By Andrew L. Martin, PsyD
Cancer-related chronic pain can arise from cells pressing on nerves, tumor-related chemical changes, or changes to nerves as a side effect of treatment. Chronic pain can cause negative changes to thoughts, mood and behavior that worsens the intensity and frequency of pain, beginning a cycle with significant functional impact.
Psychological intervention for chronic pain is designed to interrupt that cycle by treating changes to thoughts, mood, and behavior, and building skills to use thoughts and behavior to lessen the intensity and functional impact of pain.1
Kinsesiophobia (made-up mental health word), or fear of movement, is a good example of a normal reaction that can worsen chronic pain. Reduced movement leads to de-conditioning, stiffening of joints and muscles, and greater vulnerability to additional injury and pain. Also, panic and shallow breathing can create a feedback loop in the nervous system, where pain causes anxiety and the anxiety makes us focus more on the pain, and so on. Finally, giving up pleasurable activities without finding replacements can significantly impact mood, which can also affect the experience of pain.
Psychological intervention for chronic pain involves teaching patients about acute versus chronic pain and the chronic pain cycle alluded to above. Intervention can also include accepting pain-related changes, often a necessary step before a patient can fully participate in treatment.
To address anxiety and stress, patients learn to relax the nervous system with diaphragmatic breathing and progressive muscle relaxation. Mindfulness techniques are also effective, including guided imagery, which can distract and strengthen cognitive flexibility so a person doesn’t get stuck in a downward spiral of anxiety and pain.
Patients learn how to set self-care goals, increase exercise and movement (under physician guidance), and pace themselves. Pacing for chronic pain involves learning how much of an activity is possible before significant pain onset and how much rest time is needed before returning to the activity. Pacing’s ultimate goal is to have more productive time and less down-time due to injury and pain flare-ups. This approach teaches the importance of planning and engaging in pleasant activities to bolster mood. This can include learning to creatively replace activities (e.g., teaching activity to others versus engaging in the activity oneself).
Psychological intervention helps patients with techniques to replace unhelpful and unrealistic thoughts with balanced thinking that aims to reduce stress, anxiety and depression. Common signs that chronic pain is negatively affecting thinking include, “I keep thinking about how badly I want the pain to stop,” “I worry all the time about whether the pain will end,” “they should have been able to fix my pain,” and “I keep thinking of other painful events.”2
Interdisciplinary treatment often yields better outcomes for complicated conditions that affect multiple systems. Including psychological intervention can help round out a whole-person treatment approach toward chronic pain.
Andrew L. Martin, PsyD, joined Orthopaedic & Spine Center and the Interventional Pain Management Team as their Pain Psychologist in January 2021. osc-ortho.com
1. Murphy, J.L., McKellar, J.D., Raffa, S.D., Clark, M.E., Kerns, R.D., & Karlin, B.E. Cognitive behavioral therapy for chronic pain among veterans: Therapist manual. Washington, DC: U.S. Department of Veterans Affairs. Retrieved from https://www.va.gov/painmanagement/docs/cbt-cp_therapist_manual.pdf.
2. Sullivan, M. (2009). The Pain Catastrophizing Scale [Measurement instrument]. Retrieved from https://sullivan-painresearch.mcgill.ca/pdf/pcs/PCSManual_English.pdf.