Medical Issues, Therapy, Toolkit

Chronic Pain – All in Your Head?

February 24th, 2011

By Tammy Fletcher MA, IMF, CFT, Health/Illness/Medical Issues Topic Expert at GoodTherapy.org

Click here to contact Tammy and/or see her GoodTherapy.org Profile

According to Carmen Green, M.D., a pain specialist at the University of Michigan’s Health System Center for Interventional Pain Medicine, as many as one-fifth to one-third of Americans live with some form of chronic pain (Gazella, 2005). Let’s say there are about 300 million people living in the United States right now, that means that as many as ninety-nine million people may be experiencing physical pain, many on an ongoing basis.

Why so many? And why do the numbers seem to be increasing? A few reasons come to mind. One, on average we are living longer. Conditions that used to result in death are now more treatable, extending our lifetimes. With increased longevity may come chronic pain related to these conditions or simply to the aging process. Another reason for the increase in our pain is the increase in obesity in the United States. According to the Centers for Disease Control (CDC), as of 2009 only two states had an obesity rate of less than 20%: the District of Columbia and Colorado (Centers for Disease Control and Prevention, 2009). The CDC reports that obesity may lead to diseases that may include chronic pain.

With chronic pain intruding on so many millions of lives, you might imagine that the practice of medicine has kept up with these trends, and that a patient experiencing moderate to severe pain on a daily basis might have an array of effective, cost-efficient choices in care to assist in enhancing quality of life and restoring a desired level of activity and function to the patient’s life. There are a growing number of specialists in the effective treatment of pain, including medical doctors and osteopathic physicians who complete specialized education and certification in this area.

Given this information, why do so many patients report difficulty in finding adequate medical care for their pain? I hear again and again from clients who feel they are not taken seriously, seen as drug seekers, or told their pain is “all in their head.” So in addition to living with a condition like diabetes or fibromyalgia, they experience the added stress of feeling no one understands their chronic pain. Chronic pain patients often feel as if their doctors don’t believe them, or see them as malingering.

This is not to say that patients don’t abuse health care systems. There is such a thing as “drug seeking behavior” as well as patients who embellish their symptoms or concoct stories of illness for various reasons. This article is not about those people. This article is for those who experience severe or intractable pain on a regular basis. Their lives have been disrupted. Their relationships have bent under the stress of their pain. Their careers may be on hold, or greatly hampered. These people want nothing more than to function. They want to be believed.

As I mentioned in my last blog, I am a chronic pain patient as well as a therapist. I was diagnosed with Multiple Sclerosis in 1996. Prior to my diagnosis, even I was told it was “all in my head” by my primary care physician. Guess what? It was. I had lesions on the nerves in my brain. After a very satisfying moment of firing that doctor, I set out to find one who knew what pain was and how to treat it. It took me several more years, but I found her. As patients become more educated and empowered, the medical field is going to have to keep up with us – even those of us with chronic pain.

Speaking of my own pain specialist, she reminded me to add here that there are a number of pain-causing conditions that simply defy definition or clear diagnosis. A patient wakes up, sneezes, and ends up with a ruptured cervical disc. Those cases are even more likely to be undertreated, as they don’t necessarily show up on an x-ray or a blood test. A confusing or hard-to-pinpoint diagnosis can complicate the patient’s ability to have his or her pain symptoms treated.

There is no question that chronic pain has emotional repercussions. Depression and anxiety are common among pain patients, especially those whose pain is not managed adequately.  I have noticed that in therapy sessions, often just allowing the client who experiences chronic pain to talk about what it is like is a catharsis in itself. Respect, acceptance, and the ability to hear the person’s story with empathy are all healing tools that any therapist can use for the chronic pain client.

Cognitive behavioral therapy has been shown to positively effect chronic pain, while providing clients with techniques to control pain in whatever ways they are able (Keefe, 1996). Narrative therapy is making strides in supporting clients in developing a different relationship with pain, as well as coping with feelings like anger and depression. Whatever your theoretical orientation, I encourage you to learn as much as you can about chronic pain, treatment options, and the ways in which pain impacts our clients’ daily lives. Keep in mind that your client may have been told that his or her pain is unfounded, imagined, or otherwise minimized by health care providers. Your caring, professional support can be a vital part of a chronic pain patient’s health care team.

Here are some helpful resources for anyone seeking additional information about chronic pain:

  • The American Academy of Pain Medicine: http://www.painmed.org/patientcenter/main.aspx
  • The American Chronic Pain Association: http://www.theacpa.org/default.aspx
  • The American Pain Foundation: http://www.painfoundation.org/

Works Cited:
Centers for Disease Control and Prevention. (2009). U.S. Obesity Trends.
Gazella, K. (2005). Enduring chronic pain. University of Michigan Health Minute .
Keefe, F. J. (1996). Cognitive Behavioral Therapy for managing pain. The Clinical Psychologist .

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