As the Opioid Crisis shook the public’s view of painkillers and pharmaceutical companies came under fire for their marketing practices, many patients looked for alternatives. One of the leading contenders; talk therapy.
Psychologists, therapists, and social workers have become a crucial part of pain treatment programs, proving to be as effective or more so than medication. Still, finding the right pain counseling can take effort.
Many pain psychologists treat chronic pain with cognitive behavior therapy (which focuses on reframing thoughts to positively affect behavior and emotions) or mindfulness (which involves learning to become conscious of feelings without reacting to them). Acceptance and commitment therapy combines C.B.T. and mindfulness to help patients accept their emotions and respond to them. Another method is biofeedback, which monitors patients’ muscle tension, heart rate, brain activity, or other functions to make them aware of their stress and help them learn to control it. And some clinicians use hypnosis, which can be effective at managing pain for some people. What unifies all these treatments is a focus on teaching patients how they can use their minds to manage their pain.
Large medical centers and boutique practices are more likely to have comprehensive pain treatment but tend to be in urban areas. People in rural areas or those who can’t afford the services get left out, said Rachel Aaron, an assistant professor of physical medicine and rehabilitation at Johns Hopkins Medicine. But even in cities, not all large medical networks have pain services.
If you are interested in trying a pain therapist, Dr. Aaron said, the first stop should be your primary care doctor. Some insurance plans cover pain psychology, but others do not. It’s important to talk to a mental health provider first about how to get treatment covered.
After that, look for specialized pain clinics by calling hospitals in your area or use the Find a Therapist function on the Psychology Today website.
Some experts recommend working with licensed professionals with doctorates or master’s degrees in psychology or clinical social work with additional training in chronic pain, and to interview them about their training and approach before getting started. Most important, you should feel comfortable enough to open up with them.
Most pain therapy programs start with six to eight weekly sessions, said Fadel Zeidan, an associate professor of anesthesiology and executive director at the Center for Mindfulness at the University of California, San Diego. Often the first session is an evaluation to learn about the pain problem and the emotional issues it may be causing. You might then learn mindfulness techniques to separate the physical and emotional aspects of pain, train yourself to reframe negative thought patterns, or practice paying more attention to pleasant sensations.
The definitions insurance companies use for chronic pain are rapidly changing – with pain being increasingly seen as its own disease – but for now, it’s hard to get a trip to a pain psychologist covered. That can put one-on-one treatment out of reach for many.
Beth Darnall, the director of the Standford Pain Relief Innovations Lab, said the technology could provide new alternatives since many of the psychological tools shown to diminish pain could be learned and shared with minimal training. She has created a program, based on C.B.T. and other models, called Empowered Relief, which is affordable and can be done from your home.
Patients can sign up for a single two-hour online class, often fee, delivered by her or one of 300 instructors, all health care professionals, who offer simple skills to calm the nervous system, reframe pain and change how your brain processes it. It’s been integrated into the Cleveland Clinic for chronic pain and spine surgery patients, as well as several insurance companies. In one trial, a single class was comparable to eight sessions of C.B.T. She is also working on an app and even virtual reality platforms.
Dr. Darnall emphasized that psychological counseling was just one component of a treatment program for chronic pain, which could also include medication or lifestyle changes. ”It’s a menu, and patients might land on two or three different options that offer a good formula for them.”