What psychological therapies can help chronic pain patients?

Psychotherapy can alleviate the symptoms and suffering of those affected.

Imagine being in constant pain for more than 3 months.Do you think it would affect your mood? Do you think psychological therapy could help you?

The Malaga psychologist Ana Claudia Alda, of the cabinet Psicólogos Málaga PsicoAbreu, informs us about how Psychology can help people suffering from chronic pain.

• Recommended article: "Chronic pain: what it is and how it is treated from Psychology".

What is chronic pain? Psychological consequences

Chronic pain is pain that lasts more than 3 months and is associated with a chronic disease (osteoarthritis, fibromyalgia, etc.). This type of pain is a stressful experience for the person who suffers from it, therefore, the person suffers changes at a psychological level:

• Emotional area. Emotions such as fear or anxiety appear in this situation. Fear begins to develop due to the appearance of pain and anticipatory anxiety is experienced. It is frequent that sadness also appears due to the situation experienced.

• Cognitive area. There are cognitive patterns that are frequently present in the patient with chronic pain and that, in addition, increase and maintain the pain. Catastrophic interpretation of pain and its consequences, unrealistic expectations about the progression of pain or disease and the belief that it is appropriate to avoid activity to reduce the possibility of pain are some of the cognitions involved in the maintenance of pain.

• Behavioral area. One of the most frequent responses to chronic pain is avoidance. The person avoids situations or behaviors because he/she thinks that if he/she does them the pain will increase. This implies a total deactivation of the person, a decrease in pleasant activities and the weakening of muscles.

Social and occupational effects

The person also suffers changes in the family, social and occupational areas.. In a situation such as chronic pain, it is to be expected that the social and family life of the person suffering from it will be modified: reduction of activities, feeling of being misunderstood by others, etc.

Similarly, the person often has to stop working or reduce working hours. The person feels that he/she is no longer useful, that he/she is not as valid as before and, in addition, these changes influence the economic sphere. All this becomes stressors that increase the person's emotional discomfort and pain.

What is the role of psychotherapy?

The approach to this medical problem is based on the biopsychosocial model.. This model establishes that it is not only necessary to pay attention to medical or Biological variables, but that other variables such as psychological and social ones also play a great role in the modulation of pain. Thus, it is established that the best way to work in these cases is with a multidisciplinary intervention, including psychology.

As the psychologist Ana Claudia Alda has previously commented, chronic pain causes changes at the psychological level (emotional, cognitive and behavioral) that can maintain or increase pain. The role of psychotherapy is to help the person to adapt to this new situation through effective coping strategies such as active coping or acceptance.

What psychological interventions are used in chronic pain?

The psychological intervention that has classically been used in chronic pain to achieve the adaptation of the person has been Cognitive-Behavioral Therapy.

However, in recent years another approach has appeared that is beginning to have evidence in this field, namely Acceptance and Commitment Therapy.

1. Cognitive-Behavioral Therapy

From this perspective, the understanding of how dysfunctional thoughts and beliefs affect the emotions and behaviors that appear before and behaviors that appear in the face of pain.

They seek to change or modify maladaptive beliefs and thoughts and train the person in adaptive behaviors in coping with pain through the use of techniques such as: cognitive restructuring, relaxation, behavioral exposure, training in communication skills and problem solving.

2. Acceptance and Commitment Therapy

This type of approach focuses on acceptance of pain to change behavioral avoidance patterns.. The therapist exposes the person to acceptance as a form of active coping, which allows involvement in life goals outside the realm of pain.

In this way, we would enter the field of commitment. The goal is for the person to have a meaningful, engaged life, even though pain, negative thoughts and unpleasant emotions are present. Metaphors are often used to facilitate the understanding of what is happening.

In addition, behavioral and relaxation techniques are used as in Cognitive Behavioral Therapy such as improved communication skills, problem-solving training, and progressive relaxation.

Bibliographical references:

• Esteve, R. and Ramírez C. (2003). The challenge of chronic pain. Málaga: Aljibe.
• González, M. (2014). Chronic pain and psychology: an update. Rev. Med. Clin. Condes, 25(4), 610-617.