Non-Medication Help for Chronic Pain?

“I’m on an opiate reduction program for my pain and need more help!”

“My doctor is cutting back on my oxycontin and won’t prescribe other strong medication.  She is afraid of lawsuits with prescribing regular ‘opiate’ pan medication.  Nothing else works well for me well.  I have tried everything in the past year, from physical therapy, acupuncture, hypnosis, many medication.  Surgery didn’t help at all.   My doctor said the only thing I haven’t done yet is see a health psychologist who works with pain patients and that I should try it.  I am skeptical that it will help.  This pain is not  “just in my head”.  I am open to anything that might help, however. Thanks—–Jill.”

Jill presents with a common report we receive in primary care settings, because among adults, especially as they get a bit older, pain conditions abound.  I would say that roughly half of our clinic patients have a pain condition, in addition to many other problems.  Some of them have ongoing pain that lasts longer than about 3 months, which we call “chronic pain”. 

As I have a chronic pain condition myself (degenerative disk disease), I want to you to know that I empathize well with what you already know about pain; it is certainly something that affects every aspect of our life:   

1. Our sleep tends to be quite poor because of pain.  We may not be able to fall asleep, due to pain.  Or, we cannot get comfortable enough to fall asleep.  We may wake up during the night experiencing pain.   We tend to be sleep-deprived nearly every day. 
2. We have “bad pain days” where we become impatient, irritable around loved ones.   We hate it when we are like this!
3. Having a very bad day where everything goes wrong causes our pain to feel much worse.
4. We are quietly angry and resentful because we feel pain is robbing us of life enjoyment.   We are frustrated with all the doctors we have seen because they cannot fix the condition causing our pain. 
5. We have regular periods of nagging anxiety and worry.  What if I move the wrong way or do something to cause a pain flare- up.  What is my life going to be like when I’m much older and I don’t have the help I need?  
6. We are less effective at work because pain affects our ability to concentrate and stay focused.  Completing a task is harder than it should be.  We are slower than we used to be because of pain.   
7. Unexpected life stress, task demands or problems always seem to make our pain condition feel much worse. 
8. Chronic pain feels like a never ending struggle we cannot “win”.  It can make us feel hopeless and helpless; we can become depressed because it wears on us, physically and emotionally.  We may have had passing thoughts that death might be better than living with the pain

Sound familiar?

It is clear that the treatments you seek take into account the complex interaction between your pain condition, stress, effects on your emotional life and ability to think and concentrate. Psychologists trained in behavioral medicine are well-versed in treatments for chronic pain that involve non-surgical and non-medication approaches.  You are probably aware that so far, medical science does not seem to be able to end your suffering from pain.   The approaches used in behavioral medicine will not likely end your pain either.  However, these approaches can absolutely help you function better.  For instance, they can help you attain numerous brief periods of escape or respite from your pain during the day. They are also helpful in reducing or eliminating the gradual worsening of pain over time due to what is called the deconditioning syndrome.  Most chronic pain patients tend to suffer from this problem  Furthermore, the methods definitely help patients get a few more things done during the course of a typical day, despite your pain, and without worsening your pain condition.   Finally, the interventions place an emphasis on helping patients derive more pleasure and enjoyment out of daily life.  

So, in general, the specific behavioral health interventions I am referring to almost always improve patients’ overall quality of life, sometimes just a little but many times, a lot.   I would recommend that you find a practitioner who is well trained in what is called health psychology or behavioral medicine, who has received formal education and supervision in these methods and has broad experience working in a pain clinic.    I would welcome the opportunity to talk to you more about non-medication therapy approaches to helping your chronic pain condition. 

Copyright 2019  David M. Stein, Ph.D.  Readers are welcome to link to this article.   Copying this article without the written permission of the author is not permitted.  Copying the article and presenting it on another website without appropriately crediting the present author and linking to this website is considered plagiarism.  This action will be reported to state or provincial licensing boards as an ethics violation.