Psychosocial Treatment for Chronic Pain

Living with pain on a daily basis can be complicated, especially when that pain may have roots in both your body and mind.

To bring some context to the idea of treating chronic pain through non-physical therapies, we spoke with Garry Spink, PhD, a psychologist with Rochester Regional Health who specializes in psychosocial assessment and treatment of chronic pain.

What is chronic pain?

Pain is defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.

A person cannot have pain based on sensory neurons alone. Other factors can influence pain, including thoughts associated with pain or expectations linked to a previous experience with pain.

When psychologists consult a patient about their pain, they often ask questions about the intensity, frequency, and location of the pain. This can help the provider to determine what may influence a patient’s expression of pain. Some of those factors may include a person’s culture, background, and environment.

Providers should strive to respect a patient’s perception of pain at all times.

Setting up an assessment

The decision to see a psychologist to treat pain is often set up by specialty providers who make a referral.

One of the early conversations a psychologist may have with a patient is about how pain is seen commonly as biological – despite evidence linking the mind and the experience of pain.

A provider will then ask the patient to describe their pain in detail. Some of these questions may include:

• Where is it?
• How intense is it?
• Where did it start?
• Does it flare up at certain points?
• Are there certain stressors that cause it to flare up?
• Are there certain strategies that help decrease the pain?
• Is there family history with pain or mental illness?

Knowledge about previous treatments and experiences with pain medications can be helpful for a psychologist, as well. Chronic pain intersects with anxiety and depression; they influence one another.

All of this information helps to paint a full picture of the patient’s unique pain so a provider can create the best course of treatment for a patient and work with them to set goals related to their pain.

“Frequently the patients I meet with have some area of their life where the pain has been a substantial factor in holding them back,” Dr. Spink said. “That could be social get-togethers, being engaged with family, gainful employment, or other things,” Dr. Spink said.

Possible therapies

Selecting a therapy will be different for each patient, depending on what each person is currently experiencing or may have experienced in the past. Individualized treatment is key for treating chronic pain.

Cognitive behavioral therapy focuses on identifying triggers for pain, reinforcing behaviors, and how people think about or perceive their pain. By re-training the brain to think about pain differently, it can change a person’s experience with pain.

A psychologist can work with a patient to identify their limits with pain and help to build up their strength.

“It’s like running a marathon,” Dr. Spink said. “If you’ve been in pain for a long time, your body is probably not conditioned to go out and do what it used to do before it was in pain, so we have to get it back to that point. I wouldn’t go out and run a marathon tomorrow if I haven’t trained. I wouldn’t make it five steps. But if I trained over a few months, I would be able to do much better.”

Physical therapy meshes well with psychology. Since certain movements can trigger pain, psychologists can work together with a physical therapist to heal certain parts of the body using behavioral modification techniques at the same time the physical therapist is helping with stretches or other exercises.

Not every patient will be using all of these therapies to help alleviate pain in their life. Some will only utilize one; others may use a combination of therapies.

Making progress

Becoming whole is not something that will happen overnight. Chronic pain is not a simple fix that can be resolved in a single session.

Patients will need to be committed to the idea of putting time into their therapy. For example, if a person is referred to a psychologist to be treated for a depressive disorder linked to chronic pain, the process will be gradual.

As progress is made, a person’s thoughts may begin to improve before the physical expression of pain begins to lessen. Psychologists will help a person reorganize their brain in a way that helps the pain go away over time.

“You are retraining pathways in the brain to be able to help people experience less pain and less interference,” Dr. Spink said.