Ouch, I’m In Pain

One of the more challenging conditions to help patients manage is chronic pain. It can be frustrating for all disciplines involved to get at the bottom of what the patient is going through, what the source of pain is, and how to help them feel better. Chronic pain definitely has a physical component, however, there are behavioral health needs as well. With that in mind here are some things to consider when working with patients that have chronic pain:

•  Depression frequently occurs in patients with pain:

-Aggressively addressing the depression and pain simultaneously is necessary for recovery to occur
-Pain may exacerbate depression and depression may exacerbate pain

•  When typical analgesic doses fail to alleviate pain, you can refer to a behavioral health consultant (BHC) who will:

-Work with the patient to learn to live with their pain
-Help patients to learn they may have more control over their pain then they originally thought
-Ensure that the patient understands that a consult to BHC is NOT because we do not believe that their pain exists but to help patients live better with pain (It’s not “all in their head.”)

• BHC will often do Cognitive Behavioral Therapy (CBT), meaning:

-A focus on restructuring negative thought processes related to pain
-When patients have more realistic thoughts about their pain, they may be able to deal with it better
-Use of a pain journal to keep track of specific thoughts and behaviors that exacerbate the pain and what helps the pain
-Relaxation skills (progressive muscle relaxation or stretch based relaxation along with deep breathing) are taught
-Promotion of appropriate level of physical activity and helping patients to learn to monitor pain during activity
-Teaching positive affirmations “I am strong enough to handle this pain”
-Relapse prevention – examining events leading up to increase of pain and emphasizing that one bad day does not undo all the good days or future good days

Please check out the attached image to see a visual example of the CBT model for chronic pain management. Feel free to ask for my assistance with your dental or medical patients that may be dealing with pain, I’m happy to help!