Psychological Therapies
Although the tenor of that oft-quoted sentence is dramatic, the rest of the sentiment from the humanitarian and physician reads: “We must all die. But that I can save him from days of torture, that is what I feel is my great, ever-new privilege.” In the e
- PDF / 438,872 Bytes
- 18 Pages / 595.28 x 790.87 pts Page_size
- 18 Downloads / 136 Views
76
Leanne R. Cianfrini, Cady Block, and Daniel M. Doleys
Key Points
• When we critically analyze reciprocal and plastic connections between limbic, thalamic, and sensorimotor areas of the brain, it becomes obvious that what we experience as pain is larger than the sum of its sensory, affective, and cognitive components. • Acknowledging that psychological factors are involved with the pain experience does not mean that the pain is “in the patient’s head.” • Cognitive behavioral therapy (CBT) is a cost-effective adjunct to medical interventions and is backed by strong empirical evidence for positive changes in health-related quality of life, coping and depression, social support, subjective pain intensity, and painrelated activity interference. • While the cognitive techniques involve modifying pain-related maladaptive thoughts and aim to create realistic appraisals, the behavioral “conditioning” and physiological relaxation techniques can affect activity engagement, treatment adherence, overt pain behaviors, and muscle tension. • Physicians can implement many of these basic cognitive techniques and offer potent behavioral suggestions during even the briefest of consultations;
L.R. Cianfrini, Ph.D. (*) • D.M. Doleys, Ph.D. The Doleys Clinic / Pain & Rehabilitation Center, Inc., 2270 Valleydale Road, Suite 100, Birmingham, AL 35244, USA e-mail: [email protected]; [email protected] C. Block, M.S. Department of Psychology, University of Alabama at Birmingham, 1300 University Boulevard, Campbell Hall Ste 415, Birmingham, AL 35294, USA e-mail: [email protected]
practical tips for setting appropriate expectations and encouraging self-management are suggested. • The incremental benefit of combined treatments can address the limitations that we have seen with pain monotherapies. • The more advanced cognitive and behavioral techniques can be secured through collaboration with mental health providers in the community or by employing a qualified therapist in the office for a seamless interdisciplinary and biopsychosocial therapeutic approach.
Introduction Pain is a more terrible lord of mankind than even death itself. – Albert Schweitzer, On the Edge of the Primeval Forest, 1914
Although the tenor of that oft-quoted sentence is dramatic, the rest of the sentiment from the humanitarian and physician reads: “We must all die. But that I can save him from days of torture, that is what I feel is my great, ever-new privilege.” In the early twentieth century, Dr. Schweitzer elegantly described in three sentences the destructive nature of pain and the obligation and privilege of the physician to relieve it. He continues, “So, when the poor, moaning creature comes, I lay my hand on his head and say to him: ‘Don’t be afraid! In an hour’s time, you shall be put to sleep, and when you wake you won’t feel any more pain.’” So begins the promise of the interventionalist. One undercurrent of this chapter is to demonstrate the power of such words—contained within self-reported pain descriptors and our own well-intentioned assurances—to infl
Data Loading...
