One of the first questions I usually get when I meet with a patient suffering from chronic pain for the first time is, “Why am I here?”
Certainly, a fair question given the fact that most pain conditions can be treated medically with interventions meant to reduce pain and promote healing. Yes, you’ll experience some disruptions in your life, but the pain is meant to protect you from inflicting more damage to your injured body part. In short, your body sustains tissue damage, your brain registers it as pain, and then initiates the protective and healing process – sometimes with the help of modern medicine. But what happens when the pain doesn’t go away?
Before we answer that question, let’s set the stage by defining pain. Pain is defined as:
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (Gorczyca, Filip, & Walczak, 2013).
As you just read, the definition of pain includes the emotional experience that often accompanies pain. Chronic pain is recognized as pain that persists past the normal healing time, usually lasting or recurring for more than 3 to 6 months (Treede, 2015). While acute pain is adaptive in that it serves as an important warning signal, chronic pain does not serve the same function.
When pain persists beyond the expected healing time, treatment providers consider other factors that contribute to the experience of pain. A purely biomedical approach to treatment shifts to a biopsychosocial approach. Biopsychosocial is exactly what it sounds like (almost), psychological and social components are considered in addition to the biological aspects of pain, better known as identifiable tissue damage. The biopsychosocial approach views “pain as a dynamic interaction among and within the biological, psychological, and social factors unique to each individual” (Gatchel & Howard, 2021). Psychologically, pain can be experienced as suffering, through the experience of grief and fear of pain, for example. Socially, pain can be experienced as social withdrawal and lack of support. These psychosocial variables contribute to the overall experience of pain. While the equation varies from person to person, the experience of chronic pain can be influenced by a number of factors that can be explored, and possibly explained using the biopsychosocial model.
While a full overview of the biopsychosocial aspects of chronic pain is well beyond the scope of this blog post, there are several common concerns that I’ve heard from patients over years. These concerns typically come in the form of statements made by providers/family/friends or the beliefs and values that patients have. The primary objective of this blog post is to address these concerns to introduce transparency into the treatment options available. Below are just a few of these concerns.
“Your pain should have gone away by now.”
Yes, by all accounts, you shouldn’t be in pain anymore. You’ve undergone numerous treatments and have allowed enough time to pass but you’re still in pain. Perhaps the psychosocial variables described above have not been considered. As the pain persists, the more guarded your body becomes. This can result in muscle deconditioning, disability, negative thought patterns, and fear of pain or reinjury. These variables serve to maintain current behaviors and beliefs that amplify the pain—mood cycle.
“Your pain isn’t real.”
Your pain is real. Chronic pain is an extremely complex condition which elicits varied responses and experiences. Because of this, an approach that includes a combination of different treatments can address the differences in the ways that pain is experienced.
“Just push through the pain.”
Here’s the thing about pushing through the pain – it’s considered by most as admirable and praiseworthy. This belief that “no pain, no gain” is ingrained into society’s definition of hard work and anything less means that we’re not trying hard enough. This might be useful if you’re training for a marathon or trying to lose a few pounds so you don’t have to buy a new wardrobe (a little self-disclosure there), but chronic pain does not respond as well to this philosophy. Honoring your limits can be one of the most difficult aspects of pain, however, learning how to identify and accommodate for physical and emotional limitations can go a long way in expanding your limits. The more you stretch yourself beyond your limits, the more boxed in you’ll be.
“Accept your life in pain.”
In my experience, acceptance is considered a bad word in the chronic pain world. Trust me, I learned this the hard way in my younger years. When the topic of acceptance is broached, the general response is: “I do not accept that I will be in pain for the rest of my life.” Acceptance does not mean that pain and disability will be ever present, just present. Accepting that there are certain limitations right now can allow you to honor your limits and maintain a certain level of control over your pain.
“Medication is the only effective treatment available.”
Medication certainly has a valuable place your repertoire of pain management tools. The goal of psychological treatment of chronic pain is not to eliminate the use of medication, rather it is to provide additional tools in your tool bag. Ideally, you’ll be equipped with active and passive coping mechanisms. Active coping mechanisms are considered those that things that you can do for yourself to cope – solving problems, seeking information, seeking social support, changing the environment, and engaging in pain reduction activities (relaxation, meditation, etc.). Taking medication, getting massages or chiropractic adjustments are examples of passive coping mechanisms. Don’t let the word passive color your perception, passive coping mechanisms can be just as important as active coping mechanisms and the two can be used together.
Because pain is typically viewed as a purely physical sensation, referral to a psychologist without adequate explanation can leave the patient feeling confused, frustrated, and even insulted. The message that appears to be loud and clear is that the pain is somehow manufactured by the patient. Psychosocial factors certainly influence the ways in which we respond to and experience pain. Psychological treatment aims to increase the patient’s awareness and understanding of these factors while teaching methods of reducing their impact on pain and disability.
Bruns, D. (n.d.). Managing Chronic Pain: How Psychologists Can Help With Pain Management. https://www.apa.org/topics/pain/management
Gatchel, R.J. & Howard, K.J. (2021, March 9). The Biopsychosocial Approach. Practical Pain Management. https://www.practicalpainmanagement.com/treatments/psychological/biopsychosocial-approach
Gorczyca R, Filip R, Walczak E. Psychological aspects of pain. Ann Agric Environ Med. 2013;Spec no. 1:23-7. PMID: 25000837.
Quintner, J.L., Cohen, M.L., Buchanan, D., Katz, J.D., Williamson, O.D. (2008). Pain Medicine and Its Models: Helping or Hindering? (7), 824-834.
We at PNBC are pleased to introduce our new psychologist to the practice, Dr. Stacy Ann Aquipel.
Dr. Aquipel is a clinical psychologist licensed in California (PSY28518) with specialty training in geriatrics and health psychology, including treating individuals experiencing mood disorders, anxiety, grief and loss, emotional trauma (including acute stress and PTSD), substance abuse issues, acute and chronic pain, interpersonal difficulties, and the after-effects of brain injuries, strokes (CVAs), medical complications, acquired disabilities/functional deficits, and neurodegenerative conditions/dementias.
She has provided individual and group psychotherapy primarily to adults in inpatient, residential, and outpatient settings, including psychiatric hospital, community mental health, long-term care/skilled nursing, and substance abuse treatment programs. She also has experience conducting psychological and neuropsychological assessments with adults and older adults for diagnostic, care planning, and capacity evaluation purposes.
Dr. Aquipel primarily utilizes an existential-humanistic, person-centered, biopsychosocial, and strengths-based approach in psychotherapy that integrates aspects of Acceptance and Commitment Therapy (ACT), psychoeducation/skills training, mindfulness, and Cognitive-Behavioral Therapy (CBT). She is dedicated to providing trauma-informed, as well as multiculturally affirming and responsive care.
For this week’s blog post, we would like to highlight some recent accomplishments for some of our clinicians at PNBC, as well as their extracurricular work activities.
Dr. Corbett is a steering committee member of the California Psychological Associate Division 1 Health Psychology Section and worked with the steering committee to raise awareness of Health Inequities and Disparities. Dr. Corbett recently wrote an article highlighting the impact of implicit racial bias within healthcare systems and the growing body of research connecting implicit bias to chronic health disparities. She is currently work on additional research with the steering committee to continue facilitating positive change to reduce health inequities and disparities.
Dr. Corbett also provides clinical supervision to large clinical trials pediatric research study at UC San Diego. The study focuses on improving treatment outcomes in pediatric obesity treatment. Dr. Corbett started up the study several years ago and currently oversees treatment implementation, provides clinical supervision to group leaders and coaches, and provides treatment to parents.
Dr. Corbett also works with the San Diego County Department of Probation Youth Development and Community Support Services. The Department of Probation has been working to transform the juvenile justice system and implement the Georgetown University Youth in Custody Model. Dr. Corbett works with the Department of Probation providing trainings on promoting and implementing positive youth development within juvenile justice settings, and key aspects of adolescent development.
Dr. Corbett is member of the Chula Vista Police Chief’s Community Advisory Board and recently worked with The Department to review and revise several important policies to ensure adherence with best practices.
Dr. Sarah Jurick, Neuropsychologist
Dr. Sarah Jurick had 8 peer-reviewed manuscripts accepted for publication or published in 2020, and was selected for a paper presentation at the upcoming INS meeting next month, with a talk entitled, “Trauma-focused Treatment Enhanced with Cognitive Rehabilitation Improves Memory Performance in Iraq and Afghanistan Veterans with Cognitive Impairment.” In addition to her clinical work at PNBC, Dr. Jurick conducts longitudinal research studies of active duty service members and veterans at the Naval Health Research Center. A list of her extensive publications may be found here.
Dr. Delia Silva, Neuropsychologist
Dr. Silva was elected as Chair-Elect for the California Psychological Association (CPA) Division 8 (Neuropsychology) for 2021. Her term as chair will run from 2022-2023. Division 8 has been involved in legislative advocacy for psychologist practices in California, and providing educational and networking benefits to its members. Division 8 is currently working on promoting and sponsoring a series of diversity educational programming developed through UCSD’s Clinical Neuropsychology Seminar (CNS) for post-doctoral residents.
Dr. Silva continues to serve through 2021 as Secretary for the Hispanic Neuropsychological Society (HNS), a national organization that has been a leader in promoting opportunities and resources for neuropsychologists and students to establish competence in working with Latino/a/x populations.
In a year full of uncertainties and the continuing need for social distancing, the holiday season in 2020 may not feel very festive. You may feel that there is not too much to celebrate about 2020 and may choose to forego in this holiday rituals altogether! If you do that, however, you might be missing out on an opportunity!
Because of the events in your life, you may feel like you have little to no control, but by engaging in rituals, you are making the choice to empower yourself, no matter how small it may seem.
A ritual is an act or series of acts performed in a customary way. Rituals may be as elaborate as a ceremonies marking events (like a wedding to mark the start of a marriage), or as simple as having a cup of coffee in the morning to start the workday. Rituals bring us a sense of comfort with their predictability through repetition. Rituals are also performed with intention, which can serve to bring about a desired outcome that we want to achieve. Rituals can also provide us with a sense of closure. Psychological theories examining the purpose of rituals have postulated that they serve three main purposes 1) Regulate emotions, 2) Prepare us for some type of action, and 3) Social connectivity (Hobson et al., 2018).
Holiday rituals typically consist of family gatherings, specific meals, decorating homes, and (for many), engaging in religious rites. While it is true that the holidays in 2020 may not be celebrated exactly in the same way you have celebrated in years past, engaging in the holiday rituals that are within your control may still bring a sense of comfort. This year, your holiday rituals may be done with the purpose of closing out this year and welcoming the new year with a positive outlook. Perhaps you can create a new ritual for yourself to leave negativity in the past and enter into the future feeling lighter and stronger.
Some ideas to consider:
- Make your favorite holiday meal. If you have leftovers, gift them to your neighbors.
- Put up the holiday decorations and listen to holiday music while you do it.
- Call your loved ones and friends that you have been meaning to reconnect with.
- Try a new holiday tradition that you have not done before. For ideas, search the internet for New Year’s Eve traditions from around the world and see what you find!
- Clean your house and throw away things that you know you need to let go of.
- Write down the negative events that you want to leave in the past and then burn that sheet of paper (in a safe place, of course!).
- Think about what change you want to make for 2021 and visualize that goal. Make an effort to engage in that visualization each day.
It is your choice. Are you going to give up on the holidays this year, or are you going to take it back and use it to power you into a better place for 2021?
Written by Delia Silva, PsyD. Dr. Silva is a neuropsychologist at Pacific Neurobehavioral Clinic, PC.
Hobson, N. M., Schroeder, J., Risen, J. L., Xygalatas, D., & Inzlicht, M. (2018). The psychology of rituals: An integrative review and process-based framework. Personality and Social Psychology Review, 22(3), 260-284.