David Kannerstein, Ph.D.  

Why See a Psychologist for Pain?

chronic painYou may be thinking “why should I see a psychologist if I have chronic pain?  Are you saying the pain is all in my head?”  In a word, NO! Chronic pain is rarely, if ever solely psychologically caused.  However, the mind and the body are tied together in profound ways, and the mind can either be of enormous help in healing or can be an insurmountable obstacle.  Seeing a psychologist assuredly does NOT indicate that the pain is all in the person’s head, as unfortunately some patients have been told by physicians unable to locate the physical cause of the pain precisely. 

Indeed, one reason many people are suspicious about seeing a psychologist for help in managing pain is that psychological concepts have been misused to stigmatize people suffering with pain.  These include concepts like malingering, secondary gain, psychosomatic or somatization disorders, and personality disorder.  It is my experience that these concepts are not generally valid with respect to patients with pain.  There are, however, multiple ways I can help you deal with pain.

First of all, even very high functioning individuals can probably benefit from training in approaches such as hypnosis; meditation or mindfulness; relaxation techniques including guided imagery or visualization, breathing techniques, and progressive muscle relaxation (PMR).  The goal of working with the psychologist is to enable the patient to practice these on his or her own eventually.  There are various ways these techniques help reduce pain and emotional distress.  These include: relaxation (increased tension often leads to an exacerbation of pain); lessening of one’s resistance to the pain, hypnotic techniques such as distraction, distortion, and dissociation. 

Secondly, many people who develop chronic pain do become very anxious or depressed as a result of the pain and the losses associated with it. You may be dealing with major stressors including:

  1. financial losses;
  2. being unable to carry out favored activities or household responsibilities and the loss of one’s role in the family and community as a result ;
  3. dealing with having their pain and suffering challenged by employers and insurance companies as in Independent Medical
  4. Exams (IMEs), disability evaluations, or worker’s compensation hearings.

These stressors may be traumatic for you. You may also be suffering from both physical and psychological trauma from whatever accident or injury gave rise to the pain. Patients with co-existing pain and emotional distress can benefit from psychological treatment which includes both the techniques mentioned above as well as talk therapy. The most commonly used form of psychotherapy used to treat patients with pain at present is called cognitive-behavioral therapy (CBT) and involves learning how to changes one’s emotional distress by changing one’s thoughts and behaviors.  Other therapeutic approaches can also be useful at times including psychodynamic therapy, family (and marital) systems approaches, and EMDR (Eye Movement Desensitization and Reprocessing). I generally combine therapy with the mind-body approaches mentioned above.

Another group of people with pain who may benefit from psychological treatment are those who have pre-existing emotional distress such as depression, bipolar disorder,  or PTSD (Post-Traumatic Stress Disorder).  Chronic emotional distress leads to increased arousal in one’s sympathetic nervous system which aggravates painful sensations.  It is often necessary to address these pre-existing issues before the patient can learn to effectively cope with their pain.