Psychotherapy for Chronic Pain

According to research by the American Psychological Association, about one-third of Americans experience chronic pain each year. Chronic pain is pain that lasts far beyond the time when normal healing should have occurred. Chronic pain often has its origin in physical causes, such as sprains or strains from injuries, inflammation from disease, damage from repetitive motion, overwork, injury to joints, or arthritis. However, chronic pain can also have a psychological or emotional component that is rarely addressed by conventional medical treatment.

In the Diagnostic and Statistical Manual of Mental Disorders, the handbook of the American Psychiatric Association, chronic pain disorder has the following characteristics:

• The pain has been present for at least six months.
• The pain significantly interferes with activities of daily life.
• The pain is associated with psychological factors that either caused it, worsened it, or prolonged it.
• The pain may or may not be associated with a medical condition.

Psychotherapy can treat chronic pain caused or prolonged by stress, anxiety, and emotional trauma. It also can be used in conjunction with alternative or conventional medical therapies to help people better cope with chronic pain that has a physical cause not relieved by medical treatment.

How Psychotherapy Helps People with Chronic Pain

Chronic pain is both individual and subjective. Pain that may be manageable for one person may be debilitating for another. One important aspect of psychotherapy is validation for the patient that the pain is real and has far-reaching side effects. Once that has been established, psychotherapy can help people cope with the daily effects of living with chronic pain.

Psychotherapy can help people with chronic pain by:

• Coaching patients in behaviors that limit the degree to which pain affects daily life.
• Developing strategies to encourage and reward normal activities and discourage manipulative behaviors.
• Encouraging thought patterns that give the patient more control over his or her mood and level of anxiety.
• Suggesting strategies that increase the sense of control the patient has over his or her life.
• Helping the patient develop social relationships and a sense of self-worth to combat isolation and pain-related depression.
• Suggesting complementary alternative therapies such as relaxation techniques, hypnosis, meditation, yoga, or biofeedback to help relieve pain.

What is Psychotherapy?

Psychotherapy, sometimes called talk therapy, is the treatment of emotional or mental health disorders without using pharmaceutical drugs. Treatment involves the patient and a trained professional psychiatrist, psychologist, or counselor interacting on a regular basis. Through this interaction, an atmosphere of trust develops so the psychotherapist can coach the patient in techniques that help him or her to change unhealthy behaviors, thoughts, or emotions. Psychotherapists are most effective in treating chronic pain when they are part of a multidisciplinary team that includes conventional and alternative medical practitioners.

How Do Psychologists Treat Chronic Pain?

Sessions with a psychotherapist usually last 50 minutes and occur once or twice a week. The first step a psychotherapist will take in treating a patient with chronic pain is to determine if the pain has a physical cause with emotional and psychological components or if the cause is purely psychological. If the pain is partially caused by a physical condition, it should be treated by an alternative or conventional health-care professional experienced in pain management who is willing to work with the psychotherapist.

On the initial visit, the psychotherapist may use a pain assessment tool such as the West Haven–Yale Multidimensional Pain Inventory to gain a picture of the ways in which chronic pain is affecting the patient’s daily activities and mood. In addition to directly addressing the issue of pain, psychotherapists also use a variety of techniques to help patients cope with the side effects of chronic pain, such as depression, suicidal thoughts, anxiety, social isolation, sexual dysfunction, fear of disability, and marital or family stress. Therapy is individualized, and the patient may participate in group, family, or individual therapy sessions.

Many medical insurance plans cover or partially cover a limited number of sessions with a licensed psychotherapist. Patients should check with their insurer before beginning treatment.

Types of Psychotherapy for Chronic Pain

Two of the most common types of psychotherapy used with patients experiencing chronic pain are cognitive-behavioral therapy and behavior modification. Cognitive-behavioral therapy helps motivate patients to become aware of their thinking about pain. Once aware of habitual thought patterns, they are coached to consciously and consistently replace negative thoughts with positive ones. Ideally, this change from negative to positive thinking will, with repetition, result in positive changes in behavior.

Behavior modification is used when, for example, the patient is using chronic pain as a way to get attention or to avoid an unpleasant activity. Behavior modification often involves teaching family members not to “reward” the patient when he or she uses pain as a tool to manipulate people or situations.

Additional Resources

American Psychological Association website “Psychology Matters” has an article on psychological approaches to help people with chronic pain.

American Psychological Association has published 10-step program to help people change their behavior to relieve or better cope with chronic pain: Turk, Dennis C., and Frits Winter. The Pain Survival Guide. Washington, DC: American Psychological Association, 2006.