Treating Chronic Pain.
A research article published last summer in the International Journal of Molecular Sciences (June 26, 2019) strived to provide guidance to a world that’s continually seeking to better understand chronic pain while developing improved therapeutic approaches to treating and managing chronic pain.
Titled “Chronic Pain: Structure and Functional Changes in Brain Structures and Associated Negative Affective States,” authors Seoyon Yang and Min Cheol Chang analyzed previous studies that focused on the mechanisms behind chronic pain development.
They also reviewed the link between chronic pain and negative affective states, such as anxiety and depression.
Spoiler: the link between the two are undeniably quite strong.
“As pain develops into a chronic condition, negative emotional states may be accompanied by other emotional disorders such as anxiety, anhedonia, cognitive deficits, sleep disturbances, and suicide,” Yang and Chang wrote.
“Understanding the affective aspects related to chronic pain,” they added, “may facilitate the development of novel therapies for more effective management.”
After discussing and analyzing the neural areas of the brain related to chronic pain, the authors discussed various approaches to treating chronic pain they argue should be used in combination, depending on individual circumstances.
Such an approach mirrors the pain-management philosophy we advocate for here at the Integrative Pain Science Institute. Our comprehensive approach to natural pain management strategy includes:
· Musculoskeletal Interventions: As physical therapists, this is our bread and butter. But when it comes to chronic pain, it’s often not enough. We must add additional services to our chronic pain toolbox.
· Functional Nutrition Assistance: It’s important to teach patients about the benefits of an anti-inflammatory diet in managing both chronic pain and other chronic conditions and diseases.
· Psychological Interventions: Such interventions include offering Psychologically Informed Care and training in Acceptance and Commitment Therapy (ACT). For physical therapists looking to more confidently address psychological factors when training chronic pain patients, we offer education for both approaches.
Treating Chronic Pain:
Acceptance & Commitment Therapy
“Psychological interventions for chronic pain include operant behavioral therapy, cognitive behavioral therapy, and motivational interviewing,” Yang and Chang wrote. “These approaches focus on factors that influence chronic pain, such as failure to obliterate pain responses and maladaptive learning responses.”
Among the psychological approaches available to chronic pain sufferers, Acceptance and Commitment Therapy (ACT) has emerged as an effective option.
A therapeutic approach that strives to temper fear and build confidence in those suffering from chronic pain, ACT is a type of counseling that stresses mindfulness, acceptance and “psychological flexibility.”
ACT works to make it possible for people to be more aware, focused and engaged in the chronic pain journeys. It’s not trying to teach people to control their thoughts and emotions in order to avoid pain; rather, it empowers people to face pain head-on, with a willingness to commit to specific goals that can improve their conditions over time.
ACT is about acceptance, establishing a set of personal values, and then taking incremental steps that can improve long-term pain sensations through committed actions.
By providing the patient this semblance of control and empowerment over a condition they once thought controlled them, ACT has shown to reduce anxiety and depression related to chronic pain.
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From Mental to Physical
As Yang and Chang stated in their research, “several therapeutic approaches … should be used in combination” when treating chronic pain. This, of course, also includes areas where physical therapists can truly shine.
“Integrative strategies such as exercise, yoga and nutrition have been suggested to have analgesic effects [on chronic pain sufferers,]” the authors wrote. “During and after exercise, different endogenous systems are activated and various neurotransmitters that modulate pain perception are released, resulting in increased levels of endogenous opioids, nitric oxide, serotonin, anti-inflammatory cytokines, brain-derived neurotrophic factor, and endocannabinoids.”
In other words, the body often naturally responds to exercise by making you feel good … or better.
But, when it comes to a full, well-rounded, natural approach to chronic pain treatment, one method (exercise and/or movement) just isn’t enough.
Physical therapists who are trained in and able to offer relief that also includes psychological and nutritional approaches will truly set their practices apart within their local health care markets.
To learn more about Acceptance and Commitment Therapy and how to incorporate such approaches within your PT clinic, visit our website. There, you can also learn more about the ACT courses we offer physical therapists, as well as join a waiting list for our next course, “ACT for Chronic Pain.”