A multidisciplinary treatment approach is the most effective way to address the complex problem of chronic pain. Multidisciplinary treatment teams are generally composed of 2 or more treatment disciplines (e.g., psychology, anesthesiology, neurology, or physical therapy), each with expertise in the assessment and treatment of chronic pain. Team members work together to provide the best treatment program for a patient’s pain.
Psychological Approaches to Pain Management:
Psychological factors -- mood, beliefs about pain and coping style-- are important in an individual’s adjustment to chronic pain. Over time, chronic pain creates increased, and debilitating, pain. For example, when pain persists over time, a person may avoid doing regular activities for fear of further injury or increased pain. This can include work, family events, social activities, or hobbies. As the individual withdraws and becomes less active, their muscles may become weaker, they may begin to gain or lose weight, and their overall physical conditioning may decline. This can contribute to the belief that one is disabled. As pain continues, the person may develop hopelessness, e.g., "this is never going to get better," or negative thoughts about themselves, e.g., "I’m worthless to my family because I can’t work." This type of thinking can lead a person increasing levels of depression and anxiety. These moods can maintain and increase the pain cycle and the level of experienced pain.
The fact that psychological factors can have an impact on the experience of pain does not mean that the pain is "in the person's head" or not real. Most people who report pain are really experiencing it, even if a physical cause cannot be identified.
Dr. Wayland is a survivor of a disabling, chronic pain injury. He understands the pain cycle and offers both understanding and appropriate optimism with those people working to become pain managed.
Cognitive Behavioral Therapy (CBT) has been found to be highly effective in helping patients to reduce pain, disability and distress. CBT for chronic pain management involves modifying negative thoughts related to pain -- this pain is going to kill me, I’m worthless because of the pain, I can’t cope with this pain -- and on finding and increasing a person’s activity level and productive functioning. This approach for pain management promotes positive changes in thinking and behavior. Treatment can be delivered individually or in a group setting.
CBT for pain management is tailored to the individual needs of the patient but may include:
• Eye-Movement Desensitization Reprocessing (EMDR)
• Relaxation Training
• Stress and Anger Management
• Activity Pacing
• Psychotherapy for insight and development of coping skills (Cognitive Restructuring)
As part of a multidisciplinary pain treatment team, CBT may incorporate exercise goals set by the physical therapist, or may include recommendations made by the anesthesiologist for taking pain medications at prescribed time intervals.