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Section 13
Therapy for Chronic Pain

Question 13 | Test | Table of Contents
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed three manifestations of anxiety in chronic pain clients.  These three manifestations of anxiety in chronic pain clients included:  generalized anxiety; social anxiety; and fear of mortality.

On this track, we will present three techniques for helping clients lessen their chronic pain in day-to-day life.  These three techniques to help lessen daily, chronic pain include:  Brain Talk; Focus Anger; and Name Your Symptoms.

3 Techniques to Help Clients Lessen Their Chronic Pain

Technique #1 - Brain Talk
The first technique to help lessen daily, chronic pain is "Brain Talk."  This technique is an easy way for clients to harness their conscious mind to overpower their unconscious.  It accomplishes many of the same results as meditation and journaling, but since this exercise can be done internally, it’s easier to do during the day.  This technique involves the client talking back to his or her brain.  Because the manifestation of pain often comes as a result of emotional stress, I feel that this Brain Talk is an effective way for a client to examine his or her emotional stress at the time. 

Greg, age 32, had two daughters and an ex-wife that constantly caused him emotional stress.  When his fibromyalgia flared-up, he knew it was because he was experiencing anger.  I asked Greg that the next time his fibromyalgia acted up to stop and ask his brain, out loud if he was alone, in his head if he was not, what exactly the problem was and then to shift through all his common emotional stressors. 

A few weeks later, Greg stated, "I’m beginning to get the hang of this.  The last time that I began to feel pain in my neck, I stopped myself, and stated, ‘I hurt.  You know that I’m hurting.  When I hurt, it means you’ve been hiding anger again.  What is it now?’  Then I started to shift through my list of aggravators, which is extensive, and once I started doing that, the pain started to dissipate.  It was like, my mind was trying to get my attention, and once it had it, it stopped misbehaving." 

Think of your Greg.  Would "Brain Talk" help to alleviate his or her chronic pain?

Technique #2 - Focus Anger
The second technique to help lessen daily, chronic pain is "Focus Anger."  Like Greg, many chronic pain clients stuff their anger into a little room inside their head, not willing or able to let it out.  Many times, this is a result of societal pressures.  Clients do not wish to express their anger because it is not accepted to "lose your head."  For healthy people, this just results in bottled-up anger, not emotionally healthy, but also not physically bothersome. 

However, many clients who suffer from chronic pain begin to have flare-ups if their anger is not correctly expressed.  They need to release their anger, but if they have repressed it, they will release it on someone who does not deserve it. 

Kyle, age 29, would become frustrated with the chronic pain in his chest due to his thoracic spinal stenosis, a narrowing of the spinal canal which causes severe chest pains if not treated correctly.  When Kyle became angry or emotionally stressed about certain aspects of his life, he forgot to do his treatments for his condition.  He didn’t exercise and forgot to take his medications.  To relieve his disorienting anger, I asked Kyle to try the "Focus Anger" exercise.  I asked him to keep track of his anger and his expressions of it. 

To do this, Kyle kept a log, in which he listed a summary of the reason he was angry, what time it occurred, the source, and how he got rid of it.  I asked Kyle to focus on expressing his anger in a non-violent, constructive manner.  The next week, Kyle came back with a page-long log.  The log included the following entry:  the summary stated, "A key vendor didn’t return essential questionnaire in time for newsletter deadline." 

Under the time, he listed, "Wednesday morning."  Under the source, he listed the vendor’s name and he expressed his anger by "writing candidly about vendor’s sloppiness in comparison chart’s comments section."  Because he had expressed his anger, Kyle could move on and focus on something more important:  his health.   Kyle stated, "Every time I got angry, I got out this log and wrote it down, and then I was more motivated to express my anger."  

Think of your Kyle.  Would he or she benefit from "Focus Anger"?

Technique #3 - Name Your Symptoms
In addition to Brain Talk and Focus Anger, the third technique to help lessen daily, chronic pain is "Name Your Symptoms."  In this exercise, I ask my chronic pain clients to visualize their pain as a negative object or person.  I also ask them to give their pain a name, particularly one that they find less than appealing. 

Cynthia, age 45, would become discouraged when she would have minor setbacks in her fibromyalgia treatment.  I suggested that she try the "Name Your Symptoms" exercise to try and give her some perspective.  I stated to Cynthia, "Try naming your fibromyalgia so that you can call it up to confront it.  You can do this by graphically describing it in your own terms.  Try and make sure that the name paints a vivid picture in your mind." 

Cynthia came back next week and stated, "I’ve figured out a name for my symptoms.  I’m calling them ‘Hulga’ because, for me, that name exemplifies a very ugly and bitter person.  I’m trying to think of my pain as a teenager having a tantrum, not getting its way, because I’m the good solid parent."  I stated to Cynthia, "Now, whenever you have a setback, having a name with which to conjure up your symptoms will help you look back and remember how bad it used to be.  Looking back at a graphic personification of your old illness makes it faster and easier to send the tantrum-throwing child to time out."

Think of your Cynthia.  How would he or she personify his or her chronic pain?
On this track, we presented three techniques for helping clients lessen their chronic pain in day-to-day life.  These three techniques to help lessen daily, chronic pain included:  Brain Talk; Focus Anger; and Name Your Symptoms.

On the next track, we will examine three long-term coping techniques.  These three long-term coping techniques include:  Self-Motivators; Emotional Essay; and Assert Yourself.

Peer-Reviewed Journal Article References:
Chen, S., & Jackson, T. (2018). Pain beliefs mediate relations between general resilience and dysfunction from chronic back pain. Rehabilitation Psychology, 63(4), 604–611.

Guite, J. W., Russell, B. S., Pantaleao, A., Thompson Heller, A., Donohue, E., Galica, V., Zempsky, W. T., & Ohannessian, C. M. (2018). Parents as coping coaches for adolescents with chronic pain: A single-arm pilot feasibility trial of a brief, group-based, cognitive–behavioral intervention promoting caregiver self-regulation. Clinical Practice in Pediatric Psychology, 6(3), 223–237.

Kerns, R. D., Burns, J. W., Shulman, M., Jensen, M. P., Nielson, W. R., Czlapinski, R., Dallas, M. I., Chatkoff, D., Sellinger, J., Heapy, A., & Rosenberger, P. (2014). Can we improve cognitive–behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy. Health Psychology, 33(9), 938–947. 

Lim, J. A., Choi, S. H., Lee, W. J., Jang, J. H., Moon, J. Y., Kim, Y. C., & Kang, D. H. (2018). Cognitive-behavioral therapy for patients with chronic pain: Implications of gender differences in empathy. Medicine, 97(23).

McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178–187.

Vowles, K. E., Witkiewitz, K., Levell, J., Sowden, G., & Ashworth, J. (2017). Are reductions in pain intensity and pain-related distress necessary? An analysis of within-treatment change trajectories in relation to improved functioning following interdisciplinary acceptance and commitment therapy for adults with chronic pain. Journal of Consulting and Clinical Psychology, 85(2), 87–98.

What are three techniques for helping clients lessen their chronic pain in day-to-day life? To select and enter your answer go to Test.

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