By Geralyn Datz, Ph.D.
Geralyn Datz, Ph.D., is a licensed clinical psychologist who specializes in behavioral medicine and is the current President of the influential Southern Pain Society. She participated in last week’s Twitter Chat on psychology and chronic pain. She shares her observations.
I thought the pain psych chat from Stanford Pain was a marvelous idea.
When people hear “pain psychology” it seems to make intuitive sense, but it’s very hard to bridge the gap between medicine and mental health today. This is because we are still very dualistic in our thinking.
Part of us understands that the mind affects the body, and the body affects the mind. But another part of us, and I mean the collective us as in healthcare, and us as individuals, just want our suffering to go away. It is very hard to take responsibility, self-manage symptoms, look inward, and even just accept things that are unwanted and poorly timed, like an injury or getting a disease.
Thanks to social media, it’s easier to raise awareness of the importance of the Mind Body Connection, and the connection of pain psychology to pain management in particular. Venues like Twitter and Facebook allow us to take down our titles, come out of our typical work space and setting, and start a conversation, in snippets, about the things we consider most important. That really cuts through a lot of administrative, medical, and professional red tape, so to speak. We just have our thoughts and people can simply agree or disagree.
The “opioid story”—rising death toll, addiction rates and just the general lack of getting better while people are on these medications and the recent CDC guideline—has dominated both media reports and discussions about pain management.
It has created an opportunity to have a discussion about raising awareness of other treatments for chronic pain, like pain psychology and non-prescription treatments.
When I treat patients, I understand that lack of movement, depression, lack of sleep, losing one’s place in the world, losing self-esteem, losing work, are all very unhealthy. Healthcare providers know these things. There is also a large quantity of research supporting work and valued activities as having a very strong relationship to physical and mental health. The part that’s not intuitive for providers, is how to accomplish this treatment. There are barriers including insurance and lack of knowledge of how to refer and who to refer to.
Pain patients are often so relieved when they hear that it’s normal to have depression, for example. But that same depression has health problems associated with it, that lack of sleep and lack of movement just makes a body break down. I think this is all very understandable to a patient with pain.
What is a harder sell is the idea of change: Changing behaviors, changing attitudes, changing thinking.
Unfortunately, many, but not all, surgical and interventional providers have a singular mindset on how to relieve pain, in their case, with surgery or injections. While these treatments can be helpful in certain instances, they are vastly overused.
What’s the patient to do? It is very hard for a patient, with or without a pain psychologist, to stand up and say, “Hey, I don’t want this or that treatment, I want to try something else.”
Maybe it’s exercising more, eating more healthfully, or learning how to control thinking and emotions. Maybe it’s finding a new healthcare provider that offers treatments that have not been discussed. All of these actions involve an internal shift on the part of the patient, which is very hard, and almost impossible without guidance from an experienced professional.
And then there is the time it will take to learn these treatments.
And then there’s the cost.
Some things aren’t reimbursed (like joining a gym or extra physical therapy visits outside of what your insurance covers).
It can be frustrating.
What the heck are we going to do?
The Twitter chat started a dialogue. I loved seeing the participation from patients, providers, and physical therapists, and thought leaders. That is very encouraging. It’s important for patients to know that chronic pain affects the brain, hormone function and generally disrupts our biological systems. The thing that we are just learning to grasp is that a lot of this can be reversed. Even the effects of chronic opioid therapy can be reversed under the proper circumstances. And this is where the coordination of mental health, activity, healthy behaviors, and laying down new neural pathways is so vital in pain rehabilitation.
Some chronic pain patients, especially those who have been suffering for a long time, are skeptical. I understand that.
One of the most exciting things we see in our Clinic, is how our functional restoration program can get a patient in who’s even 10 or 15 years post injury and you see them moving, walking and even running. It’s not magic. It only happens through a very tailored multidisciplinary intervention with patients with pain. It takes an enormous amount of coordination and unlearning of old habits to produce dramatic changes. But I am here to tell you it is possible and we see it every day.
We need to keep talking as a pain community. The Twitter chat was a great start.
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#PainPscyhChat (use this hashtag to see and join the Twitter Chat)