My Treatment: Thoracic Outlet Syndrome - Treatment Options: Psychology of Pain

Thoracic Outlet Syndrome Psychology of Pain

As with other chronic pain conditions, thoracic outlet syndrome can cause feelings of depression, sadness and loss. Often depression is heralded by other symptoms, such as increased fatigue, less energy, less interest in or enjoyment of activities, poor concentration, loss of appetite, worse sleep, and feelings of guilt or worthlessness. When these feelings or symptoms persist on a daily basis, the resulting depression may need to be treated with medications. Frustration and anger also are normal responses to any chronic pain condition, including back and neck pain. However, because the mind can influence the body (and vise versa), such negative emotions can further aggravate pain.

To complicate matters, TOS may be accompanied by a physical reaction to the pain known as "muscular bracing" — or holding the body in an extremely rigid posture in an effort to "protect" an area from further pain. Unfortunately, muscular bracing can lead to major muscular tightness that require additional treatment with medications and physical therapy. That's because at the basic brain level muscles develop a "memory" that continues to produce a repetitive muscle bracing pattern and subsequent pain.

Along with medication management and physical therapy, psychological pain management techniques that incorporate a "mind-body" connection can help break this vicious cycle. These may include breathing exercises, self-hypnosis, various forms of biofeedback training and other alternative therapies. As a chronic pain patient, it's important for you both physically and psychologically to become actively involved in your treatment. Developing a behavioral pain management program that works best for you can help you gain a sense of control over your pain. It's important to find a qualified health care provider who is knowledgeable about TOS and muscular bracing, as well as the use of behavioral pain management techniques.

Finding a Qualified Mental Health Professional
In terms of finding a qualified professional to help with emotional issues, 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?
(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):

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 a qualified specialist who is knowledgeable about chronic pain issues, or a Pain Medicine doctor who may know the answers to many of the above mental health specialist prior to referring you for treatment.