1. Psychological Treatment for Chronic Pain
Background and Definitions
Treatment Options
Some Christian views on Chronic Pain
10/17/17 Professional Development Presentation for SF Christian Psychotherapy Services

2. Psychological Treatment for Chronic Pain
Acute Pain:
Usually associated w/ physical cause: disease, inflammation, or injury
Onset usually quickly after injury; resolves once healing occurs
Usually thought of as temporary
Chronic Pain:
Nerve signals keep firing/pain continues even after you have healed/injury has stopped or even with no clear cause
Lasting pain: 3 to 6 months or more
May have no direct relationship between the extent of injury and the perceived pain

3. Psychological Treatment for Chronic Pain
Causes: past injuries, surgeries, illnesses
List of conditions causing pain:
Sensations: dull ache, throbbing, burning, shooting, squeezing, stinging, soreness, stiffness, …

4. Psychological Treatment for Chronic Pain
Treatment Options:
Medications (oral, injections, topical, rectal, etc)
Physical Intervention: surgery, acupuncture, electrical stimulation
Counter Stimulation: massage
Relaxation therapies: PMR, diaphragmatic breathing, meditation
Cognitive/Attentional therapies: biofeedback, visualization, distraction, music
Behavior Modification to decrease and replace maladaptive pain behaviors: (complaining, taking more medication, assuming special postures, inactivity/relief of responsibility, isolation, receiving special attention, … etc.)

5. Psychological Treatment for Chronic Pain
Classes of Analgesic Medications:
Opioid/”Narcotics”:
Bind opioid receptors on CNS (brain and spinal cord), digestive tract, and respiratory tract
Also causes drowsiness or LOC
Potentially addictive due to also activating reward pathways
Potential for developing tolerance
Common Side effect: constipation
Opium Derivatives: Ex: morphine, codeine, Demerol, oxycodone, Darvon, fentanyl, hydrocodone, heroin, Tramadol, buprenorphine, Dilaudid

6. Psychological Treatment for Chronic Pain
Non-opioid:
Non-steroidal anti-inflammatory drug (NSAID)
Also have antipyretic (reducing fever) and anti-inflammatory effects
General Side Effects: ulcers/irritate stomach, renal failure, allergic reactions
Ex: Aspirin, ibuprofen (Motrin), naproxen (Aleve)
Acetaminophen (Tylenol)
Lacks anti-inflammatory effect
OD is lethal

7. Psychological Treatment for Chronic Pain
Alternative Medications used as analgesic
Tricyclic antidepressants (ex amitriptyline (Elavil)
Anti-seizure agents such as gabapentin (Neurontin)
Corticosteroids as anti-inflammatories
Nerve blocks: (Ex anesthetic drug, like lidocaine, can be injected into a nerve branch so that a certain part of the body become desensitized to pain)

8. Psychological Treatment for Chronic Pain
The Impact of Pain on the Individual and Families

9. Psychological Treatment for Chronic Pain
“Much of the variation in pain perception can be explained by the interplay between afferent nociceptive signals to the brain and descending modulatory systems that are activated endogenously by cognitive and emotional factors.”

10. Psychological Treatment for Chronic Pain
Loss of
Control
Esteem
Hopelessness
Identity
Functioning
Self
Inactivity
Depression
CHRONIC
PAIN
Social
Isolation
Catastrophizing
Anxiety
“Personality”
Changes
Self-
Centered
Hypervigilant
Muscle
Tension
Impatience

11. Psychological Treatment for Chronic Pain
Gate Theory of Pain Perception: Factors that “Open Gates”/Increase Pain
Physical Factors
Emotional Factors
(may effect the perceived unpleasantness of the pain)
Extent of the injury/illness
Sensitization of the nervous system to process pain signals (in situations not usually perceived as painful)
Inappropriate activity level
Inadequate sleep
Negative emotions: hopelessness, anxiety, anger

12. Psychological Treatment for Chronic Pain
Gate Theory of Pain Perception: Factors that “Open Gates”/Increase Pain
Thinking about and focus on the pain may increase the intensity
Negative thoughts/interpretations of the pain
Stressful relationships
Social isolation
Cognitive Factors
Social Factors

13. Psychological Treatment for Chronic Pain
Gate Theory of Pain Perception: Factors that “Close Gates”/Decrease Pain
Physical Factors
Emotional Factors
(may effect the perceived unpleasantness of the pain)
Medications
Counterstimulations (ex heat, massage, TENS transcutaneous electrical nerve stimulation, acupuncture)
Appropriate activity level
Adequate sleep
Relaxation
Positive emotions
Adequate restfulness

14. Psychological Treatment for Chronic Pain
Gate Theory of Pain Perception: Factors that “Close Gates”/Decrease Pain
Managing attention: concentration on other things (distraction techniques, imagery)
Adaptive/positive attitudes and outlook.
Anticipated effect of pain relief/placebo
Harmonious and supportive relationships
Life involvement and increase in life activities
Cognitive Factors
Social Factors

15. Psychological Treatment for Chronic Pain
“The weakness and pain of our body will influence and provoke our hearts. The responses of our hearts, whether weighted towards belief or towards unbelief, serve to
modulate the pain experience for better or for worse.”
*Michael R. Emlet is a counselor and instructor on the CCEF faculty. He is a medical doctor and practiced family medicine for twelve years before earning his M. Div. at Westminster Theological Seminary.

16. Psychological Treatment for Chronic Pain
Some Christian views of physical pain
1. Chronic Pain as a natural consequence of a fallen Genesis 3 world and the decay of the body but the believer’s hope is that the created order will one day be set right:
Rev 21:4 “ ‘He will wipe every tear from their eyes. There will be no more death’
or mourning or crying or pain, for the old order of things has passed
away.” NIV
2. Chronic Pain can produce Intimacy/a deep experience of God
Job 42:5 “My ears had heard of you but now my eyes have seen you.” NIV

17. Psychological Treatment for Chronic Pain
3. Suffering equips us/gives us the credibility to comfort others
2 Corinthians 1:3-5 ”Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God. For just as we share abundantly in the sufferings of Christ, so also our comfort abounds through Christ.” NIV
Suffering gives us compassion for others who are hurting, enabling us to minister more effectively.
"People who suffer want people who have suffered to tell them there is hope. They are justifiably suspicious of people who appear to have lived lives of ease."
illness