Psychological Methods for Relieving Pain
Psychological treatment for pain can range from psychoanalysis and other forms of psychotherapy to relaxation training, meditation, hypnosis, biofeedback, or behavior modification. The philosophy common to all these varied approaches is the belief that people can do something on their own to control their pain. That something may mean changing attitudes, feelings, or behaviors associated with pain, or understanding how unconscious forces and past events have contributed to the present painful predicament.
PSYCHOTHERAPY
Freud was celebrated for demonstrating that for some individuals physical pain symbolizes real or imagined emotional hurts. He also noted that some individuals develop pain or paralysis as a form of self-punishment for what they consider to be past sins or bad behavior. Sometimes, too, pain may be a way of punishing others. This doesn't mean that the pain is any less real; it does mean that some people with pain may benefit from psychoanalysis or individual or group psychotherapy to gain insights into the meaning of their pain.
RELAXATION AND MEDITATION THERAPIES
Relaxation and meditation techniques enable people to relax tense muscles, reduce anxiety, and alter mental state. Both physical and mental tension can make any pain worse, and for people who have conditions such as headache or back pain, tension may be at the root of the problem. Meditation, which aims at producing a state of relaxed but alert awareness, is sometimes combined with therapies that encourage people to think of pain as something remote and apart from them. The methods promote a sense of detachment, so that the person thinks of the pain as confined to a particular body part over which he or she has marvelous control. The approach may be particularly helpful when pain is associated with fear and dread, as in cancer.
HYPNOSIS
No longer considered magic, hypnosis is a technique in which an individual's susceptibility to suggestion is heightened. Normal volunteers who prove to be excellent subjects for hypnosis often report a marked reduction or obliteration of experimentally induced pain, such as that produced by a mild electric shock. The hypnotic state does not lower the volunteer's heart rate, respiration, or other autonomic responses. These physical reactions show the expected increases normally associated with painful stimulation.
The role of hypnosis in treating people with chronic pain is uncertain. Some studies have shown that 15 to 20 percent of hypnotizable people with moderate to severe pain can achieve total relief with hypnosis. Other studies report that hypnosis reduces anxiety and depression. By lowering the burden of emotional suffering, pain may become more bearable.
BIOFEEDBACK
Some individuals can learn voluntary control over certain body activities if they are provided with information about how the system is working-how fast their heart is beating, how tense their head or neck muscles are, how cold their hands are. The information is usually supplied through visual or auditory cues that code the body activity in some obvious way- louder sound meaning an increase in muscle tension, for example. How people use this biofeedback to learn control is not understood, but some masters of the art report that imagery helps: individuals may think of a warm tropical beach, for example, when they want to raise the temperature of their hands. Biofeedback may be a logical approach in controlling pain that involves tense muscles-such as tension headache or low back pain-but results are mixed.
BEHAVIOR MODIFICATION
This psychological technique (sometimes called operant conditioning) is aimed at changing habits, behaviors, and attitudes that can develop in people with chronic pain. Some people become dependent, anxious, and homebound if not bedridden. For some, chronic pain may be a welcome friend, relieving them of the boredom of a dull job or the burden of family responsibilities. These psychological rewards-sometimes combined with financial gains from compensation payments or insurance-work against improvements in the person's condition and can encourage increased drug dependency, repeated surgery, and multiple doctor and clinic visits.
There is no question that the person feels pain. The hope of behavior modification is that pain relief can be obtained from a program aimed at changing the individual's lifestyle. The program begins with a complete assessment of the painful condition and a thorough explanation of how the program works. It is essential to enlist the full cooperation of both the person and family members. The treatment is aimed at reducing pain medication and. increasing mobility and independence through a graduated program of exercise, diet, and other activities. The person is rewarded for positive efforts with praise and attention. Rewards are withheld when the person retreats into negative attitudes or demanding and dependent behavior.
RELAXATION: COMMONALITIES BETWEEN THE MANY TECHNIQUES
MINDFULNESS
To succeed in using any relaxation methods, one must cultivate the ability to focus only on one thing- that thing which one is presently doing. This activity may be meditation, dancing, breathing, or any other single, focused activity. Mindfulness is an attitude of remaining present, watchful, and aware of what is happening without becoming emotionally involved or captured by the images or sensations. Being truly present implies the absence of either anticipating or ruminating.
TIME
All relaxation interventions take time to learn and to do. Many may be used when there is an emergency or when the amount of time available is limited, but to be most effective, they must be practiced until they are almost automatic. The discipline and self-responsibility involved in learning a relaxation intervention must be communicated to the client early in the training.
TIMELESSNESS
One goal of all relaxation interventions is a decrease in muscle tension and its accomplice, anxiety. The sense of timelessness that accompanies the achievement of real relaxation makes it possible to eliminate anxiety, manipulate pain, and gain voluntary regulation of physiologic change. This state of timelessness is the condition through which one goes even more deeply into the transpersonal and transcendental levels of creative insights and deeply meditative states.
MENTAL AIM: PASSIVE VOLITION
One element that all relaxation interventions share is passive attention or passive volition, which is the opposite of trying to make or making a change happen- Like experts in the Japanese martial art of Aikido, individuals allow the energy of the thought or image of relaxation to carry them with it to the state of calmness. This technique is similar to golfers who picture the ball going into the hole before they swing. The opposite happens when people 'choke' in sports. That is they are trying so hard they tense up do not succeed.
When attempting to lower muscle tension, clients often find that they are not succeeding. They immediately begin to try harder, which further increases tension and makes them realize that their old coping skill is no longer valid. In order to be successful, they must step aside mentally; adopt an expectant, but non active attitude; and allow the body/mind to let go of tension. Documenting this phenomenon with biofeedback is the only objective way of validating this experience.
COMPASSIONATE GUIDE
A major factor in the success of any relaxation intervention is the building of rapport, openness, and trust between guide and client. Practitioners come into the profession with a large measure of compassion and empathy but may need to reevaluate their motives, particularly when dealing with "difficult"patients. A practitioner must be open to possibilities; be accepting of the other person's responses; and be able to adjust to that person's needs, likes, and dislikes as they appear during a relaxation teaching session. It is essential to find a therapist who can teach relaxation skills with an attitude of acceptance.
RELAXATION RESPONSE
We are all familiar with the intense internal reaction that we experience when faced with an emergency: a truck cuts in front of us on the highway, a child darts into the street. What some researchers refer to as an "adrenaline rush," the familiar "fight or flight response," is actually a complex series of psychophysiologic processes that prepare us to deal with the real or perceived emergency. It is important to note that people respond in an identical manner to an imagined threat as to an actual threat to their well being.
A non-religious form of meditation that is similar to transcendental meditation has been applied in health care settings and been validated in a variety of studies. The strategy consists of 20 minutes a day of focused, passive concentration on a neutral word, such as one. Slow repetition of the word, repeated with each exhalation, has been shown to bring about the same psychophysiologic responses as other deep relaxation processes. Further studies have documented deep relaxation when the client focuses on a short, personally meaningful religious statement or quotation.
The changes that occur when an individual reaches a deep level of relaxation are exactly opposite to those of the "fight or flight" response. Changes occur in the autonomic, endocrine, immune, and neuropeptide systems as follows:
Increases in:
I.peripheral blood flow
2.electrical resistance of the skin
3.production of slow alpha waves
- activity of natural killer cells
Decreases in:
1.oxygen consumption
2.carbon dioxide elimination
3.blood lactate levels
4.respiratory rate and volume
5.heart rate
6.skeletal muscle tension
7.epinephrine level
8.gastric acidity and motility
9.sweat gland activity
10.blood pressure, especially in the hypertensive individual
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