by: Yvette Colón, PhD, BCD, LMSW-C
Photo Credit: Maggie Buckley
Q: How does mental health treatment improve the overall pain patient experience and their pain management plan?
A: Pain is a subjective, multidimensional experience. It integrates knowledge of symptoms and treatments and individualizes illness experience, mediated by the individual’s emotional, cognitive, behavioral, cultural, spiritual, and social interpretations. All of these play significant roles in human functioning in the context of disease or illness. Effective pain management requires a comprehensive, integrative response, including psychological services and other mental health interventions. Pain care is often fragmented; people with chronic pain benefit from thorough assessment and integration of care. Chronic pain can interfere with everyday life. It can diminish quality of life and affect one’s ability to function adequately. The inability to participate in social activities and hobbies can lead to decreased self-esteem. People with chronic pain can experience sleep disturbances, fatigue, difficulty concentrating, decreased appetite, and mood changes. These negative changes can increase the intensity of your pain and affect your overall mood. The difficulty of dealing with pain and its negative effects can result in depression and anxiety. Anxiety disorders are the most prevalent type of mental health disorders, and they frequently co-occur with various medical conditions, including chronic pain. Up to 28.7% of the U.S. population has Generalized Anxiety Disorder, but an estimated 35% of people with chronic pain have anxiety. Anxiety disorders are associated with higher health care costs; comorbid chronic pain and anxiety disorder leads to worse outcomes.
Psychological treatments for anxiety and chronic pain are similar. The goals are to teach the patient how to predict and manage physiological and psychological symptoms and use appropriate coping skills to minimize symptoms. Despite their prevalence, anxiety disorders often go unrecognized in pain care facilities, compromising the overall benefit of pain treatment. Pain-related anxiety can co-exist with pain-related depression. Pain and depression are highly intertwined and may co-exacerbate physical and psychological symptoms. Several studies indicate that approximately 40-80% of people with chronic pain report depression after the onset of pain. This pain-related depression can reduce physical, psychological, social, and occupational functioning. Psychological treatment for depression and chronic pain are similar. The goals are to relieve distress and suffering, increase feelings of control, improve relationships, and teach the person with chronic pain to be aware of negative beliefs or actions that can make pain feel worse. While psychosocial interventions have been primarily tested for mental health problems, there is evidence that psychological interventions are effective for chronic pain. Although some practitioners may treat pain and mental health conditions separately, there are several psychotherapies that can help manage both at the same time. There are many evidence-informed behavioral health interventions that can help change one’s relationship with pain, reduce stress, and increase coping. These interventions will be discussed in detail in future blogs:
- Acceptance and Commitment Therapy
- Cognitive-Behavioral Therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
- Medical Hypnotherapy
- Mindfulness Practice/Mindfulness-Based Stress Reduction
- Psychoeducation
- Support Groups/Group Therapy
There are many behavioral health specialists (social workers, psychologists, counselors, and psychiatrists) who can provide psychotherapy to help people with chronic pain and their families. They can help patients identify problems caused by pain; help patients identify, express, and manage their emotions; help patients and family members move toward better physical and psychological functioning; reduce suffering; and enable people with pain to live full and rewarding lives in the face of illness. Many health insurance policies cover mental health visits and ongoing psychotherapy with licensed mental/behavioral health providers. Contact the health insurance company to determine level of coverage and any required copays. You also have the option of self-pay; be sure to ask a potential psychotherapist their rates (often called “sliding scale” rate).To find a psychotherapist, search www.psychologytoday.com/us/therapists.
Bibliography
- Asmundson, G. J., & Katz, J. (2009). Understanding the co‐occurrence of anxiety disorders and chronic pain: State‐of‐the‐art. Depression and Anxiety, 26(10), 888-901.
- Goesling, , J., Lin, L.A., & Clauw , D.J. (2018). Psychiatry and pain management: At the intersection of chronic pain and mental health. Current Psychiatry Reports, 20(2), 1-8.
- IsHak, W.W., Wen, R.Y., Naghdechi, L., Vanle, B., Dang, J., Knosp, M., … & Louy, C. (2018). Pain and depression: A systematic review. Harvard Review Of Psychiatry, 26(6), 352-363.
- Jordan, K.D. & Okifuji, A. (2011) Anxiety disorders: Differential diagnosis and their relationship to chronic pain. Journal of Pain & Palliative Care Pharmacotherapy, 25(3), 231-245.
- McWilliams L.A., Cox, B.J., & Enns, M.W. (2003). Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain, 106, 127-133.
- Poole, H., White, S., Blake, C., Murphy, P., & Bramwell, R. (2009). Depression in chronic pain patients: Prevalence and measurement. Pain Practice, 9(3), 173-180.
- Thernstrom, M. (2010). The pain chronicles: Myths, mysteries, prayers, diaries, brain scans, healing, and the science of suffering. New York, NY: Farrar, Straus and Giroux.
- Waguih, W.I., Wen, R.Y., Nagdechi, L, Vanle, B., et al. (2018). Pain and depression: A systematic review. Harvard Review of Psychiatry, 26(6), 352-363.