BEHAVIORAL & ALTERNATIVE PAIN MANAGEMENT
Chronic pain is perhaps among the most difficult medical condition to treat. Misconceptions abound even among medical practitioners.
Here are some of them:
1. Pain is a physical phenomenon that can be objectively measured like blood pressure or body temperature.
NO. The IASP (International Association for the Study of Pain) defines pain as ““An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” As per IASP definition, pain cannot be objectively measured. It is a subjective experience.
2. Pain is physical, so requiring medication and injections to reduce pain
NO. Pain may be triggered by physical injury or related to a disease state like cancer, but the perception, modulation, and maintenance of pain is done at the brain and the Central Nervous System (CNS) by a variety of brain structures which also regulate emotion (such as fear/anxiety, and depression), memories, beliefs, attention, impulsivity, consciousness, autonomic functions etc. Pain medications and injection could reduce pain experience but so could changing one’s beliefs and emotions states such as fear, anxiety and depression.
The image at the top of the page depicts how pain is processed and modulated by different structures in the brain. There is no single pain center in the brain. The yellow colored regions on this slide depicts the different pain structures which regulate pain. This would explain why people who have chronic pain are also frequently depressed and why by relaxing in the dental chair you may experience less pain and vise versa. And some patients could undergo tooth extractions with no local anesthesia (by using only hypnosis).
3. Acute, procedural, and chronic pain are the same.
NO. They are very different.
Behavioral and alternative pain management:
Given that many factors contribute towards the subjective experience of pain, behavioral and alternative pain management (BAPM) targets all the structure of the brain responsible for pain perceptions and modulation. As an example, I use CBT (cognitive behavioral therapy) to alter/modify the belief system related to the pain. E.g., “I am going to die from my pain” to “This pain has been a bit distressing, but I will get over it just like I have done it before many times”. Identifying automatic negative self-talk and replacing them with more neutral or positive self-talk goes a long way in increasing self-efficacy and contributes towards better management of pain.
By teaching my clients relaxation training, they learn to lower the anxiety and hyper-arousal state and, in the process, decreasing the pain. By reducing the depression and negative emotional states, clients learn to reduce their pain. I also use hypnotic strategies for pain management by teaching self-hypnosis and getting them to create anesthesia or analgesia; cognitive-perceptual alteration of pain; decreasing awareness of pain and unconscious exploration to enhance insight or resolve conflict.
Devices such as Cranial electrotherapy Stimulation (CES) and Stress Eraser (SE) may be considered and incorporated into the treatment
regime. CES to reduce pain, depression and anxiety; and SE to teaching clients to breath at his/her natural resonant frequency in order to
increase heart rate variability (HRV), a correlate of health.
Refer to Hypnosis/Hypnotherapy page for specific case examples.
For more information, please refer to the American Society of Clinical Hypnosis (ASCH); and American Pain Society (APS) websites.