Join Now
Sign In
What techniques do you employ to help patients deal with their pain?
Topic Tags:
Topic Tags:
Diseases:
Diseases:
1
Expert Answers
SethResnickMD (Physician - Psychiatry (Verified) ) - 12 / 13 / 2011
I personally have specialty-level training in the field of Pain Medicine, having completed a fellowship in Pain and Palliative Care, so I have an understanding of the varied options and multifaceted approaches to pain management. With my background in psychiatry, I additionally have an understanding about the importance of the interdisciplinary approach, as its roots stem from psychiatric care is best applied to treating any psychiatric or medical condition, including quite substantially the treatment of pain, particularly when chronic, as well as in the cancer patient. For better or worse, the experience of pain is a complex and multidimensional phenomenon, so its management also requires utilizing an array of techniques. In addition to the continuing advances in interventional pain medicine, which include nerve blocks and injections and infusions or continuous delivery of medications including anesthetic agents and opioid pain medications as well as corticosteroids which have potent anti-inflammatory properties, as well as electrical stimulation, delivered to or around the central nervous system; and the use of medications in a variety of classes – opioid pain medications which can be administered in pill form and via host of other routes, corticosteroids, NSAIDs (non-steroidal anti-inflammatory drugs) many of which are available over the counter but present a host of potential medical risks, what are called muscle relaxants, anesthetic agents, and other classes called “adjuvants” which include some antidepressants, anti-seizure medications also used in psychiatry, and other channel blockers; there are other somatic treatments that involve electrical stimulation as well as the delivery of other types of energy – thermal, mechanical, or chemical – across the surface of the body, such as Transcutaneous Electric Nerve Stimulation or Cranial Electric Stimulation – and physical therapy – key to most types of persistent pain to improve functional status, as well as psychotherapeutic techniques, ranging from supportive psychotherapy and cognitive behavioral therapy, to incorporating mindfulness-based, relaxation, and hypnosis/ hypnotherapy techniques, to biofeedback, and support groups, along with non-medical treatments such as massage, acupuncture, and other mind-body approaches.
I am not an interventionalist, so I basically do nothing with a needle. That rules out a fair amount of the mainstream approach to pain management as it exists in practice today. Psychiatry happens to be one of four medical fields in which there is formal sub-specialization in Pain Medicine, the others being Neurology, Physical Medicine and Rehabilitation (PM&R or Physiatry), and Anesthesiology which is the most common. Since training generally entails the same program regardless of specialty, anyone completing a fellowship program in the field can pursue expertise in the main existing approaches. The involvement of psychiatry comes from an understanding, which certainly needs much further characterization, that psychiatric factors are indelibly and complicatedly interwoven with the experience of pain, both driving and exacerbating or, for that matter, ameliorating, pain and resulting from it. While people, particularly those who suffer from the very real experience of pain, are troubled when they perceive others think that “it is all in their head”, and, conversely, family, friends, lay people, or even clinicians, can become distraught when dealing with someone who is debilitated from that which does not present with a clear physical manifestation or appearance, there is no truth more useful to recognize in dealing with the mysteries of pain than the fact that “pain is in the brain”. While it is a controversial and weighted statement, there can be nothing closer to the truth. In dealing with psychiatric problems, psychiatrists and their patients, alike, are used to confronting stigma, and dealing with uncertainty, complexity, and compound logic which may involve, and typically expects, more than one explanation for things, so that dealing with the, at times elusive, problem of pain is something which we may be particularly adept and uniquely skilled to pursue, though one might argue that the trouble with pain is even greater due to the expectation of a physical explanation that often escapes the understanding of what is typically framed as a physical problem. However, a distinction must be made from the term “nociception” which is specifically defined as the ‘neural processing of noxious stimuli’ and is that which is specifically at play when we think about the sensation from the physically harmful effects of tissue injury. "Pain", on the other hand, the end product of nociception, if you will, is a perceptual phenomenon and, as such, is nothing other than a brain phenomenon. With this in mind (no pun intended) how could one’s emotions and thoughts, also perceived and processed, respectively, in the brain, not affect and interact with the experience of pain? This is such a simple concept that is unfortunately lost on so many, because it is, at the same time, somewhat difficult to grasp with respect to our expectations.
This all goes to explain the underpinnings of the multidimensional approach to pain, and the richness and importance of the psychiatric understanding, support, and treatment for someone with pain, and the value added by the involvement of a psychiatrist, with expertise in medical pain management, in the approach to the patient with pain. What is called ‘needle-jockeying’ involves highly technical procedures which would not be conducive to a psychotherapeutic encounter. Assessment of non-interventional pharmacologic approaches to pain is within my practice, as my input with potentially overlapping psychiatric medication can be helpful, but, without being able to give details depending on the case and the setting, I generally do so in the context of multidisciplinary pain management. In addition to medication evaluation for juxtaposed pain and psychiatric issues, psychotherapy is a main focus of all of my practice, on some level. In addition to psychopharmacology, I have expertise in psychotherapy which incorporates basic training in hypnosis, an evidence-based intervention for pain. The meaning of pain to a given individual, and the dramatic effects it has in changing one’s life when it enters, calls for such work.
I am not an interventionalist, so I basically do nothing with a needle. That rules out a fair amount of the mainstream approach to pain management as it exists in practice today. Psychiatry happens to be one of four medical fields in which there is formal sub-specialization in Pain Medicine, the others being Neurology, Physical Medicine and Rehabilitation (PM&R or Physiatry), and Anesthesiology which is the most common. Since training generally entails the same program regardless of specialty, anyone completing a fellowship program in the field can pursue expertise in the main existing approaches. The involvement of psychiatry comes from an understanding, which certainly needs much further characterization, that psychiatric factors are indelibly and complicatedly interwoven with the experience of pain, both driving and exacerbating or, for that matter, ameliorating, pain and resulting from it. While people, particularly those who suffer from the very real experience of pain, are troubled when they perceive others think that “it is all in their head”, and, conversely, family, friends, lay people, or even clinicians, can become distraught when dealing with someone who is debilitated from that which does not present with a clear physical manifestation or appearance, there is no truth more useful to recognize in dealing with the mysteries of pain than the fact that “pain is in the brain”. While it is a controversial and weighted statement, there can be nothing closer to the truth. In dealing with psychiatric problems, psychiatrists and their patients, alike, are used to confronting stigma, and dealing with uncertainty, complexity, and compound logic which may involve, and typically expects, more than one explanation for things, so that dealing with the, at times elusive, problem of pain is something which we may be particularly adept and uniquely skilled to pursue, though one might argue that the trouble with pain is even greater due to the expectation of a physical explanation that often escapes the understanding of what is typically framed as a physical problem. However, a distinction must be made from the term “nociception” which is specifically defined as the ‘neural processing of noxious stimuli’ and is that which is specifically at play when we think about the sensation from the physically harmful effects of tissue injury. "Pain", on the other hand, the end product of nociception, if you will, is a perceptual phenomenon and, as such, is nothing other than a brain phenomenon. With this in mind (no pun intended) how could one’s emotions and thoughts, also perceived and processed, respectively, in the brain, not affect and interact with the experience of pain? This is such a simple concept that is unfortunately lost on so many, because it is, at the same time, somewhat difficult to grasp with respect to our expectations.
This all goes to explain the underpinnings of the multidimensional approach to pain, and the richness and importance of the psychiatric understanding, support, and treatment for someone with pain, and the value added by the involvement of a psychiatrist, with expertise in medical pain management, in the approach to the patient with pain. What is called ‘needle-jockeying’ involves highly technical procedures which would not be conducive to a psychotherapeutic encounter. Assessment of non-interventional pharmacologic approaches to pain is within my practice, as my input with potentially overlapping psychiatric medication can be helpful, but, without being able to give details depending on the case and the setting, I generally do so in the context of multidisciplinary pain management. In addition to medication evaluation for juxtaposed pain and psychiatric issues, psychotherapy is a main focus of all of my practice, on some level. In addition to psychopharmacology, I have expertise in psychotherapy which incorporates basic training in hypnosis, an evidence-based intervention for pain. The meaning of pain to a given individual, and the dramatic effects it has in changing one’s life when it enters, calls for such work.
Similar Questions
Note: All content on this site is informational and not a substitute for professional medical advice.
Always seek the advice of your physician or other qualified health provider with questions regarding your health.
Note: Usernames have been made anonymous and profile images are not shown to protect the privacy of our members.
Thank you for flagging this content. We will look into it right away.
Add Answer
1) Question:
2) Background Info (optional): What context or background information is relevant to this request?
Notes:
The more clear and thorough your request, the more likely you will receive support.
Many of our members are learning from this information or english might not be their first language. Please use standard english and spell out all words. For example, use 'you' instead of 'u'.
The more clear and thorough your request, the more likely you will receive support.
Many of our members are learning from this information or english might not be their first language. Please use standard english and spell out all words. For example, use 'you' instead of 'u'.
Newsletters
Share Conversation
To tell people about this conversation, type their email addresses here (separated by commas):
From:
Add a personal note here:
Breast Cancer Updates
Sign up for our
Breast Cancer
updates for the latest news, best answers and featured experts.
Ads keep TalkAboutHealth freeadvertisement
Similar Questions
Updates
Sign up for email updates of the latest news, best answers, and featured experts.
Benefits
Custom health, wellness, & medical offers from our partners including clinical trials, market research opportunities & new programs.
Upcoming Workshops
-
Breast Cancer Oncology
Mon., May 20th
Expert: Katherine Crew, MD -
Melanoma Oncology
Mon., May 20th
Expert: Steven O'Day, MD -
Gastric (Stomach) Cancer Oncology
Tues., May 21st
Expert: Manish Shah, MD -
T-cell Lymphoma
Tues., May 21st
Expert: Francine Foss, MD -
Breast Cancer Oncology
Wed., May 22nd
Expert: Linnea Chap, MD -
Cancer Support and Psychosocial Education
Thurs., May 23rd
Expert: Jeff Kane, MD -
CLL - Chronic Lymphocytic Leukemia
Fri., May 24th
Expert: Jennifer Brown, MD, PhD
SHARE Support
1) Call SHARE at: 866-891-2392
to speak directly to a trained breast cancer survivor for support and guidance.
2) Direct message the trained peer supporter you select.
3) E-mail us at support@talkabouthealth.com, and we will find the right match for you.
More info
to speak directly to a trained breast cancer survivor for support and guidance.
2) Direct message the trained peer supporter you select.
3) E-mail us at support@talkabouthealth.com, and we will find the right match for you.
More info
3 Quick Ways You Can Help
1) Spread the word! Tell people you think might want some support. Tell medical professionals, health providers, and organizations.
2) Like us on Facebook and follow us on Twitter!
3) Volunteer - email us at volunteer@talkabouthealth.com for more information.
More Ways To Help!
2) Like us on Facebook and follow us on Twitter!
3) Volunteer - email us at volunteer@talkabouthealth.com for more information.
More Ways To Help!
View All Newsletters
