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Content Editor: Mark
Disorbio, Ph.D., Editorial Review Board: Daniel
Bruns, Psy.D.,
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 pain, and particularly
with CRPS, negative emotions
can make your pain worse. While we are not sure
what causes this, 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 psychological treatments that can
help you with this.
Many psychological
pain treatments 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):
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?
Do you frequently consult with pain
medicine specialists? 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):
Do you have training in health psychology and/or
behavioral medicine?
Do you affiliate with professional organizations
in these fields?
Do you have experience in working closely with
medical doctors?
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?
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?
Do you obtain consultations easily and
frequently? Again, you want to make sure that your provider is not
professionally isolated.
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. 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: Are you a religious person? Are you a spiritual person? What do you believe about spirituality and has your belief been any source of
comfort to you during your illness? Would you like to talk more about these issues? 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
npf@nationalpainfoundation.org
with your thoughts and suggestions.
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