Psychological disturbances ranging from anxiety to mood swings to sadness and depression are an all too familiar byproduct of Complex Regional Pain Syndrome (CRPS). This is due in part to the disorder’s mysterious and difficult-to-treat nature. Often, CRPS patients feel a loss of control from both physical and psychological perspectives. Compounding the problem, CRPS frequently is misunderstood by medical providers, friends and family members. This lack of understanding and support from others can contribute to feelings of isolation, loneliness and general distress. This is why it’s important to find a health care provider who understands CRPS and who works with a team that includes a psychologist or counselor.
As is the case with any chronic neuropathic pain, and particularly with CRPS, negative emotions often worsen heighten the sensation of pain. While we are not sure what causes this, e are not sure of the mechanism for this, but it may be that emotions directly activate the damaged or diseased nerves causing pain. Therefore, it is very important for you to learn to control your emotions in response to the pain itself and to the difficulties that your chronic pain condition creates for you. There are several good techniques that will help you keep your emotions in check from further aggravating your chronic pain condition..
Many psychological pain treatments are psychological in nature. Most are fairly simple and do not require in-depth or long-term counseling. Examples include biofeedback, relaxation training, yoga and clinical hypnosis. The precise ways in which these techniques work for pain management are unknown, but patients frequently report less suffering and an improved ability to cope with chronic pain conditions such as CRPS. These simple techniques can be used in individual, group or even educational sessions.
More intensive individual counseling and/or the use of prescription drugs may be required for more severe and troubling emotional problems. For example, crisis intervention for catastrophic events such as an impending divorce, loss of a job or loss of health insurance coverage can be a critical part of CRPS management. Prescription drugs may be indicated for clinical problems such as severe and persistent sleep disturbances, panic attacks, anxiety or severe depression.
Mental health specialists vary considerably in their level of training and their experience in helping patients with chronic pain. Here are some questions you can ask to find out a professional's qualifications in helping you with emotional problems that frequently accompany pain:
Do you belong to a recognized professional pain society, such as the American Pain Society or the American Academy of Pain Medicine? This indicates a commitment to learning about pain.
If the mental health specialist is a psychiatrist (a medical doctor with special training in evaluating and treating emotional disorders):
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Do you have experience in consultation-liaison (medical) psychiatry, a sub-specialty dealing with the emotional problems that commonly occur with any chronic medical illness, including pain?
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Do you frequently consult with pain medicine specialists?
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(Better yet) are you Board Certified in Pain Medicine?
If a psychologist (a non-medical doctor with special training in emotions and their evaluation and treatment) or social worker (non-medical counselor):
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Do you have training in health psychology and/or behavioral medicine?
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Do you affiliate with professional organizations in these fields?
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Do you have experience in working closely with medical doctors?
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Do you have specific training and/or experience working in a Pain Center or with Pain Medicine physicians? You want to make sure that your provider is not isolated from multi-disciplinary treatment?
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Do you have close affiliations with expert psychopharmacologists (psychiatrists with expertise in the medications used to treat emotional problems) who can prescribe medications skillfully when needed?
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Do you obtain consultations easily and frequently? Again, you want to make sure that your provider is not professionally isolated.
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Do you understand the role of physical therapy and medications in pain management?
Unfortunately, often there are no credentials that can help you distinguish among psychologists, psychiatrists, medical social workers and the numerous others who advertise themselves as chronic pain specialists. In any case, it is best to obtain a referral from your Pain Medicine doctor who may know the answers to many of the above questions and be familiar with the skills, experience and qualifications of the specialist prior to referring you for psychological treatment. If the professional works in a recognized Pain Clinic, that is a good indication that he or she is knowledgeable about chronic pain issues and will be able to help you as part of the pain management team.
The message traditional medicine often conveys is that control of pain comes from outside sources such as medication, surgery and other invasive procedures. These treatments all have their place in the overall treatment of pain. However, if you are living with a painful condition it is essential that you become an active participant in the management of your pain condition. This sense of empowerment can be developed not only through formal counseling, but also through your own individual reading. Numerous educational resources are available for people experiencing chronic pain, including Web sites and self-help books dealing with chronic illness (see the CRPS Articles and CRPS Support Groups). Ask your Pain Medicine doctor for additional sources of information.
As a CRPS patient you also can gain control over your life by learning as much as you can about the disorder and treatment options. Not only is this information personally empowering, it will enable you to inform others �?including health-care providers and insurers �?about the disorder. Approaching this condition from many angles �?physically, psychologically and environmentally �?is critical to effectively managing CRPS.
Spiritual Dimensions of the Pain Experience
Richard L. Stieg, MD, MHS, Denver, Colorado
Research and clinical experience strongly suggests that many people in pain turn to spiritual guidance for help and would like their health care provider to discuss this with them. Sadly, this is a dimension that professionals often are very uncomfortable with and may believe that such discussion plays no role in healing. This author begs to differ. My patients usually are surprised and pleased when I broach the subject with them with such simple questions as:
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Are you a religious person?
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Are you a spiritual person?
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What do you believe about spirituality and has your belief been any source of comfort to you during your illness?
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Would you like to talk more about these issues?
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Would you like more information about these subjects?
I have been amazed at the number of patients who not only think that the subject is important, but that it is the most important aspect of their experience as a human being suffering with pain. Many relate that spiritual practices such as reading, praying, meditating and participating in community spiritual groups such as organized church have been crucial to their survival. They often say they would like to talk about this aspect of their pain experience and would like more information. I then lend a listening ear, along with a list of resources for further information.
Some have defined “spiritual�?by simply describing people’s personal relationship with a transcendental being (God, omnipresent being). This may or may not be in the setting of an organized religion. Clearly, a person can be spiritual and yet not religious, or be an avid church-goer without being truly spiritual. It has been my experience as a physician (and research supports this) that being a religious or spiritual person is of tremendous benefit in coping with personal illness or with sick loved ones.
Furthermore, losing one’s spiritual connection is often a part of a cascade of chronic illness. I find that many of my patients are “dispirited�?and have given up all hope of ever being well or “whole�?again. Medical and nursing programs are increasingly recognizing this and offering courses in their schools to help health care professionals talk openly with their patients about spiritual matters.
Despite our differences, Americans have a rich tradition of a deeply religious base that is mixed with individual liberal thought, community service and tolerance of many ways of thinking, ranging from orthodox religions to a wide variety of other spiritual practices. Patients appreciate being able to talk about their own belief system and to use this in the service of their own healing. Many believe that our best spiritual guides are within �?we simply need to be reminded of this fact. Health care professionals are in a unique position to tap into this rich source of healing because our patients turn to us as they seek help and guidance to deal with their chronic pain.
We welcome your feed back on this subject as the National Pain Foundation has begun exploring the need for further research and more information on its web site on this important subject �?please e-mail us at [email protected] with your thoughts and suggestions.
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