the well-being of patients with chronic pain, and sometimes help reduce pain medication.

It has long been known that regular meditation practice can teach a person to intentionally change the electromagnetic activity of the brain. In this case, the switching of electromagnetic waves leads to a change in the hormonal background - that is, the general condition of the body changes. Scientists note that during EEG meditation, one can see mainly alpha waves, corresponding to deep relaxation during wakefulness, and in especially experienced meditators and theta waves - they speak of relaxed attention, tracking inner experiences at rest. Both of these conditions are associated with increased production of endorphins and serotonin, natural pain relievers.

Chronic pain continues to be an unbearable burden on each of us and society as a whole. And yet science is developing at an incredible rate in our time. Not all new developments in the field of psychotherapy yet have a sufficient evidence base, but scientists are making colossal efforts in finding the most effective means to rid mankind of suffering. The main thing is to meet your pain and try on yourself all those methods that will help you cope with it.