Relevance of Psychological Interventions in Chronic Pain Management: Analytical Essay

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Discuss the relevance of psychological interventions in pain management.

In this essay, I am hoping to discuss the relevance of psychological interventions in pain management and how these interventions work and help in the management and treatment of chronic pain if they do at all. I will investigate the various types of psychological interventions and how they contribute to a patient’s physical and mental well-being and also if this psychological intervention can being used alongside healthcare and manual therapy. Chronic pain according to (Breivik, Collett, Ventafridda, Cohen & Gallacher, 2006) has been estimated in nineteen percent of adults in Europe, with reports of it affecting their daily activities as well as social life. One of the main causes of disabilities worldwide has shown to be chronic pain with conditions ranging from lower back pain to osteoarthritis (Vos et al., n.d.). Lower back pain is said to affect somewhere around one-third of the adults in the United Kingdom annually, with less than a quarter consulting a medical professional (Macfarlane, Jones & Hannaford, 2006). After the first incidence of Lower back pain, 62% are still suffering with pain and sixteen percent of these are unable to continue to work (Lise Hestbaek, 2019). Within the United Kingdom alone, just under nine million people suffer with osteoarthritis and seek treatment for this limiting disease. Although there is no cure for osteoarthritis, many people still seek treatment for help managing and making sure the symptomology do not worsen (‘Osteoarthritis’, 2019).

Pain is defined as “a highly unpleasant physical sensation caused by illness or injury” (‘the definition of pain’, 2019). As there are different ways of describing and feeling pain, the experience of pain varies with each person. Pain is usually short-term; however, for many people, the pain remains over a period of time and is then considered to be chronic (Otis, 2008). Chronic pain is defined as pain that lasts longer than twelve weeks despite medication or treatment (‘Chronic pain’, 2019). There are several types of chronic pain nociceptive, somatic, visceral, neuropathic, psychogenic, and idiopathic. All these types of chronic pain can cause a range of conditions from headaches to fibromyalgia (‘How We Experience Different Types of Chronic Pain’, 2019). (‘The silent epidemic – chronic pain in the UK | News | British Pain Society’, 2019) says that around twenty-eight million people within the United Kingdom suffer with pain that lasts over three months. They also say that fourteen percent live with chronic pain that is severely disabling (‘The silent epidemic – chronic pain in the UK | News | British Pain Society’, 2019). Patients who suffer with chronic pain are at an increased risk of further developing complications, including physical dysfunctions and altered mental states (Fine, 2011). When a patient suffers with chronic pain every aspect of their life is affected, including employment, relationships with others, and the ability to complete daily activities. Individuals who suffer with chronic pain tend to experience physiological and emotional consequences. The individuals tend to have a fear of being judged negatively and have a raised level of guilt and shame compared with a person perceived to be healthy (Turner-Cobb, Michalaki & Osborn, 2015). These physiological effects can spiral further and ultimately lead to further negative feelings, resulting in depression and anxiety. As chronic pain can further develop into a primarily biopsychosocial problem, treatment may diversify to include psychological interventions (Roditi & Roditi, 2011).

Due to the complexity of chronic pain and only the partial resolution of chronic pain by medical interventions, psychological interventions can be introduced to manage pain. Psychological interventions involve a conversation about your feelings in order to improve your thoughts and hopefully bring about a change in feelings and behavior. These interventions are said to work for a range of, behavioral, emotional, and mental problems and are effective in the treatment of people from all ages, races, genders, and cultures. Psychological treatments can treat a wide variety of conditions from depression, anxiety to stress and chronic pain (‘Psychological treatments’, 2019). Instead of solely focusing on fixing the pain, psychological interventions can be used to aid the emotional and psychological aspects of pain. These interventions are known as “operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy and acceptance, and commitment therapy” (Sturgeon, 2014). (Gatchel, Peng, Peters, Fuchs & Turk, 2007) states how Biopsychosocial factors like stress can affect a patient’s perception of pain and response to treatment. Hence the need for psychological interventions alongside medical interventions, in the treatment of chronic conditions, enables patients to live a functional and able life.

Skinner (1938), Operant conditioning uses rewards and punishments for behavior as a method of learning. Skinner proposed, “Behaviour which is reinforced tends to be repeated (i.e., strengthened); behavior which is not reinforced tends to die out or be extinguished (i.e., weakened)”. He identified three different types of responses that follow any behavior, a neutral operant; which neither decrease nor increase the tendency of behavior being repeated, reinforcers; which increase the tendency of behavior being repeated (can be positive or negative) and punishers; which decrease the tendency of behavior being repeated. From the basis of operant conditioning a theory named ‘behavior modification’ developed, which is mainly based on changing environmental events in relation to an individual’s behavior (Mcleod, 2019). Behavior modification is the basic of CBT.

Cognitive behavioral therapy or CBT is said to be a type of psychotherapeutic treatment, which allows the patient to gain an understanding in to the beliefs and feelings that are responsible for behaviors. A vast range of conditions can be treated using CBT, from anxieties, depression, phobias (agoraphobia and social phobias) as well as addictions. The effects of CBT are relatively short-term, but it helps patients deal with a problem unique to themselves (‘Cognitive Behavior Therapy and How It Works, 2019). Similar to this (‘Cognitive behavioral therapy (CBT)’, 2019) says that there is an interconnection between your feelings, physical sensations, thoughts, and actions and that negative feelings and thoughts can engulf you in a vicious cycle. By breaking down a problem into smaller parts, CBT can help a person deal with the problem in a more positive way. There are many advantages of using CBT therapy; it helps aid mental health disorders, where medication itself has not being successful. Compared to other talking therapies, CBT can also be completed in a shorter time frame. Also, skills learnt throughout the treatment can be integrated in everyday life to help with any other stresses. Although CBT is efficient in helping some conditions, it may not be the correct type of treatment for everyone. Unless a patient commits to the CBT treatment, the problems will not go away, regardless of the therapist’s advice and help. As well as commitment, patients with a more complex condition may not find the treatment useful, due to its structured nature. Another disadvantage of the intervention is that the confrontation of emotions and feelings can initially lead to an increase in anxieties and negative emotions (‘Pros & Cons of CBT Therapy | The CBT Therapy Clinic – Nottingham – West Bridgford’, 2019).

Acceptance and behavior therapy (ACT) is an “action-oriented approach to psychotherapy that stems from traditional behavior therapy and cognitive behavioral therapy”. ACT differs from CBT as instead of struggling, denying, and avoiding negative emotions, patients learn to accept their feelings (‘Acceptance and Commitment Therapy | Psychology Today, 2019). (‘How Does Acceptance And Commitment Therapy (ACT) Work?’, 2019) says there are six core mechanisms involved in ACT therapy that all contribute to a patient well being. Acceptance is the first method, although it is not an end goal, it is a way of promoting actions that will achieve positive results. ACT teaches patients to accept the existence of unpleasant feelings instead of avoiding them. The next core principle is cognitive defusion, which helps a patient react to negative experiences and come through the experience positively. Being present and self as context are the next two principles, but the most important principles are values and commitment to action, which work hand in hand. People abide by their own values, which influence their steps. In ACT patients are helped to commit to actions in order to pursue long-term goals in accordance with these values, without awareness of the affects of behavior a positive change can not be made. Similarly to this (Overview, Program & Motion, 2019) explains how ACT can help sufferers of chronic pain. Sufferers of chronic pain stop taking part in activities and hobbies they used to enjoy, as they associate these with pain, this is known as experiential avoidance. ACT helps enable patients to increase activity levels and enjoyment of life without the complete elimination of pain. Despite persistent pain, ACT hopes to help patients live life and enjoy, regardless of their pain. Practitioners of ACT doesn’t challenge a patient’s perspective about pain, but in turn teaches them to embrace and stop focusing on the pain, as negative experiences are a part of life.

From this essay, we can see that using psychological interventions in the treatment of chronic pain is an essential tool. These interventions vary widely in their techniques from breaking down problems to accepting them, but all of these interventions have the same goal in promoting a positive attitude and increasing patients’ mental state toward chronic pain. Psychological interventions and osteopathy can be used directly alongside one another in the management of a patient’s pain. We have seen how chronic pain can cause many biopsychosocial problems, but with the implementation of psychological interventions, we can nullify these before they lead to further negative thoughts. By breaking this cycle using psychological interventions as well as using manual therapy we can greatly improve not only a patient’s physical state but also mental state. As we know how complex pain is, the use of just manual therapy alone will not benefit all patients in their battle with chronic pain, therefore using a physiological intervention alongside it and teaching them to accept their pain can help a patient to live life and enjoy, regardless of their pain. As osteopaths are highly involved in the treatment of a wide range of chronic pain conditions, the implementation of these psychological interventions can be incorporated into treatment to lower negative feelings towards certain treatments like manipulation, which will benefit a patient greatly. As we further investigate the interconnection between a patient’s feelings, physical sensations, thoughts, and actions we can see the use of these intervention will be even more vital in attitudes toward chronic pain. Techniques used in physiological interventions can also help us deal with the stresses of daily life, not only in pain management. With this being said I feel that the need for psychological interventions in the management of pain, as well as chronic pain, is fundamental. The use of these interventions alongside manual therapy will not only

Improve a patient’s physical well-being dramatically but will improve their outlook and attitudes toward chronic pain, leading to a massive increase in a patient’s quality of life.

Bibliography

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Relevance of Psychological Interventions in Chronic Pain Management: Analytical Essay

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