People experiencing chronic pain can feel isolated and alone, and nothing increases that more than feeling like no one understands what you are going through. Even the most supportive loved ones might suggest that the pain is psychological—all in your mind. While it’s true that pain is largely a process of neurotransmitters, there is no arguing that its effects are all-too real. In a comprehensive treatment plan, chronic pain therapy can be the one thing that bridges the gap between mind and body. Here’s how it works.
How can mental health therapy help with chronic pain?
In 2011, the Institute of Medicine (IOM) published Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. It cited the startling facts of chronic pain, the far-reaching of effects of which had not been fully understood until this article brought them together. The IOM labeled chronic pain as “biopsychosocial.” This finally acknowledges that chronic pain is a complex phenomenon that isn’t just about a physical sensation.
Since then, it is not shocking that the study of pain has still focused largely on the physical sensations. Physical pain is easier to measure. But there is some progress.
The stigma of mental health issues is real and remains one of the largest barriers to seeking help. Recent research articles have reframed that not as stigma but as discrimination aimed at some of the most-affected groups.
Regardless of the label, the benefits of chronic pain therapy exist in the research.
- A review of studies updated in 2020 found that pain patients receiving psychological treatment were likely to feel less pain (and less distress when pain flared)
- Chronic pain therapy often successfully addresses conditions that both increase and are increased by chronic pain (e.g., anxiety and depression)
- Patients who participate in group therapy or support groups experience better physical and mental health outcomes
And chronic pain therapy is urgently needed. A 2018 study across 18 states in the U.S. found that almost 9% of people who died by suicide cited chronic pain in their suicide notes.
Whether we want to acknowledge it and study it or not, chronic pain and mental health are inextricably linked. Treating one helps treat the other.
Types of chronic pain therapy available
Chronic pain therapy—like many other therapies for chronic pain—is not a one-size-fits-all approach. Just as our pain is as different as we are, the therapy that helps the most will also be similarly individual.
While a number of chronic pain therapy approaches exist, here are five of the most common.
1. Cognitive behavioral therapy for chronic pain
Cognitive behavioral therapy (CBT) is one of the most well-known types of therapy. This is a form of “talk therapy” where a therapist and patient work through a specific issue or set of issues. The goal is not to reach a resolution but to change the behavior and thought pattern surrounding those issues. The idea behind this therapy is that a specific pattern of thought is contributing to your experience of something. CBT works to break or change that negative thought pattern.
Patients might use journaling, desensitization, or cognitive rehearsal to change their thought patterns. By keeping track of your thoughts, or examining them without attaching any significance to them, you may find your pain levels more manageable. CBT does not remove the pain or treat the cause. What it does is change the way you think about and interact with your experience of it.
Many people benefit from CBT for chronic pain. Those with other conditions such as substance abuse disorders, eating disorders, phobias, ADHD, and PTSD also have success with this type of chronic pain therapy. CBT works to treat both chronic pain with a specific cause and chronic pain whose cause is as yet undiagnosed.
2. Group therapy for chronic pain
The isolation of chronic pain can be an insurmountable obstacle to treatment. Many people feel utterly alone, with friends and families who either don’t believe them or feel helpless in the face of their unresponsive pain.
This is where group therapy for chronic pain comes in.
Group therapy for chronic pain is frequently confused with support groups. There are some significant differences between the two (though, both can be very helpful). Put very simply, support groups exist to help you cope with the daily struggles of chronic pain. Group therapy exists to help you unpack your condition and grow.
Support groups are truly valuable when you are feeling isolated and lonely in your pain. They do not need to have a licensed therapist as a facilitator (but sometimes they do). Often, they focus on successes, tips for coping, and support for daily struggles. Support groups are usually free and available both in-person and online.
On the other hand, group therapy for chronic pain is committed to helping each participant change. It is more structured than a support group. It is led by a licensed therapist who usually screens participants to include those working on similar issues. Group therapy is often more affordable than individual therapy, but it is not free.
Research on these two types of chronic pain therapy is hard to come by. It is a challenging study to design in a scientifically-valid way. Most evidence of its effectiveness is anecdotal, but it is worth a try.
When it comes to support groups, it’s safe to say that everyone in pain could benefit from understanding and support. And if you have a therapist or doctor you trust but need to economize, group therapy with that person can still provide benefits. Talk to trusted healthcare workers for recommendations.
3. Acceptance and commitment therapy for chronic pain
Acceptance and commitment therapy (ACT) for chronic pain helps people to look at their situation and accept it. It does not try to change your outlook or modify your thinking. It simply notes that yes, you have fibromyalgia, but how can you live with that understanding anyway?
Unlike CBT for chronic pain, acceptance and commitment therapy does not try to reframe or otherwise change your patterns of thought or behavior. It’s the difference between looking at your pain and saying, “Why me?” and looking at your pain and saying, “Why not me?” It’s a very Zen-like approach to thinking about chronic pain as a thing that simply exists—no more or less.
ACT might work well for patients in the early stages of chronic pain, especially those who are experiencing extreme distress at the thought of life in pain.
4. SFBT for chronic pain
Solution-focused brief therapy (SFBT) might be the most utilitarian form of chronic pain therapy on our list. Short-term and hyper-focused on a goal, this type of therapy wants patients to experience specific successes when it comes to chronic pain. SFBT works to improve a person’s daily life through reachable targets.
Using the phrase “preferred future” as a guiding light, SFBT helps pain patients describe what they want that to look like. This helps people to take concrete control of their lives, a big plus for people in chronic pain.
This approach might benefit patients looking to take measurable steps in their treatment. Consultations focus on successes and lay out a process to reach their goals.
5. EMDR for chronic pain
In the ground-breaking book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Bessel van der Kolk makes the case that when it comes to trauma, our bodies remember. Long after the traumatic event has passed and the acute injuries have healed, the trauma of the event—whatever it is—remains lodged in our cells, causing lingering pain. Van der Kolk used EMDR for PTSD and sexual assault survivors, conditions that are often related to chronic pain as well.
Eye Movement Desensitization and Reprocessing (EMDR) consists of therapist-directed eye and hand movements to essentially access the patient’s traumatic memories and integrate them. This integration can be very difficult, but on the other side of it is healing.
Research studies on EMDR as a chronic pain therapy are small but promising. Various studies have found that EMDR reduces pain and decreases mood disorders and other associated psychological issues.
Patients who have chronic pain as a result of a specific traumatic event may benefit most from this type of chronic pain therapy.
How to get started with chronic pain therapy
Getting started with chronic pain therapy can feel intimidating. Even with mental health awareness at an all-time high, many people still feel uneasy recognizing that they need help.
This is a normal feeling. Many people try everything else before they seek out chronic pain therapy. It may be a cliché, but it’s true that the first step is accepting that you need to try something different. After that, there are five steps to getting started with chronic pain therapy.
Step 1: Talk to your doctor
Your doctor has been coordinating your treatments so far, and it makes good sense to seek out references from them. They may work closely with therapists who specialize in chronic pain.
If your doctor does not have a referral for you, visit an online support group for suggestions. You can also ask people you know for recommendations.
Step 2: Set up your initial psychological evaluation
Many people are put off by the term “psychological evaluation.” It’s really just a way to assess your current mental health and to design an appropriate plan for treatment. It’s similar to an initial consultation with your doctor.
It doesn’t mean you will be declared insane, immediately be placed on medication, or get an on-the-spot diagnosis. What it does mean is that you will begin to carve a path to better mental health by creating a plan with your therapist.
Your initial consultation may be in-person, but many therapists are offering telemedicine. This can be helpful on those days when chronic pain flares prevent you from leaving the house.
Step 3: Attend regular appointments
Attending regular therapy appointments are the key to making progress. It can be very challenging to commit to talking about your mental struggles, especially if that is not something in your past experience. Maybe you show up and don’t feel like talking. This is okay. Your therapist is used to that and expects it. They are trained to help you to open up and examine what’s on your mind.
However, if you only attend therapy sporadically, constantly skipping or rescheduling appointments, it’s difficult to develop a relationship that is helpful. If money is an issue and insurance only covers a limited number of appointments, plan a schedule with your therapist that makes sense.
Then stick to it.
Step 4: Do your homework
No, there won’t be a quiz, but yes, there is usually homework. The majority of the breakthroughs and progress happen outside of the therapist’s office.
You may be asked to write things down or to put something in action and then report back at your next appointment. Make every effort to follow through on these “assignments.”
Consider one of the sayings of Alcoholics Anonymous: it works if you work it. So, work it.
Arizona Pain is a Phoenix-based pain management clinic that offers psychological evaluations, cognitive behavioral therapy, and biofeedback for patients in pain. Additionally, we host two support groups a week for peer support.
If you are in Arizona and ready to explore chronic pain therapy, get in touch to see how we can help.