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Pain Management: Cognitive Therapy for Chronic Pain and Fibromyalgia
Pain Management: Cognitive Therapy for Chronic Pain and Fibromyalgia

Section 2
Pain Perception

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Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs, Nurse CEUs

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On the last track, we discussed three kinds of pain frames which act as an appraisal for the client.  These three kinds of pain frames which act as appraisals were:  threat; loss; and challenge.

On this track, we will examine external and internal factors that affect a client’s perceptions of pain.  These factors that affect a client’s perceptions of pain come under three categories, which are:  biological; social; and personality.

Three Factors that Affect a Client's Perception of Pain  

#1 Biological Factors
The first factor that affects a client’s perceptions of pain comes under the category of biological.  Obviously, there is more than just a mental side to a client’s pain and the knowledge related to the physiological aspects of pain become increasingly more important as cognitive research continues.  For example, we now know that short-term stress responses include constriction or dilation of various blood vessels, which can have a direct impact on muscular or visceral pain.

Such disorders, however, as fibromyalgia, although recognized as disease states, are poorly understood in terms of pathophysiology or course of illness.  As such, a symbiotic relationship must occur between the biological information about a disease and one’s cognitive wellbeing. 

Lucy, age 31, had anxiety attacks related to her panic disorder.  Frequently, Lucy would experience shortness of breath and sharp, searing pain in her chest.  When these symptoms first began, she thought she was having a heart attack and rushed herself to the hospital.  This happened several times, and caused a great amount of embarrassment.  She began to fear the panic attacks to such an extent, she would instigate one just by worrying about it. 

Because I knew that the actual biological stimuli of her pain was not serious, I could easily treat it without prescription medication.  I gave Lucy several breathing exercises that calmed her down once an attack began, but it was through the knowledge of the endocrine system that such a procedure could have proved helpful.

#2 Social Roles
The second factor affects a client’s perceptions of pain comes under the category of social roles.  This category covers a great number of roles including those related to gender, family, society, occupation, and roles within the healthcare system.  These roles can many times define the attitudes taken during periods of persistent pain

For example, in gender roles, the male gender role is stereotypically stoical, or nonchalant, whereas the female gender role is stereotypically that of increased sensitivity.  Interestingly, this tendency may be ingrained early on in childhood.  In an observational study of preschool children, although boys and girls did not differ in the frequency or severity of pain causing incidents, adult caregivers provided more physical comfort to girls who were expressing distress

Rachel, age 29, suffered from fibromyalgia.  She stated, "When I was first diagnosed at 11, I was in so much pain that I would give such displays of physical anguish.  I would roll around on the ground and scream until my mom would hold me and try to comfort me.  When I was alone, though, I never screamed or thrashed about.  There was no one there to comfort me, so why try?  I had a friend, Gary, who was fibromyalgic as well, but he never went through such tantrums as I did.  His father ignored him, and told him to act like a man."  Rachel had been reacting to society’s perceptions of how girls express pain. 

Think of your Rachel.  Is he or she reacting to a social stimuli?

#3 Personality Factors
In addition to biological and social factors, the third factor affects a client’s perceptions of pain comes under the category of personality factors.  If a client has prescribed him or herself to a certain style of thinking, that client may have predisposed his or herself to certain reactions towards pain. 

In a diathesis-stress model of chronic pain, Dr. D.C. Turk has proposed that certain predispositional factors increase one’s risk for becoming disabled following exposure to physical trauma.  Such personality characteristics as neuroticism, negative affectivity, and emotional vulnerability may be linked to the experience of pain. 

Paul, age 22, had been always been dependent on his parents, emotionally, financially, and socially.  In his developing years, Paul had found it difficult to connect to other children and as such, he had very little friends to play with in the neighborhood.  Lacking this social stimulation, Paul had become increasingly reclusive and physically sensitive. 

The day that Paul fell down the stairs in his parents' home, he expressed a great deal of pain, although there were no broken bones or strained muscles.  Paul, who had become reliant on his parents and thought himself utterly defenseless was using the pain to extract affection and comfort from his mother and father who had asked him to leave two weeks before. 

Think of your Paul.  Is his or her personality affecting the way in which he or she experiences pain?

Technique:  Plan of Escape
To help chronic pain clients like Lucy, Rachel, and Paul, I asked them to make a "Plan of Escape."  Clients with chronic pain often worry about the pain to such an extent, that the stress incites a flare-up.  Stress related to chronic pain will be discussed on a later track.  Because much of these clients' emotional distress arose out of the fear of pain rather than the pain itself, I asked them to write a list of activities or methods to deal with their pain if it started again. 

For her fibromyalgia, Rachel wrote, "If I'm at home, I'll have a soothing, warm bath.  If I am at work, I will take an hour off and go for a light walk to relax the muscles."  After a few weeks, I asked Rachel how her "Plan of Escape" had worked for her.  She stated, "I feel better knowing that I have a way of dealing with the pain if it flares-up again.  Plus, it's almost like rewarding myself for getting through the pain.  When I don't panic and execute my "Plan", I give myself a healthy snack."  By attaching a positive aspect to her flare-ups, Rachel had cancelled out a small fraction of her negative perception of her pain.

On this track, we discussed external and internal factors that affect a client’s perceptions of pain.  These factors that affect a client’s perceptions of pain come under three categories, which were:  biological; social; and personality. 

On the next track, we will discuss discussed concepts of automatic thoughts.  These concepts of automatic thoughts include:  negative automatic thoughts; helplessness; and automatic thought evaluation.

Peer-Reviewed Journal Article References:
Hooley, J. M., Ho, D. T., Slater, J., & Lockshin, A. (2010). Pain perception and nonsuicidal self-injury: A laboratory investigation. Personality Disorders: Theory, Research, and Treatment, 1(3), 170–179.

Pollatos, O., Herbert, B. M., Füstös, J., Weimer, K., Enck, P., & Zipfel, S. (2012). Food deprivation sensitizes pain perception. Journal of Psychophysiology, 26(1), 1–9.

Tsur, N., Defrin, R., Levin, Y., Itzhaky, L., & Solomon, Z. (2019). Pain perception and modulation in ex-POWs who underwent torture: The role of subjective and objective suffering. Psychological Trauma: Theory, Research, Practice, and Policy, 11(8), 820–827. 

Online Continuing Education QUESTION 2
What are three external and internal factors that affect a client's perceptions of pain? To select and enter your answer go to CE Test.

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Pain Management: Cognitive Therapy for Chronic Pain and Fibromyalgia

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