Chronic Pain

When approaching a patient with pain, the first step is to do a very thorough pain history to determine the etiology of pain, severity of pain, duration of the pain and the impact of the pain on the patient’s life and physical functioning. The etiology of the pain will guide us to understand the expected duration of the pain and the approaches that are most likely to be effective in treatment. For cancer patients in moderate to severe pain, opioid pain medications are often effective. We may use opioid pain medications in conjunction with acetaminophen or non-steroidal anti-inflammatories (NSAIDs). Our goal in treating patients is to get a stable control of pain with a standing medication regimen, with the availability of “breakthrough” or “rescue” medications for acute exacerbations of pain that may occur. When starting patients on new pain medication regimens we make sure to have close follow-up with patients to assess for efficacy as well as side effects of the regimen. We also make use of other members of the interdisciplinary palliative care team, including our massage therapists to assist in pain management. Certain cancer pain syndromes may also be amenable to interventional procedures such as nerve blocks, in which case we work with and make referrals to our colleagues in Anesthesiology who specialize in interventional pain management.

People often question whether or not their doctor thinks they are crazy because the person is referred to counseling as a means to helping them deal with chronic pain. We have grown up in a society that seems to ebrace a division of the physical from the psychological. In today's conceptualization of wellness, that division exists no longer. Today we consider not a person's illness as much as a person's wellness, their optimum state of being regardless of their abilities or disabilities. Today we understand that the mind, body and spirit are interconnected and each affects the other. Overemphasizing treatment in one area may not treat the problem, chronic pain, but actually throws the person out of balance creating more distress. In working with clients with chronic pain, I try to help them understand that there is more than just the physical pain involved here. When we have had pain for some time, we feel a sense of grief, longing and resentment. Grief for a lifestyle we may no longer live or for dreams that may never be attained. Longing for the freedom from pain and for people we may have let go of or let go of us. And resentment of doctors, medication, caregivers, the Universe or even God for the unfairness of our pain. When we look at the holistic impact of pain, it's easy to understand why psychotherapy can be helpful in some cases. "How?" you ask. Feeling constant pain can change an optimist into a pessimist in short order if the person isn't aware of what's happening to them. The more negative people are, the more they tend to focus on the evidence that they "should" feel that way (we call that emotional reasoning -- making reason for the way I feel). When a person feeling physical pain becomes depressed and focuses on the loss and catastrophe that they think their lives now represent, they actually can feel the pain more severely. Pain seems to feel stronger when our bodies are tense and tight. Working with a counselor or therapist skilled in working with clients in pain can add value to other medical and therapeutic interventions. Clients can learn to manage stress through relaxation exercises, breathing techniques, guided medications and other psychotherapy interventions that can lessen the subjective experience of pain. Therapists can help clients focus not on the "horribleness" of their plight but to a more realistic experience of co-existing with pain, living life in spite of the pain. "Feel the pain and do it anyway." At least then you don't let pain rob you of an experience you will treasure like a trip with the family or obtaining a long sought goal. Therapists can help you understand what you truly value in life and encourage you set about getting it, or make decisions about what you no longer value and letting that go. The most effective pain management today seems to include three prongs, medical intervention, physical therapy and psychological counseling. If you are experiencing pain and are frustrated with your treatment, ask your pain management specialist about adding ancillary providers such as a physical therapist and a psychotherapist or psychologist. You may not be able to eliminate your pain, but you can co-exist with it and live a life you love.