Treatment of chronic pain can be challenging, partly because of the associated problems of depression and anxiety. The patient–provider relationship is one of the key components of managing the psychological aspects of chronic pain,
“Chronic pain is very tricky to treat. For a number of patients, their pain is essentially permanent and ‘untreatable,’ in the sense that it is not going to fully go away. Thus, the treatment can focus on helping patients to be as functional as possible with chronic pain,” said Kevin E. Vowles, PhD, who spoke at the meeting.
However, “helping patients be as functional as possible with chronic pain” should not simply replace “helping patients relieve chronic pain”. Due to the anti-opiate hysteria, too little emphasis is placed on relieving pain with opioids, and too much on asking patients to live with their pain undertreated.
Where the boundary falls between relieving some pain and then functioning with the pain that remains is a matter of judgement and the particulars of a patient’s situation. Because physicians only know about a patient’s pain but don’t feel it, it’s too easy to say that, because our pain is chronic, they don’t want to treat it with opioids, and instead want us to “learn to live/function with the pain”.
The way in which physicians conduct themselves can influence outcomes, he said. Trust is essential, and the physician needs to convey that he or she has the patient’s best interest in mind.
Trust is particularly critical to adherence, said Dr. Vowles, adding that “we know that just telling patients what to do does not work very well.” The physician needs to encourage behavioral change so that patients can adapt their expectations and become comfortable with their experience of pain, he said
The ultimate outcome of treatment is not to alter an internal perception but to change the way patients respond to their pain so that they can get on with their lives, ideally in a manner that also allows increased engagement in valued and meaningful activity.”
It is not useful for the patient to try to determine if the pain is “real” or “psychogenic,” he said. ”This dichotomy does not help patients or providers. This is really an outdated concept.
Some psychological strategies for the treatment of chronic pain include use of acceptance and commitment therapy (ACT), and mindfulness approaches as part of cognitive-behavioral therapy (CBT). These therapies can help patients view their pain in context and make behavioral changes that accommodate the pain
treating the psychological components of chronic pain is absolutely critical,
We have found that
- 75% have depression,
- 60% have reduced enjoyment of life,
- 70% have poor concentration and
- 75% have sleep disturbances.