Psychological Approaches to Pain Management

There are many ways to lessen pain, including drugs, surgery, physical therapy, and mental or psychological approaches. The main focus of the next few lessons will be how to use various psychological techniques to eliminate suffering.

In the last lesson we discussed how the experience of pain could better be understood by looking at its four main components -- Sensation, Emotion, Attention, and Thought. The acronym we used for these four components was SEAT.

First, pain is composed of a Sensation, for example the feeling of pain in your finger when you accidentally bang it with a hammer. Second, pain is composed of an Emotion -- the tendency to escape from or fight the source of the pain. This is also known as the "fight or flight" defensive reaction. If a snake is biting you, you will do anything you can to prevent further injury. Third, pain imprisons your Attention, and keeps you from doing anything else. A bad headache will nag at you and prevent you from attending to other tasks. Finally, you can have negative Thoughts about your horrible plight. You might feel sorry for yourself, or you might be horrified at the extent of your injury. All four of these components contribute to suffering, and each component can make the other ones worse. For example, negative thoughts about your sorry state can contribute to your emotional turmoil and make your attempts to escape more urgent. If you feel you cannot escape, these thoughts can contribute to depression and helplessness.

Anything we can do to reduce the impact of any of the four SEAT components will lessen our suffering. Psychological approaches to pain management focus on one or more of the SEAT components. If we can alleviate even one component of pain, it will tend to lessen the others because the four components interact and intensify one another. For example, suppose a person is suffering from tension headache. Muscle tension is a result of the fight or flight Emotional reaction. If we can reduce this Emotional reaction we will reduce the muscle tension that causes the Sensation of pain, etc. For another example, if we can treat the Thought component by changing negative thoughts into hopeful or positive ones, we will indirectly effect the Emotion, Sensation, and Attention components.

Psychological approaches to pain management can be categorized roughly as follows:

1) Relaxation training: In relaxation training we learn to relax the body and mind, and stop fighting and struggling. Relaxation feels wonderful -- it is the opposite of the fight or flight reaction. When we are relaxed we simply let things be the way they are. Relaxation training works directly on the emotional component of pain. With continued practice, it has surprisingly beneficial effects on both acute and chronic pain. It has other benefits as well, such as reduction in anxiety and stress, and increased enjoyment of life.

2) Biofeedback: In biofeedback we become aware of our body's physiological reactions, and we learn how to control them. Biofeedback consists of using a machine to give us information about body functions we are normally unaware of, for example blood pressure, blood flow, muscle tension, and so on. With practice, we gain control over these functions. Biofeedback can be used as an adjunct to relaxation training, or it can also be used for changing responses directly related to pain or emotion. For example, it can be used to reduce back muscle tension that causes backache, or to change blood flow patterns related to anxiety.

3) Meditation: The word meditation has a wide variety of meanings, ranging from secular to spiritual or religious. In the present context, meditation refers to a simple psychological technique with no other connotation. The most effective type of meditation for pain relief combines relaxation training with learning to modify or refocus attention. For example, we can learn to bring our attention toward certain physical sensations and away from others. By relaxing and learning to control our attention, we have all the benefits of relaxation training, plus direct control over the Attention component of pain. Another benefit of meditation is that we get a different insight into the nature of thought, so we can learn not to be trapped by negative thoughts. By learning to disengage from negative thoughts, we free ourselves from the Thought component of pain.

4) Hypnosis: Hypnosis is a state of highly focused attention and heightened suggestibility. Hypnosis can relieve pain by altering the Attention component directly, for example by redirecting attention away from the pain. Hypnotic suggestion can be used to overcome negative thoughts, instill positive ones, and promote behavioral change. For example, "pain thoughts" are helplessness and powerlessness. We can use suggestion to change these thoughts to something positive, such as "This pain is temporary, I can overcome it." This change can improve mood, and consequently alleviate suffering. By changing thoughts, we can also change emotions.

5) Imagery: Imagery is related to hypnosis in that it involves a highly focused state of attention. Imagery can be used by itself or as an adjunct to other forms of treatment. For example, a person can imagine a pleasant scene such as lying on a beach and listening to the waves roll in and out. This can create relaxation itself, or it can be combined with other relaxation techniques. The category of imagery also includes repeating relaxing or "autogenic" phrases over and over. Another use of imagery is to create helpful physiological states directly. Imagining a cool head and warm hands may prevent a migraine headache, because this helps to create a physiological state that is the opposite of the usual fight/flight response to migraine pain.

6) Other important approaches: Some types of psychological pain therapy do not fit neatly into the above categories. For example, some therapists find group therapy particularly helpful, while others utilize psychodynamic or Freudian approaches that emphasize subconscious causes for pain. Still other therapists use techniques from Cognitive/Behavioral therapy that we will describe later, such as reward, punishment, and stimulus control. Finally, we must realize that pain creates tremendous strain on families and relationships, and that effective treatment of pain involves treating the families of the pain sufferer.

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Share Your Favorite Pain Relief Technique! Many people have a favorite pain relief technique. For example, some migraine sufferers will place their hands in hot water, or rub their scalp hard with their tips of their fingers. A person who cuts their finger might say, "Poor finger", thus depersonalizing the pain. Please share your favorite technique with others by sending your description to webmaster@painrelievers.org.