Dr. J. Fred Stoner Explains Psychotherapeutic Approaches in the Treatment of Pain
As a pain management physician, Dr. J Fred Stoner sees many patients with chronic pain issues and understands that there is a need for management beyond polypharmacy and prolonged use of pain meds. As a condition on its own, pain is perceived differently by everyone, and poses different challenges as well, but in general it takes a toll on both the physical, and the psychological wellbeing of a patient. A new type of management, psychotherapy, aims to improve both these aspects of pain, as well as the emotional, social, and occupational functioning. Dr. Stoner recalls an article in which he read that there are four main therapies, operant-behavioral therapy, cognitive behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. While there are more than four, these encompass the main types of therapy and the thought behind the usefulness of psychotherapy in treating all aspects of chronic pain in patients.
Operant Behavioral Approaches
This approach works to help patients stop avoiding activities or incidences that may elicit pain, as many times the avoidance leads to deconditioning and depression as patients feel they are unable to do anything. It utilizes both positive and negative reinforcement to reduce what the patient perceives as pain-related behaviors and pushes more for adaptive behaviors such as graded pattern activity and activity pacing. This model also works with families, as many times they are guilty of contributing to pain behavior by reinforcing their pain through attention or allowing patients to avoid undesirable activity. This therapy has shown efficacy in lower back pain, mixed chronic pain, as well as in complex regional pain syndromes.
Cognitive Behavioral Therapy
Another treatment option is CBT, which uses a biopsychosocial approach that works on behavioral and cognitive responses to pain. As a common treatment in other psychiatric disorders, CBT has many advantages, although it has been argued that its role in pain management is limited as it is hard to adapt to the intractable nature of chronic pain. Similar to the operant behavioral approach, therapists work to improve psychological functioning by helping patients with their coping skills-through the use of structured relaxation, scheduling pleasurable events, and pacing of behavior. Dr. J Fred Stoner distinguishes that the difference in CBT is that it approaches maladaptive thoughts and behaviors rather than helping to avoid them. CBT works to help cognitive restructuring by identifying and replacing unrealistic thoughts or behaviors of pain with thoughts that are more positive and work towards more adaptive behaviors. It has been found to help in conditions such as irritable bowel syndrome, mixed chronic pain, SLE, spinal cord injuries, and multiple sclerosis.
Mindfulness-based Stress Reduction
This therapy Dr. J Fred Stoner explains works to “uncouple” the sensation of pain from the emotional aspect of pain while promoting a detachment of the somatic from the psychological sensations. He explains that since the pain itself cannot be abolished, the therapy works on activities that help to promote the thought of pain being viewed as a discrete entity that is not associated with an underlying issue or disorder. Through this, the therapy aims to keep patients from forming maladaptive practices and focusing on the pain as a whole event that takes over both the mind and body. It has been found to be helping in chronic neck pain, fibromyalgia, arthritis, as well as chronic migraine.
Acceptance and Commitment Therapy
This therapy is different in that it allows the patient to focus on the pain rather than working to separate from it and works to help patients foster ways of responding to the pain in a more positive fashion. It helps minimize the focus that is placed on reducing pain and maladaptive patterns and works to direct a patient to work on fulfilling personal goals instead. By emphasizing awareness and acceptance of the thoughts and emotions of the patient, the therapy helps use the pain as a positive reinforcement and driving factor to help steer them into behaviors that help them achieve their goals. This therapy has been used in musculoskeletal pain and whiplash-associated disorders.
More information here: www.drjfredstoner.com