You can’t cure chronic pain just by thinking it away

From PubMed:  Psychological therapies for the management of chronic pain (excluding headache) in adults

BACKGROUND: Psychological treatments are designed to treat pain, distress and disability, and are in common practice. This review updates and extends the 2009 version of this systematic review.

OBJECTIVES: To evaluate the effectiveness of psychological therapies for chronic pain (excluding headache) in adults, compared with treatment as usual, waiting list control, or placebo control, for pain, disability, mood and catastrophic thinking.

MAIN RESULTS: Overall there is an absence of evidence for behaviour therapy, except a small improvement in mood immediately following treatment when compared with an active control.

CBT has small positive effects on disability and catastrophising, but not on pain or mood, when compared with active controls.

CBT has small to moderate effects on pain, disability, mood and catastrophising immediately post-treatment when compared with treatment as usual/waiting list, but all except a small effect on mood had disappeared at follow-up.

I doubt this is a surprise to any pain patient:  You can’t cure chronic pain just by thinking it away in therapy!  While attention to and working on the psychological aspects of pain eases suffering, it’s not enough to defend against most chronic pain.

It’s been proven that chronic pain is associated with depression and anxiety, and some have seized upon this as “proof” that the pain is caused by psychological factors.  From personal experience, I can say that it’s the other way around: chronic pain causes depression and anxiety.  Treating physical pain with psychotherapy is ineffective when the pain itself is not physically addressed as well.

So often, we pain patients are accused of contributing to or indulging in our pain for “psychological” reasons.  So many of are pressured to “fix our thinking” because others assume that if we can’t find and fix the physical problem, then it must be a mental problem.  This is just another example of our warped cultural attitudes toward pain and disability (see my previous post “Breaking Bad” Reflects our Cultural View of Disability and Illness).

And another point:

Psychotherapy was not designed to be such a simplistic medical tool.  Medicine is focused on curing physical pain by forcefully changing the body, while psychotherapy aims to ease  emotional pain by teaching better coping skills.  “Fixing” and “nurturing” are very different treatments, so tying to make quantitative comparisons seems almost silly.

The current focus on healthcare performance metrics is forcing rigid measurements upon a subjective practice, trying to measure quantity when the therapeutic goal is quality.

4 thoughts on “You can’t cure chronic pain just by thinking it away

  1. teeks55

    This takes me back to when I first began having pain….30+ years ago. After all the usual tests were run, the tests that they had back then, that is…..and they couldn’t figure me out…..they decided to blame me for my own pain. They told me I was depressed and that was why I was having “pain”……although some doubted I had pain at all and was just a complainer, a whiner, a liar.

    I told them OVER & OVER & OVER again…..NO…..I am depressed BECAUSE I HAVE BEEN IN PAIN FOR TWO YEARS AND NO ONE KNOWS WHY….. WHO THE HELL WOULDN’T BE DEPRESSED???? They didn’t have an answer for that one. So they threw me in a psych ward for 3 weeks where I made ceramic ashtrays and was medicated for depression. When I got out, I was no better.

    They sent me to live in a halfway house for mental patients for a few months, and lo and behold, while I was there, I ended up back in the hospital because my physical pain was unbearable. This time, FINALLY…..a doctor came into my room after a few days there and said…..well….I think I know what you have. It’s called FIBROMYALGIA. My whole life changed in an instant.

    When I went back to the halfway house from the hospital, and they realized that I was not freaking nuts, but had a chronic pain condition that I’d been living with for 2 YEARS without a diagnosis…..the staff there, as well as my “counselor” who I’d been seeing for months….(he had tried to convince me to give up complaining about pain and confront my “depressive tendencies”) COULD NOT LOOK ME IN THE EYE. They literally hung their heads as I packed my bags and moved out.

    Shortly after that, I got hooked up with a world renowned rheumatologist at the U of I College of Medicine (Dr. Alfonse Masi) who worked with Dr. Muhammed Yunus (the father of fibromyalgia, the man who defined the criteria of fibro diagnosis with the 18 tender points) (google him)…..I saw Dr. Masi for over 20 years before he retired from seeing patients. He believed me, he understood my pain, he tried to help me, and he grew to be like a grandfather to me.

    I will never forget the horrendous feeling of being treated like I was mentally ill all those years ago, when what I had was a valid chronic pain condition. I am still angry to this day. I was treated like crap and it took 2 years before someone finally figured it out. Now things are a little better than back then, but still, the stigma and the stereotypes continue. I can only pray that the medical community will get educated and stop the ignorance….thankfully more are realizing that chronic pain is not only valid but it is widespread and highly undertreated.

    It’s been a very long hard road. I would not be here if it weren’t for my online friends and my husband. I get lots of support from them. I have an appointment with a rheumatology nurse practitioner this coming Friday…..I haven’t really seen any specialists since Dr. Masi retired. This should be interesting. I just stayed away from most docs, except my last doc for the pain meds that he prescribed me…..but he is now no longer practicing any more and I am without a doctor. And I am really struggling with the pain now that I am 58 years old……everything is much worse now. I now also have osteoarthritis which is really bad. I have been borderline lupus and borderline RA for all of these 30 years also…..high inflammation in my blood work but no diagnosis for it as of yet….. so we shall see what the NP says on Friday. Wish me luck! Sorry such a long post, but this subject really hits home with me.

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  2. forevershea37Kathryn Benedic

    Teeks55,
    I read your post and it could have been my own story. I suffered for years with chronic, debilitating pain that changed the entire direction of my life, in all aspects, my carèer, caring for my family, and my social life.

    I was going from doctor to doctor, having repeated tests done over and over. The results were all the same. A few doctors at first when listening to my story where convinced that I had lupus, RA, and other types of illnesses, but when the test results came in, they dismissed me as a nut job and ended up with the theory that somehow I was creating my own illness. They would acknowledge that my blood test inflammation (sed rate) was very high, I usually ran a low grade temperature, and at times had redness and swelling in various joints, visual signs of Raynauds in my hands and feet, and some other physical signs of illness. But, because they could not come up with a conclusive diagnosis they would recommend that I try psychological counseling, which I did. They had convinced me that it was all in my head, and I must be creating these symptoms of chronic pain myself.

    I can remember thinking, how can this be possible? My life had been good and I certainly did not want this and had fought back with all I had emotionally to deal with and ignore the pain but it continued. My entire life was changed and I was depressed and had anxiety not understanding what could be wrong and I knew there was something going on that I had no control over. I finally made an appointment many years later with a Rheumatologist on my own.

    The Rheumatologist immediately explained to me that I had a condition at that time (early 80s) called “fibrositis”. And he highly suspected Lupus. He began me on various meds to help with the inflammation, lack of sleep, etc. I moved to another city, a much larger one, and immediately began seeing a Rheumatologist there.

    Many years had gone by as I struggled to keep my life on track and was becoming more and more depressed as no one was addressing the chronic pain and by now even more physical symptoms had begun. As I was being tossed from one specialist to another, the diagnoses were piling up but no one doctor was looking at the overall picture, and suggestions of mental illness were being tossed around.

    I had finally had enough and searched out a Rheumatologist that specialized in my type of case. Finally, someone addressed the pain issue first. When the pain issue was finally somewhat better, the pieces of the puzzle began to surface that I could possibly have an autoimmune disorder.

    To make a very long story a little shorter, I was diagnosed with Mixed Connective Tissue Disorder (MCTD) with underlying Scleroderma.
    It all began to make sense.

    I did begin psychotherapy to help me cope with the changes in my life and depression and anxiety that resulted in part from the cycle of long years of untreated chronic pain and psychological issues that did contribute to the vicious cycle of physical to mental anguish. One feeding off the other, resulting in making my life a living hell.

    The end result, was me being unable to continue my career path. I have been on Long Term Disability from my company and Social Security Disability since my early 40s. My symptoms had begun in the early 80s and I was finally diagnosed in 1995. I am now 63 and remain disabled.

    Without my own research and finding a doctor that was willing to listen, I don’t think I would have ever been diagnosed appropriately. I was started on an opiate pain med ( and remain on one) that has made a tremendous difference in my quality of life. If the pain had not been addressed, I don’t think I would be here today. Life had become so unbearable that at times I didn’t know if I could continue to face living.

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  3. Zyp Czyk Post author

    My goodness – my story is the same too! The funny thing is that while we didn’t need psychological therapy for our real pain, we needed it to recover from years of being told we were making it up. My therapist suggested I might have a form of PTSD from some of my more traumatic appointments. Being desperate for relief from a virtually killing pain and then being dependent on one high-ranking “healer” after another who tells us we’re just crazy, is what I believe used to be called a “Mind F*ck”. It does feel like rape when the only person with the power to save you turns on you instead.

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  4. teeks55

    Hi to both of you……thank you both for your response. It’s incredible that we three had such similiar stories. Can you only imagine how many hundreds of thousands of us there are out there!

    I agree that I too probably have PTSD from some of the early “doctor visits/nightmares from hell” that I had. I carry around such anger these days and I believe it’s not only from the intense pain I live with every day (despite pain meds) but also what I went through back in the early days before my diagnosis. Even after my diagnosis, there have been times when I just wanted to drive into a tree because of the ignorance and arrogance of some docs (and nurses) I’ve seen.

    It is comforting to know that I am not the only one who went through this horror and I appreciate you both validating my story with your own. I’m sorry we all had to endure the BS, along with the pain. It was the most difficult and humiliating things I’ve ever endured in my life.

    I am not sure what to expect on Friday when I see the rheumatology NP. I am still shell-shocked after 30 years ~ literally shaking in my shoes when I think about this upcoming appointment. I am still afraid of the stigma, the subtle smirks, the patronizing….. even though I know that medicine has come a long way since the early days, and I know this office of docs/NP’s that I’m going to on Friday are familiar with and treat all the diseases that I have and may have. I have a list ready…..and it’s a long one. So I hope she doesn’t give me bad vibes, because if she does I will pick up my purse and walk out. I am done with being disrespected and treated like dirt because I have pain. If she doesn’t help me, I am done. I will hope that the old doctor’s office NP will continue to give me my pain meds that my old doc prescribed. If she doesn’t then I am screwed. Will let you know…..thanks again for writing, both of you!!! xoxoxo

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