Psychological Interventions Could Help Chronic Pain Patients

May 22, 2018 / Thomas Cohn, MD

New research published in JAMA Internal Medicine found that patients with noncancer chronic pain can benefit from psychological interventions, which can help to reduce perceived pain levels.

Dr. Bahar Niknejad and colleagues at the Department of Medicine at Eastern Virginia Medical School conducted a systematic review and meta-analysis of the effectiveness of psychological therapies for noncancerous chronic pain. The main factor they wanted to analyze was psychological therapy’s role in managing pain intensity, but they also examined how it influenced pain interference, depressive symptoms, anxiety, negative thoughts, self-efficacy for pain management, physical function and overall health.

The meta-analysis looked at 22 studies involving more than 2,600 individuals, and after looking at the data, researchers concluded that psychological therapies were associated with small decreases in pain intensity, pain interference, depressive symptoms, anxiety and negative thoughts, while there were small increases for self-efficacy, physical function and overall health.

“Psychological interventions for the treatment of chronic pain in older adults have small benefits, including reducing pain and catastrophizing beliefs and improving pain self-efficacy for managing pain,” the authors reported. “These results were strongest when delivered using group-based approaches. Research is needed to develop and test strategies that enhance the efficacy of psychological approaches and sustainability of treatment effects among older adults with chronic pain.”

Types of Psychological Treatments To Chronic Pain

Psychological treatments of chronic pain center around the idea that if we understand our pain and why it’s happening, then we can learn to control or better cope with flare ups. Knowing this, here’s a look at some of the more popular psychological treatments for chronic pain:

Patient education about the condition.
Biofeedback (A technique where patients learn to interpret feedback regarding certain physiological functions).
Relaxation Training.
Operant Conditioning.
Cognitive-Based Approaches.
Acceptance-Based Approaches.
Expectation Management.
Emotional Stress Management.

By helping the patient find new psychological strategies to control or better cope with their pain, people often feel more in control of their symptoms, which in turn can decrease the perception of pain. If you are suffering from chronic pain, talk to your doctor about psychological approaches to best manage your condition. Reach out to Dr. Cohn for more information.

Why Are We Treating Pain The Same As We Did During The Civil War?

July 4, 2017July 4, 2017 / Thomas Cohn, MD

It is no secret that there is an opioid problem in the United States. It seems like there is a new report being published every week on the problems with opioids in this country. This week the government published data on the number of emergency room visits related to opioid use in a single year.

The data shows roughly a 100 percent increase in the last ten years in the number of hospital visits and admissions related to opioid problems. Not surprising is that despite some differences from state to state, in general, the problem affects everyone equally – male and female, rich and poor – just like any other addiction. The focus of most data being published is on opioid addiction. Unfortunately, rarely is someone talking about some of the reasons behind the problem, especially as it relates to how the United States treats pain.

How The US Treats Pain

It is really no surprise that there is an opioid problem in the United States. Pain is a very complex set of medical issues, but unlike diabetes or cancer, very little money has been spent on any aspect of pain as a medical problem, and medical school and physician training in understanding and managing pain is virtually nonexistent. Research sponsored by any government or industry sources is minimal compared to all other areas, maybe 2 percent of all money spent by the National Institute of Health and there is no comprehensive strategy to look at treating pain. Most importantly, the tools used to treat pain are the same tools we used at the time of Civil War – opioids. Most other diseases from hypertension to diabetes and cancer over the last fifty years have seen major advancements in how we treat these conditions, but not pain.

On top of the publishing of new data of how many people are being affected by opioids, the news media is full of sensational information on every aspect of the opioid epidemic. Time magazine this week had information on how drug companies and drug treatment centers are profiting from opioid problems. One of the biggest lobbying groups for money and guidelines on opioids are addiction specialists and drug treatment centers; just a slight conflict of interest. Then the sensational news moves to all the individuals who have become addicts and the problems of addicts. Unfortunately, opioid addiction and how it affects individual lives is not really significantly different from other addictions from food to alcohol, it’s just less glamorous. The latest highlight in the news is the potent drugs and overdoses, and how just touching some of these illegal drugs or using for the first time can cause overdoses.

Opioids are a problem in the United States and more data does not help solve the problem – it just makes it sensational. The real issue that is being ignored is the issue behind opioids and how we treat pain. Most of the pain treatments available date back to before the Civil War. Pain is extremely complex, and to solve the opioid issue the United States needs to get serious about finding better pain management tools and invest in them.

Shared Reading Helpful For Chronic Pain Patients

March 9, 2017 / Thomas Cohn, MD

New research suggests that shared reading may help ease discomfort and provide cognitive benefits for individuals battling chronic pain.

Shared reading, as the researchers defined, was the act of of gathering with others and reading short stories, poetry or other literature out loud. Researchers said by reading literature that triggers memories of experiences throughout life, like happy childhood memories or relationships, patients can experience benefits similar to or that outweigh the effectiveness of cognitive behavioral therapy for chronic pain.

Shared Reading And Chronic Pain

There are hundreds of different treatment options for chronic pain, because chronic pain is unique to the individual. Some people experience pulsing pain in their lower back, others battle waves and waves of headaches, while others have nerve damage that sends pain signals to the brain when their is no painful stimulus present. What works for one person will not always work for another, and unfortunately that’s the problem that many pain sufferers are running in to. In turn, they are looking into alternative options, one of which is shared reading.

For their study, researchers compared the benefits of shared reading to cognitive behavioral therapy, which is a technique that aims to change the way people think and behave in order to better manage physical and mental issues related to chronic pain. To do this, patients with severe chronic pain were asked to participate in either five weeks of CBT or 22 weeks of shared reading. At the conclusion of the five weeks of CBT, individuals in that group joined the shared reading group for the remainder of the 22 weeks. The shared reading sessions incorporated literature that was designed to prompt memories of family, relationship, work experiences or other happy memories throughout their lifetime. Participants were required to report their pain severity and emotions before and after each session, and they were asked to record their pain and emotions twice a day in a personal journal.

Study Results

At the end of the study, researchers wrote:

While CBT helped to manage a person’s emotions, shared reading appeared to help patients address the painful emotions that might be contributing to chronic pain.

Pain severity and mood improved for up to two days after shared reading sessions.

“Our study indicated that shared reading could potentially be an alternative to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by chronic pain patients,” researchers wrote. “The encouragement of greater confrontation and tolerance of emotional difficulty that sharing reading provides makes it valuable as a longer-term follow-up or adjunct to CBT’s concentration on short-term management of emotion.”

Researchers want to conduct future studies with larger sample sizes, but it’s an interesting approach to treating chronic pain. We’ll certainly keep tabs on shared reading as a potential treatment option.

5 Pill-Less Treatment Options For Chronic Pain

September 23, 2016April 5, 2023 / Thomas Cohn, MD

Opioids and other pain medications can certainly help people cope with problems associated with chronic pain, but it should not be your only method of treating your pain. Pain pills are a passive treatment option that can be successful in controlling pain in the short term, but they lose their effectiveness and leave patients at risk for dependence and abuse in the long term. Today, we take a look at five pill-less treatment options for chronic pain that can be used on their own or in conjunction with other strategies to help keep your pain away.

Treating Pain Without Pills

We’ll offer a short blurb on five pill-less treatment strategies below. Click on the link in each article to learn more about each treatment option.

1. Exercise – Exercise is one of the best treatment options for chronic pain. It helps get healthy oxygenated blood flowing to painful areas of our body, helps us keep off excess weight, and it helps off push away the stress in our daily lives. Even if it’s low-intensity workouts, regular exercise is one of the best things you can do for your body, especially if you have chronic pain.

2. Yoga, Tai Chi or Meditation – These techniques also help get blood flowing and strengthen areas of our bodies that are in pain, but they also are great for the mind. Most people don’t recognize just how mentally and emotionally draining physical chronic pain is, but these treatments can help you keep your mind healthy while you’re battling your physical pain. If you have a healthy mindset, you’ll find that the physical pain is often less debilitating.

3. Massage Therapy or Acupuncture – These two techniques are similar in that they focus on the pain pathways in our body. These techniques haven’t been emphatically proven to be effective, but some people have found relief with these options. They should be used in conjunction with other strategies because they too are passive techniques, but both massage therapy and acupuncture have been shown to be successful for some patients with chronic pain.

4. Physical Therapy – Sometimes our chronic pain is caused by an easily identifiable problem, like a pinched nerve or bulging disc. When the pain pathways can be clearly identified, physical therapy to strengthen the areas or free damaged nerves can be a great option. Ask your doctor about what stretches you can do as part of your physical therapy, or better yet, see if they’ll refer you to a physical therapist that can assist you in person.

5. Daith Piercing – If your chronic pain is in the form of constant headaches or migraines, the daith piercing may help provide relief if other options have continually failed. Our blog on daith piercings has been far and away our most popular blog, and while there is no direct evidence that the piercing can provide full relief, numerous commenters have tried the technique and noticed a reduction in headache symptom and prevalence.