Psychological Treatment

As with other chronic pain conditions, living with TOS can be stressful and produce negative emotions such as sadness, frustration, anger, anxiety, guilt and loss. TOS also can lead to depression, a medical condition that causes feelings of worthlessness, hopelessness and helplessness, and other symptoms including fatigue, reduced interest in or enjoyment of activities, difficulty concentrating, loss of appetite and poor sleep.

Because the mind and the body are so strongly interrelated, emotional distress and pain can interact with and amplify each other so that pain becomes worse as sadness, anxiety or depression increase. You may find yourself caught in a vicious cycle that is very hard to break.

Fortunately, there are effective ways to manage negative emotions, control pain and other symptoms, and adjust to the changes TOS may bring. You can do many things to help yourself. Various psychological techniques also are available, including individual counseling and cognitive behavioral therapy. Work with your health care provider or health care team to create a pain management plan that is right for you.

If you have symptoms of depression that persist or interfere with daily functioning, seek professional help. Depression is a treatable condition. Ignoring it will not make it go away.

Inappropriate use of prescription or non-prescription medications, including opioids (narcotics), is a risk for TOS patients suffering with chronic pain. In cases where misuse or abuse occurs, the services of mental health or addiction medicine specialists may be required.

Self-care Suggestions
 

It is essential to take an active role in your care. These suggestions can help you live better despite chronic pain:

• Educate yourself – Ask questions and read about TOS and chronic pain management. The more you know about your condition, the better equipped you are to help yourself and others. Increased understanding of your condition will help you in working with your health care provider or team to make decisions about your care. It can help you recognize and express the feelings pain creates.

• Follow the advice of your health care providers – Ask questions if you do not agree or do not understand what they want you to do. 

• Exercise regularly – The strengthening and stretching exercises you learn in physical therapy are especially important – do them at home as instructed. Having a regular exercise program also helps increase stamina and the ability to do normal daily activities, improves your mood, and helps decrease pain and other symptoms. 

• Avoid or limit activities that compress your thoracic outlet. Maintain good posture. Take breaks and stretch often at work. Avoid repetitive movements and heavy lifting (especially over your head). Don’t carry heavy purses or bags over your shoulder as this presses down on the collar bone and puts pressure on the thoracic outlet area.

• Avoid or control things that increase your symptoms – For example, if stress worsens your pain, learn stress management techniques to lower your stress level. 

• Have a routine – Organize your day so you can perform daily tasks efficiently.

• Be positive – Focus on your strengths and abilities, not your limitations.

• Do not isolate yourself – Even when you don’t feel well, stay in touch with family members and friends. Invite someone to your home. Use e-mail or the phone to communicate with the people you care about. Teach them about TOS so they can better understand how it affects you and your lifestyle. Talk about your feelings with a family member, friend, counselor or spiritual advisor. 

• Practice good health habits – This includes eating a nutritious diet, limiting your alcohol and caffeine intake, managing your weight, and going to bed at a regular time each night. 

• Keep a list of your medicines – Talk with your health care provider about the medicines you take. Ask for guidance on how to slowly stop taking unnecessary medicines.

Professional Resources

Self-care steps can be hard to accomplish on your own, especially if you have had pain for a long time. If you are having difficulty coping with TOS and the changes it can bring, a mental health care professional can help you regain control of your life. Some options are listed below.
 

• Individual or group therapy – This involves meeting with a counselor (such as a psychiatrist, psychologist or social worker), either alone or with a group of other people facing similar issues. You discuss your feelings and explore ways to reduce the distress that chronic pain can bring.

• Cognitive behavioral therapy (CBT) – CBT helps many people cope effectively with chronic pain. CBT helps you understand how thoughts affect your feelings and actions. For example, if you think you are too tired to go to a party, you may choose not to go (action). As a result, you may feel depressed and isolated about missing time with friends. CBT can help you learn how to:
  • function despite pain; 
  • get rid of destructive behaviors and attitudes; and, 
  • approach life with a positive, rather than negative, outlook. 

• Pain rehabilitation program – Sometimes, the help of a multidisciplinary pain rehabilitation program is required to effectively cope with chronic pain. These programs typically last for three weeks or more with six or more hours a day of group and individual physical, psychological and educational treatment sessions.

• Pharmacological treatment – The use of multiple drugs in different drug classes may lead to serious complications, including drug dependency or addiction. Psychiatrists, pain medicine specialists and addiction medicine specialists are uniquely suited and properly trained to treat these problems.

Ask your primary care provider for some names of mental health professionals, clinics and centers in or near your town. Look for those that have experience in treating chronic pain.

Finding a Qualified Mental Health Professional

Mental health specialists vary greatly in their level of training and experience with treating chronic pain. You may visit specialists such as a psychiatrist, psychologist or social worker. Ask questions to find out about a professional's qualifications to help you cope with the emotions that frequently accompany pain.

Questions to Ask a Psychiatrist 

• How much experience do you have in dealing with the emotional problems that commonly occur with chronic pain patients?
• Do you frequently consult with pain medicine specialists?
• 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.)
• Are you board certified in pain medicine?
• Are you board certified in psychiatry? 
• Are you board certified in addiction medicine (if applicable)?

Questions to Ask a Psychologist or Social Worker 

• Do you have training in health psychology and/or behavioral medicine? 
• Are you a member of professional organizations in these fields?
• Do you belong to a recognized professional pain organization, such as the American Pain Society? 
• Do you work 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 work with expert psychopharmacologists (Pop-up bubble: 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 medicine in pain management?

Unfortunately, often there are no credentials that can help you understand the difference between professionals who claim to be chronic pain specialists. It is best to get a referral from your pain medicine doctor. He or she may know the answers to many of the above questions, and may be familiar with the skills, experience and qualifications of the mental health specialist before referring you for treatment. If the specialist works in a recognized pain clinic, he or she will know about long-term pain issues and may be better able to help you.