Psychology of pain management

In medical circles pain is often considered to be the fifth vital sign. However, unlike the other four, there is not an objective means of measuring physical pain. We can count respirations, use a thermometer to measure temperature, and assess blood pressure and pulse rate. There is no device or procedure that has yet been developed which can objectively measure acute or chronic pain.

In order to assess pain, it is customary to ask an individual to rate pain on a 0 to 10 scale (0 being no pain at all, and 10 being pain which is intolerable). As you can guess, pain has a certain subjective experience which differs from individual to individual. For instance, two people can sustain a paper cut on their finger. For one individual this results in excruciating pain, while the another individual is able to shrug off this discomfort. In this respect, pain has a psychological component. This is not to say that pain is merely in one’s mind, but it does reflect that there are individual differences in pain threshold and tolerance. In order to measure pain, we must accept as fact an individual’s rating of his or her own pain experience.

Pain can be experienced in different ways or vary from time to time, such “sharp, burning, or prickling” pain, “pressure or deep squeezing” types of pain, or “shooting, shocking, burning or stabbing” pain. Potentially chronic conditions can include headaches and migraines, fibromyalgia, phantom limb pain, post-herpetic neuralgias, failed back surgery, and neuropathies. Chronic low back pain is the most common form of chronic pain, affecting 15 to 45 percent of adults annually, and about 70 percent of adults over a lifetime. It is the most common cause for job-related disability.

Medical science has limitations. For some individuals, medication alone is able to treat their pain condition. For others, physical therapy, chiropractic, massage therapy, acupuncture, or other alternative means can provide relief. In certain cases of chronic pain, surgical procedures might offer means of pain management. The reality is that in many cases pain cannot be cured; only managed.

In addition to medical forms of managing pain such as surgery, injections and medication, psychological and behavioral treatment can also offer some relief. One behavioral strategy is diaphragmatic or deep breathing.

When we are in distress we are prone to breath shallow and rapid. Since the body cannot be anxious and relaxed at the same time, we introduce relaxation by focusing on taking long, deep breaths. Breathing also focuses attention away from pain and onto another physiological process. Some physical therapists use the slogan, “Smell the roses; blow out the candles.” It makes sense. When individuals are in pain their muscles often tense. Deep breathing induces physical relaxation, which in turn reduces pain.

Relaxation as well as cognitive strategies such as teaching individuals more adaptive means of dealing with pain can help an individual to feel more in control. Cognitive distractions, social support and encouragement, recreational activities, activity scheduling, and at times rest can also be effective means of managing pain. Cognitive behavioral therapy (CBT), a form of psychotherapy which aids individuals to change maladaptive thoughts and behaviors into more effective coping strategies, has been shown through research to be effective in pain management.

Pain is a complex and dynamic interaction among physical, psychological, and social factors. Patient differences and treatment matching are important considerations. Consult a pain management psychologist for more information on psychological treatment for chronic pain.

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Dr. Mathias is board certified in clinical neuropsychology and practices with Associates in Neuropsychology and Collaborative Healthcare, P.C.