Over the years, many researchers and health care professionals alike have come to understand that pain is not a solitary central nervous system (CNS) process; that is, what you feel is not pain alone. Other CNS processes play a role in our experience and sensation of pain. These include areas of the brain involved in fear and anxiety; attention and vigilance; and memory and past experiences. As the pain becomes more chronic, these other processes take on a more prominent role. Someone in constant pain will become more vigilant and attentive to his/her symptoms so that pain always feels in the forefront of their lives. As well, being more aware of your pain along with fear/anxiety of causing further pain with physical activity (based on experience), makes many people feel that they have to restrict and limit their activities to avoid more pain. Feeling constant pain, being restricted by pain, and having at times to make dramatic changes to one’s lifestyle to accommodate pain can make people feel more anxious, stressed and depressed. They do not feel in control of their pain, their feelings or their lives. Pain is therefore a WHOLE person problem, an interplay of both the mind (our emotions) and the body.
Psychologists who specialize with chronic pain patients understand the interplay between the mind and body. By the time we see a pain patient, he/she has undergone multiple medical assessments and treatments with minimal to some relief of symptoms. Psychologists understand that emotions, thoughts and vigilance play a role in “amplifying” the pain experience. Have you ever noticed that when you are feeling very stressed, angry or depressed that your pain seems worse? Or that your pain seems less intense when you are caught up in an activity that grabs your attention or makes you feel happy? Psychologists, like myself, focus on teaching patients more effective ways to cope and manage their pain by helping them to change negative thoughts and feelings, reducing stress, improving sleep, and setting goals to engage in more positive daily activities. Making positive changes to these areas serve to lower the “amplification” of pain. This is accomplished through various psychological strategies.
For example, Cognitive-Behavioral Therapy (CBT) is often used to help patients become more aware of their negative thoughts and feelings and to develop alternative ways to look at problem areas (including pain) so that the patient can resolve them without getting caught up in them. Patients learn relaxation training and/or mindfulness meditation to teach them ways to reduce muscular tension through the body and to relax the mind, which helps to
reduce stress levels. Helping patients resume some of their daily activities is accomplished by utilizing the various skills acquired in sessions, setting small goals that are achievable and gradually increasing the level of activity while staying in control of pain. A pain psychologist will tailor the strategies to the needs of each patient and treatment goals are discussed at the very beginning so that the patient and psychologist are on the same page in terms of the patient’s needs and expectations.
Research has consistently shown that psychological counseling is one of the most effective treatment strategies for chronic pain. If you have been struggling with depression, anxiety, stress, and/or anger because of chronic pain, then it may be time to contact a pain psychologist to help lessen your emotional suffering and to get you on a more positive path to living a good life with pain.
Karen Spivak is a registered Psychologist by the College of Psychologists of Ontario since 1990. She received her Ph.D. in Psychology from Concordia University in Montreal in 1987 and pursued post-doctoral training at the Addiction Research Foundation and the Clarke Institute of Psychiatry. Since 1992, Dr. Spivak has maintained a private practice, providing psychological assessments and treatment for chronic pain, depression, anxiety, stress and post-accident adjustment difficulties In addition, she is a consultant with the Comprehensive Interdisciplinary Pain Program at the Toronto Rehabilitation Institute, and she provides counselling to pain patients as part of the interdisciplinary team at the Pain and Wellness Centre in Vaughan, Ontario.
Karen Spivak, Ph.D. C.Psych Comprehensive Interdisciplinary Pain Program @ Toronto Rehab Institute & Pain and Wellness Centre, 2301 Major Mackenzie Dr. West Vaughan, ON L6A 3Z3 email:firstname.lastname@example.org tel: 416-587-0512 fax: 1-844-358-9308