Interventions for Chronic Pain
July 2013

 

 

Effective Relief for Chronic Pain

 

Often pain does not adequately respond to medication or physiotherapy. This article focuses on psychological solutions for pain conditions such as Complex Regional Pain, Fibromyalgia, vulvodynia, migraine, and occupational overuse. A degree of Central Nervous System sensitisation will have occurred, which may be compounded by deep-seated psychological issues related to attachment disorder and all forms of abuse in childhood. People who drive themselves very hard and are ultra conscientious can also be vulnerable to pain disorders. I have found the interventions below, used in individualised treatment plans, can provide effective pain relief. For some, a fairly speedy improvement is possible, for others a longer multi-modal approach gives relief. Others can reduce medication and better manage pain levels. I work with Pain Management Services in Palmerston North, and am now associated with The Back Institute (TBI) recently established in Hastings and Napier.

 

Dissociation

We have all experienced forgetting about pain when we are concentrating on something else. Latest theories propose a cognitive-evaluative component to pain perception including appraisal, cultural values, distraction, and hypnotic suggestion. As a result two people with identical conditions can experience very different levels of pain. It is possible to learn to perceive pain differently using hypnosis and open focus.

 

Hypnosis - I have a diploma in hypnosis from the NZ Hypnosis Society for registered health professionals. For those who are hypnotisable, I use glove anaesthesia, self hypnosis, and visual imagery to reduce the perception of pain.

 

Open Focus - Les Fehmi has developed a way of functioning that is inclusive of all your surroundings and inclusive of all body sensations. This counteracts the tendency to focus on one thing, such as the source of pain. It also helps with Obsessive Compulsive Disorder. For those who are prepared to learn this technique, good results can be attained.

 

Relaxation/mindfulness

In my practice relaxation is central to all psychological interventions. Learning to let go of issues, physical tension, emotional states is the basis for improved physical and psychological status. This begins by learning to breathe properly. Next, learning to relax the muscles and the mind using effective relaxation techniques will provide the person who is willing to practice, a learned relaxation response that will help with sleep, pacing self in daily life, and ease interpersonal relations. Occasionally excessive pain is a barrier to relaxation. Brief meditation can be useful in this situation and also for those who like to be active.

 

 

Breathing techniques - I teach diaphragmatic breathing and this is practised until it becomes second nature. I also teach a breathing meditation to help with sleep onset. The use of heart rate variability biofeedback described below teaches regulation of the speed and depth of breathing. Using breathing to reduce anxiety levels is very effective. Many anxious clients report that breathing techniques help them a great deal. Some asthmatic clients no longer need to use ventolin.

 

Relaxation - I use a modified 20 minute autogenic relaxation script in preference to progressive muscle relaxation as I find that it provides complete mental relaxation as well as physical relaxation and works for all clients. I provide clients with a CD and they are asked to listen to it daily for at least a month. If people comply they experience enhanced sleep patterns and a more relaxed approach to life.

 

Biofeedback - Biofeedback takes recordings of vital signs and displays them on a computer screen for the client to learn to regulate them. I have an American qualification in Biofeedback and have completed the Biofeedback Certification Institute of America certification course. Of the many modalities I use skin sweat to demonstrate emotional reactivity, heart rate variability (synchronising the breath with the heart rate so that the heart rate change graph resembles a sine wave which is known to be good for heart health), hand temperature training to induce a relaxed state. Technically minded people tend to like these ways to learn to relax. It can be a revelation for people to find how their thoughts impact on their bodies and this enhances the effectiveness of cognitive-behavioural approaches that address cognitive distortions.

 

Meditation/mindfulness - All of the above techniques overlap with mindfulness. Mindfulness has a good research basis. Again clients need to complete home practice and people's ability to quiet the mind varies. I use a four pronged mindfulness technique that ensures rapid attainment of mind and body relaxation and is ideal for busy people such as working mothers who can schedule 5 minutes breaks during the day.

 

Physical Pain Reduction Techniques

I use an electrical stimulation device, trademark Alphastim. It is similar to a TENS machine but has many advantages. It does not hurt to use. The relief of pain can last for days. The more often it is used the more effective it can be. It employs a very weak current with a pulsed wave form similar to the body's electrical system, possibly re-regulating it. Unfortunately these devices are expensive which is a barrier to regular use but I do allow people to use my equipment at my practice on a daily basis if it helps.

 

Therapeutic interventions.

In addition to the above interventions that specifically address pain, I use a wide range of therapeutic approaches in which I have received training that assist with psychological issues related to abuse, insecure attachment, motivation, mood disorders, stress, balanced lifestyle. These therapies are Dialectical Behaviour Therapy, Neurolinguistic Programming, Emotional Freedom Technique, Narrative Therapy, hypnosis, couples therapy, Rational Emotive therapy, and Cognitive Behavioural Therapy.

 

 

Fran Lowe, PhD, Registered Psychologist

Pirimai, Napier, NZ Phone 021 055 4897