Chronic pain syndrome involves both the body and the mind, resulting in brain chemistry changes that affect not only the physical, but also mental and emotional well-being of the patient. Advances in neuroimaging, neurophysiology and evidence based medical literature are helping us better understand the multifaceted and comprehensive treatment approach necessary to achieve long-term success.
If treatment is focused only on temporary suppression of pain, and is reliant only on an opioid medication regimen, consider Albert Einstein’s famous quote: “The definition of insanity is doing the same thing over and over (or daily, in the case of chronic opioid use), and expecting different results.” In other words, to move toward a long-term improvement in quality of life, those with chronic pain must discuss a robust treatment plan with their physician that takes into consideration physical, emotional, mental, environmental, somatosensory, and genetic factors.
There are numerous effective, evidence based non-opioid therapies, many of which are easily forgotten in the treatment of patients dealing with chronic pain. Medical guidelines strongly recommended incorporation of such non-opioid treatments to achieve desired results in patients on chronic opioid therapy. Doing so can also be a very cost-effective strategy, often achieving superior results with less medical costs.
Various physical and psychological therapies are available for patients including: Graded exercises, activity diaries, mindfulness strategies and relaxation techniques.
Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that focuses on addressing psychosocial contributors to pain. Patients suffering with chronic pain often have psychosocial factors that exacerbate their pain condition. These complicating factors left unaddressed may reduce outcomes of traditional treatments.
Examples of psychosocial contributors to pain include (but are not limited to):
- Fear avoidance (pain leads to a fear of movement and activity as a perceived way to avoid pain. This avoidance strategy is counterproductive and may significantly blunt effectiveness of pain treatment)
- Catastrophizing (Believing something is far worse than it actually is)
- Low expectation of improvement in pain condition
- Pain related emotional distress
- Post-traumatic stress
- Anxiety
CBT is highly effective in improving patient function and in addition, positively influences other chronic pain treatment modalities. It focuses on positively modifying dysfunctional emotions, behaviors and thoughts. CBT provides behavioral, relaxation, and self-help techniques along with providing pain coping strategies to help modify situational factors and cognitive processes that exacerbate pain.
When chronic pain is associated with feelings of stress and distress, CBT combined with mindfulness strategies allow patients to better understand and manage thoughts and emotions.
Strong medical evidence has shown CBT, or mental health counseling combined with non-opioid treatments (e.g. acetaminophen, NSAIDs, physical therapy, and targeting pain generator therapies) can reduce risk of opioid co-dependence as well as help reduce required dosage in patients on chronic opioid therapy while increasing functionality.
The ideal goal in patients dealing with Chronic Pain is for each patient to be empowered, and for each patient to be an active participant in their own care.
Patients are encouraged to have involved discussions with their treating providers to determine the most-effective treatment program to drastically improve their quality of life, increase their functionality, decrease their pain, while reducing their reliance on opioids. As when it comes to chronic non-malignant pain, opioids alone are not the answer, and will very rarely be an effective long-term strategy.